Agenda item

24.1     The Committee considered a report regarding ESHT’s proposals for changes to the Uckfield Day Surgery Unit (DSU), including whether this change represents a ‘substantial variation’ to services, requiring a consultation with HOSC. Simon Dowse introduced the report, which highlighted the reasons for the proposals, including only being able to support local anaesthetic on site, progression in day surgery services, some activities no longer requiring surgery or being offered in other settings, and some NHS pathways no longer being supported. ESHT conducted a review of the site and found that: there were limited opportunities to increase utilisation of the unit; significantly more of the services provided at Uckfield DSU could be provided at EDGH, with the same capacity; 88% of patients using Uckfield DSU lived closer to EDGH or Conquest Hospital were travelling across county to access the site; and that moving the DSU to acute sites would have a beneficial impact on waiting times.

24.2     The Committee noted a correction to the covering sheet to the report, which reads:

            ‘The Day Surgery Unit (DSU) delivers approximately 13% of ESHT’s overall day surgery activity’.

And should instead read:

‘The DSU activity contributes approximately 13% of Trust activity at the site’.

Uckfield DSU contributes a total of approximately 1.2% of Trust overall elective activity.

24.3     The Committee asked what the impact of the service reprovision would be for staff employed at Uckfield DSU.

24.4     Mike Farrer responded that focus groups were conducted with staff throughout the pilot scheme and there were a mixture of views among staff wishing to relocate to acute sites or continue working at Uckfield. However, staff recognised the benefits for patients that were shown during the pilot and understood the reasons for the move. Staff were on temporary redeployment and were keen for the process to be concluded as soon as possible. ESHT were in contact with staff regularly to find appropriate permanent positions for all staff from Uckfield DSU and were not seeking to reduce staffing levels.

24.5     Alys Morris, Consultant General and Colorectal Surgeon ESHT, confirmed that work had been undertaken to try and increase activity on site at Uckfield DSU, however it had not been possible to make maximum use of the facility. The Getting it Right First Time (GIRFT) programme requires that procedures are conducted in the appropriate settings and the DSU only being equipped for local anaesthetic limited the surgeries that could be carried out on site. Most patients would be more appropriately treated in procedure rooms or the Sussex Surgical Centre (SSC).

24.6     The Committee asked if patients were able to elect to receive treatment at other non-ESHT sites such as Princess Royal or Royal Sussex hospitals.

24.7     Simon Dowse confirmed that the service could be accessed wherever it was available, but that this should be discussed between patients and their GP when the referral is made for treatment.

24.8     The Committee asked how local and national guidance about bringing services closer to the local community is being applied in this context.

24.9     Richard Milner confirmed that while the 10-Year Health Plan emphasised moving services closer to communities, this is only for services that are most appropriately delivered at that level. This does not relate to DSU activity, as day surgery is not appropriate for a community setting. He highlighted important work that could be moved into the vacated unit to supply local people with health services, that would be more appropriate to a community setting than day surgery.

24.10   The Committee asked what the financial implications of the relocation of the DSU were.

24.11   Simon Dowse responded that the implications would be complex due to NHS income and funding models. Income would increase slightly in relation to lists due to increased capacity resulting in higher activity levels, but this depended on contracting for elective services and how the SSC was optimised. There would be future savings of around £200,000 per annum for ESHT, once their lease terminated on the vacated unit, but the cost of the lease would remain in the healthcare system in Sussex.

24.12   The Committee asked if the ICB planned to mothball the vacated unit, or if it had potential to be used as a neighbourhood health facility in the future.

24.13   Ashley Scarff responded that there were a lot of national strategies and changes that could impact the future of the unit. The ICB had worked closely with ESHT and recognised the case for change, as the provision of day surgery had changed over the years and only 43 people per year would be impacted by the reprovision. As the cost of the lease would remain in the system, the ICB would look to utilise all community assets by filling the unit. National strategy was developing a trajectory towards community health, such as with the development of Integrated Community Teams. The ICB were working to assess the sustainability of potential new services placed in there and the staffing required.

24.14   The Committee asked what the transport and access options are for people who are less mobile.

24.15   Mike Farrer responded that Non-Emergency Patient Transport Service (NEPTS) is open for transportation for patients who require assistance accessing their appointments, the same as at other NHS sites in the County. The full information about services, including voluntary services and the reimbursement scheme for transport were available online and could also be accessed through the Single Point of Contact; information about NEPTS was distributed to patients on their appointment letters and could be found on brochures on site.

24.16   The Chair commented that the relocation of the DSU seemed like a more efficient and cost effective method of working, and the reprovision seemed to have improved outcomes for patients during the trial period.

24.17   The Committee discussed how ESHT could change their practices regarding service reconfiguration. They requested that future service changes should have a consultation with staff, residents and the VCSE sector; more clarity should be given to patients; the equalities data and Equality Impact Assessment (EQIA) should be provided to the HOSC, to see the impact on vulnerable people; and requested that the HOSC be involved earlier in the process of service reconfiguration.

24.18   The Committee RESOLVED to:

1)    Agree that the proposed changes to Uckfield Day Surgery Unit did not constitute a substantial variation to health service provision requiring statutory consultation with HOSC under health scrutiny legislation;

2)    to receive a copy of the EQIA for this service re-provision; and

3)    to receive a copy of the post-implementation review in 2026, after this has been conducted by ESHT.