Proposals to improve inpatient cardiology care

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

East Sussex Health Overview and Scrutiny Committee (HOSC) discussed two sets of proposals – firstly relating to Kent and secondly East Sussex.

As previously reported, Maidstone and Tunbridge Wells NHS Trust want to consolidate specialist cardiac services at either Maidstone Hospital and Pembury Hospital. Currently specialist procedures are split across the two main hospital sites. The Trust has said this often leads to patients being transferred from one site to another during a hospital stay. It also means the specialist heart doctors and nurses are spread across two sites and it is not possible to consistently provide a seven-day service at either site.

East Sussex Healthcare NHS Trust (ESHT) have carried-out a similar review of cardiology care. They also believe a single location for some inpatient services would be more effective.

The county’s catheterisation laboratories — where angiograms, angioplasties and of pacemaker implantations are carried out — would be located at 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.

HOSC heard more about the plans from Professor Nikhil Patel, Deputy Chief of Medicine and cardiovascular lead at the Trust.

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.

Prof Patel

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 added:

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.

Prof Patel

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 in Hasting to Bexhill Hospital instead. The ophthalmology services at Eastbourne DGH would not be affected by the change.

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