Agenda item

34.1     The Committee considered a report by the HOSC Review Board into Changes to Paediatric Services at the EDGH, which included 13 recommendations. The Committee also considered an update report from East Sussex Healthcare NHS Trust (ESHT) outlining monitoring data of implementation.

34.2     Cllr Alan Shuttleworth, who had been a member of the Review Board, noted that he agreed with the recommendations in the report, but outlined a number of areas where he remained concerned. His concerns with the new model were:

·       That the implementation of changes had been rushed and that ESHT had not sufficiently prepared for the changes, including that a number of clinical pathways were not in place from the beginning of the implementation.

·       The staffing model was not sustainable, and that the number of Advanced Paediatric Nurse Practitioners (APNPs) was too low to support the new model. He therefore felt that having a paediatric consultant on-site to support APNP staff at the EDGH was critical.

·       There would not be enough space following the closure of the Short Stay Paediatric Assessment Unit (SSPAU), and that would leave children without a quiet and relaxing space to be in while being treated given the new unit’s proximity to the Emergency Department (ED).

·       Families with planned care had not been sufficiently informed and updated on the changes being made, and more consultation with all interested groups should have been done ahead of the changes being made.

·       That more patients and families would potentially need to travel from Eastbourne to the Conquest Hospital in Hastings, and that the long-term sustainability of services remaining at Eastbourne was in doubt.

34.3     Joe Chadwick-Bell, ESHT Chief Executive, thanked the Review Board for their work and comments. She noted that the points made by Cllr Shuttleworth had been responded to in the meetings of the Review Board, and that the recommendations in the Review Board’s report would be responded to in full following discussions with clinicians and the ESHT senior leadership team.

34.4     The Committee asked why changes were implemented before everything necessary (such as the new unit) were in place to support the new model.

34.5     Joe Chadwick-Bell responded that there were several reasons. First was that it made it possible to put additional resource into ED, which had allowed children to be seen much more quickly than they had been previously. The beginning of January (which was when the changes were implemented) was one of the busiest times of year when more children presented to ED, so the changes had been introduced then to improve children’s experience by allowing them to be seen quicker and go home quicker. There was a dedicated area for children in the ED already so having the new unit in place was not vital for providing necessary care. In an ideal world the new unit would have been in place from the start, however the Trust took the view that delaying the implementation of changes would have meant delaying an improvement in services for children. There were a very small and specific number of patients and families with planned care that were affected by the changes, and they were engaged throughout.

34.6     Dr Matthew Clark, Consultant Paediatrician and Chief of Division, added that the implementation of the changes had meant there had been a significant increase in the number of children being seen by paediatric specialists earlier, and children were spending less time in ED as a result. ESHT saw the changes as an improvement and was therefore keen to implement the changes as soon as possible. The Trust was working to produce planned care pathways and would be able to update the HOSC with these in June.

34.7     Cllr Azad thanked those who had been involved in the review, and asked whether children who were severely unwell would be treated in a separate area.

34.8     Joe Chadwick-Bell explained that within the unit there was a separate room that could be used for patients with particular needs, such as infection control or for patients with mental health issues, alongside cubicle areas where other children were seen.

34.9     The Committee asked for more detail on the post-implementation independent review of the new model.

34.10   Joe Chadwick-Bell explained that independent clinician (external to Sussex) had been identified to lead the review and was due to begin in the middle of March. ESHT would share the HOSC reports and documents with them as part of the review and the Trust hoped the review would be concluded by the end of March.

34.11   The Committee asked why ESHT felt an independent review was necessary given that HOSC had conducted a review already.

34.12   Joe Chadwick- Bell explained that it was a clinical review, led by a clinician with experience in emergency care and paediatrics, different from the type of review done by HOSC. She confirmed that it was being led by someone who had been independently identified and was completely separate from Sussex-wide health services. Although ESHT did not initially commission the review, the Trust felt it was important given the level of public interest in the issue, as well as the interest from HOSC.

34.13   The Committee asked whether there was any chance of the paediatric space being used by adults at times when ED was overrun.

34.14   Joe Chadwick-Bell confirmed that the unit would not be used by adults and was a completely separate paediatric space.

34.15   The Committee asked why all clinical pathways were not in place from the implementation of the new model.

34.16   Dr Matthew Clark explained that previously emergency and elective care had be done in the same location, which created infection control issues. Separating planned and emergency care therefore required new pathways to be created, but because of the unpredictable nature of emergency care the Trust prioritised establishing these first. Planned care pathways were now being worked up and would be shared in future.

34.17   The Committee asked how the model would be sustained if the required APNP staff were not available to work or left the Trust.

34.18   Joe Chadwick-Bell confirmed that if an APNP was not available, then a paediatric registrar would be working in ED to support the new model. That would be the staffing model going forward and was the reason that it had been possible to staff the model since implementation. Dr Matthew Clark added that he shared the Review Board’s concern about recruitment, but the Trust’s previous recruitment drives in this area had been successful. ESHT would continue to build the team up to ensure the sustainability and resilience of the model.

34.19   The Committee RESOLVED to:

1)    agree the report of the Review Board; and

2)    refer the report to East Sussex Healthcare NHS Trust for consideration and a formal response to the recommendations.