Here’s why specialist heart surgeries could be based at a single East Sussex hospital

Plans to move specialist heart surgeries to a single hospital in East Sussex would be a ‘substantial variation’, councillors have said.

Thursday, 9th December 2021, 3:10 pm
Top: Eastbourne DGH, bottom Conquest Hospital in Hastings

On Thursday (December 2), the East Sussex Health Overview and Scrutiny Committee (HOSC) discussed NHS proposals to consolidate the county’s catheterisation laboratories — where angiograms, angioplasties and of pacemaker implantations are carried out — into a single location.

This would either be Eastbourne District General Hospital (DGH) or Conquest Hospital in Hastings, although the NHS says it does not currently have a preference which one.

While the proposals would see the cath labs consolidated, the NHS also plans to create emergency Cardiac Response Teams and ‘hot clinics’ at both hospitals as part of the wider changes.

The committee heard more about the plans from Professor Nikhil Patel, deputy chief of medicine and cardiovascular lead at the East Sussex Healthcare NHS Trust (ESHT), 

He said:  “Our proposals really are to try and improve our whole process, so that there is a cardiac response team that is able to see patients during working hours within the first 60 minutes — probably within the first 30 minutes — but more importantly to give a very fast cardiac opinion.  So patients will get to the cath lab if required and get emergency treatment quickly.

“[Currently] patients who come to the front end are discharged home and then may go to see their GP to be referred back to cardiology. What we really wanted to see is how we could address those patients early, stopping the long waits to come back for their second opinion.

“With a response team we can do diagnostics, ultrasound scans of the heart [and] rhythm monitoring at the front end and see people in a hot clinic sooner than the normal 12 to 18 week pathway that they have to have at the present time, so really the patient experience will be a lot better.

“Having the cath labs together means we can treat patients within the 72 hour window that is required nationally and we can also be a lot more efficient with using our cath labs.

“We would then concentrate our expertise and drive ourselves to further centres of excellence because having a high volume of cases improves patient outcomes and operating expertise.”

While Prof Patel described these as substantial changes, he said ‘90 per cent’ of patients would not see changes as a result of the proposals as most outpatient services would stay the same. 

These would include pacemaker check-ups, ultrasounds and other services which would not require an overnight stay, he said.

Other specialist cardiac services, which involve surgical procedures or investigations that may require an overnight or longer stay, would move to the single site however.

Prof Patel said: “It is also important to emphasis that the specialist advice and specialist referral and management [would] still be accessible at both sites.

“It is only the small bit of intervention, the sort of two per cent of patients who need cardiac intervention, where specialists will be in the cath lab. 

“But importantly specialist opinion, either from the nursing staff or from the consultants, will be available on sites, as it is now.”

After hearing from NHS leaders, the committee concluded that the proposals would be a ‘substantial variation’ to health services within the county. As a result, a review board will look at the proposals in detail and make recommendations.

This board is to be made up of four councillors — two from Eastbourne and two from Hastings.

During the same meeting HOSC also considered changes the NHS plans to make to how it provides its ophthalmology services in East Sussex.

The service,  which is to do with diagnosis and treatment of eye disorders, currently operates across three sites: Bexhill Hospital, Conquest Hospital and Eastbourne DGH. 

The NHS plans to move day and outpatient services out of Conquest Hospital to Bexhill Hospital instead. The ophthalmology services at Eastbourne DGH would not be affected by the change. 

The proposal would not affect unplanned or emergency care. This means emergency and general anaesthetic surgical cases (including cases which require overnight stay) will continue to be delivered at Conquest Hospital.

Clinical lead for ophthalmology Kashif Qureshi told the committee the move was motivated by a desire to both improve the quality of the ophthalmology service and to reflect a rising demand for it.

He said: “The reason why we are making this change is because ophthalmology is under a lot of pressure nationally, but also locally, due to increasing demand.

“We have an increasingly older population and eye diseases tend to increase in prevalence as patients get older, so we have an upward curve in terms of demand we are facing, certainly over the next ten years.  I think we are estimating a 25 per cent increase in demand.

“Added to that there is, nationally, a shortage of consultant ophthalmologists so we are always running to stand still in order to try and catch up with the demand we are trying to meet.

“Consequently what we are doing is to change our model of care into a fully multi-disciplinary model of care which is delivered not just by consultants, but by optometrists, orthoptists and nursing staff, who have expanded roles and [are] upskilled to deliver specialist clinics alongside consultants.”

Mr Qureshi said this model of care expands the capacity of the service and also sees waiting times reduced. However, it is also more difficult to run over three sites, due to the need for consultant supervision, he said.

He also said the trust could also make better use of its equipment when running the service over two sites, rather than three.

As with the cardiology proposals, HOSC concluded the changes would constitute a ‘substantial variation’ to health services within the county and established a review board to report back.