Democracy ignored as the closure of our walk-in centre is agreed

The campaign to stop the closure of our walk-in centre

For well over a year now, we have campaigned against the closure of our walk-in centre at Eastbourne station. We collected nearly 5000 signatures on a petition against the closure. Our population were fantastic, between 80 and 90 % of those we stopped were more than happy to sign.  Many told us of personal circumstances where the walk-in centre was a life-saver.

Eastbourne’s Chamber of Commerce; Hospitality Association; Access Group and the Borough Council all supported our campaign. As did many other local organisations. But sadly this was not enough and our CCG has taken the decision to close the centre. They have ignored public opinion and ignored many logical arguments we made against the closure.

We met with the Health Overview Scrutiny Committee’s review board from the County Council.  Later we also met with people from the CCG. But we felt that the review board were simply trying to patronise us.  They had no intention of paying attention to what we were saying. The CCG were equally indifferent to our arguments.  They responded with the usual rhetoric and propaganda that sadly we now expect.

The CCG sent us this written responnse after the meeting we held with them. Text written in blue is our thoughts on what they have said.  We will shape our next campaign by understanding how the outcome of this campaign was decided.

The arguments we made  against the closure of our walk-in centre

Our arguments against the closure under four main headings. We asked the CCG to meet with us as we wanted to hear their response to these arguments.  Our arguments came under four headings:- (i) This pandemic will leave our population with an increased need for healthcare services. (ii) Plans are in place for an increase in house building in the town and a need for more GPs. (iii) The public consultation was invalid. (iv) There has been a steady decline in the number of GPs working in our NHS and this trend seems unlikely to reverse.  Our town canot afford to be losing any GPs now.

How the CCG justified the decision to closue our walk-in centre

The CCG responded to these arguments in the form of a series of questions and answers as laid out below.

The vailidity of this consultation and timing of the proposal

Questions and responses

Why would proposals to close healthcare facilities be considered in a pandemic.? At the start of the COVID-19 pandemic the NHS saw a worrying decline in people accessing services.  Some people felt they didn’t want to ‘burden’ the NHS during the pandemic. Others were worried about how COVID-19 secure services were.

We said  we knew people had avoided seeking treatment during the pandemic.  But we also knew that many had had treatment delayed, paused or cancelled. This included some cancer patients.  We know Covid 19 left some people with long term health complications.  Mental health problems have risen dramatically right across our society. The pandemic will lead to an increase in hardship and more ill health.

The CCG ran a comprehensive communications campaign to reassure local people that services were still open.  But  accessing them would be  different from normal. It encouraged people to keep their appointments and contact health services if  worried about symptoms. After the restoration of many services, demand returned to a near normal level.

Our hospitals began tackling the waiting lists for treatment after the first lockdown.  But that didn’t last for long.  The second wave came and health services were forced into prioritising Covid patients again. 

We are acutely aware that this may increase further in the future. We have we included these type of considerations in our forward planning.

Nobody knows how long this pandemic will last and how much healthcare demand will increase.  How can the CCG include an unknown quantity in their forward planning?

Mental health

Services for those suffering from hardship and mental health issues are already available to access in a number of ways. Health in Mind, for example, is an NHS service for anyone in East Sussex experiencing emotional and psychological difficulties. People can refer themselves online, with no need to see a GP first.   It offers access to videos, resources, online therapy and courses. The Sussex Mental Healthline also provides telephone support and information 24 hours a day, 7 days a week. Care and support is available, and increasingly not tied to certain  locations. Hopefully making it easier and more convenient for people to access.

Speaking about mental health problems is hard enough face to face.  Over the phone or internet is far from satisfactory.  Services must acknowledge this fact and offer face to face contact where necessary. 

Mental health services were in crisis before the pandemic and much more funding needs to be put in place urgently.

New ways to access primary care

Further to this, local services have been expanding and improving recently, opening up new ways to access health services:

NHS 111 Clinical Assessment Service (CAS)

This service was launched across Sussex on 1 October 2020.  Anyone who rings 111 is connected to a health advisor who uses a clinical decision tool called ‘NHS Pathways’.  This tool helps advisors understand their symptoms and  determine the most appropriate support.

Health advisers who answer 111 calls have no clinical training at all

An appointment can be booked with another service to offer support. The patient can be offered a home visit, advice, or the call transferred to a clinician. The clinician is chosen according to patient need. The skill-mix of CAS includes GPs, paramedics, nurses, mental health professionals, midwives, and pharmacists. I the patient needs emergency treatment, NHS 111 CAS can book an ambulance.  Ambulances are dispatched via 999 to the patient.

When asked over 95% of people rated the 111 service as unsatisfactory. The service  enhanced on 1 October 2020 and it is too soon to assess any improvment. But it needs dramatic improvements to be even adequate. Follow this link to read about the shortage of clinicians helping advisers on 111.

Digital Appointment Booking / Directly Bookable Appointments Directly bookable appointments allow patients to be seen by the most appropriate health professional when required.  This helps maintain social distancing and improves the management of patient flow. In many instances, the enhanced NHS 111 CAS will be able to manage patients’ needs. Appointments can now be booked into the following services if patients require face-to-face consultations:

(i) Urgent Treatment Centres –  NHS 111 CAS can book appointments  for patients at UTCs in East Sussex. This reduces patient waiting time within the hospital.

(ii) GP practices – all 174 GP practices in Sussex are currently rolling out in-hours bookable appointments .  The aim is to have this facility within all practices by the end of December 2020.

(iii) Primary Care Improved Access –appointment booking into PCIA will be live by the end of December 2020.

NHS 111 First We successfully launched NHS 111 First programme across East Sussex  in October 2020. This is for  patients who call NHS 111 CAS, who need emergency care but not an ambulance to hospital.  They will be given an appointment slot at their local A&E department. This avoids long waits in A&E  and reduces the potential risk of  exposeure to COVID-19.

Primary Care Improved Access (PCIA) developments This service offers additional appointments in the evenings, weekends and bank holidays.  All people registered with a GP practice across East Sussex have PCIA available to them . PCIA currently provides a minimum of 290 extra appointments per week for Eastbourne practices and patients. The current utilisation of the PCIA appointments is at approximately 56%, so there is spare capacity.

This has been gradually increasing since the easing of the lockdown restrictions in July 2020. In addition to the PCIA, all Eastbourne Primary Care Networks (PCNs),  provide additional extended hours appointments in the early mornings and evenings.  Primary Care Networks are groups of practices who are working together. These appointments are available to patients registered with GPs in each PCN.  The following additional capacity is the minimum made available in each PCN:

ALPS Primary Care Network = 117 additional appointments per week

Victoria Primary Care Network = 54 additional appointments per week

Eastbourne East Primary Care Network = 105 additional appointments per week

Primary Care Networks

Primary Care Networks are a serious issue that and warrants a separate blog. They are a potential hornets nest of problems for both patients and staff.  Please watch out for  blog post coming soon on this website .

With regard to increased demand for mental health services and from people with complex need – the following services are in place.  These services are there to provide help, treatment and support for those with complex needs. Those on low incomes and with disabilities, will benefit from additional support.  This will be available in local GP practices and as part of the development of Primary Care Networks (PCNs).  For example, Eastbourne PCNs are planning to recruit a minimum of four social prescribers and six mental health practitioners over the next three years.
Social prescribers (sometimes described as link workers) are non-clinical professionals who work with people to meet their wellbeing needs. In addition to the NHS 111 Clinical Assessment Service (CAS), which includes mental health clinicians, there are now some other services across Eastbourne. These are available for people with complex issues, including mental health:

Sussex Mental Healthline 24/7 Single Point of Access

Drop-in Mental Health Services for Adults available Monday-Friday in Eastbourne town centre

Community Connectors -a free service, for adults aged 16 and over, experiencing social issues. This is for when those issues impact on their mental, emotional and physical health and wellbeing

Staying Well -the Staying Well Space is an out of hours (evenings and weekends) mental health crisis prevention service. It is provided by Southdown Housing at Eastbourne Wellbeing Centre seven days a week

Crisis Resolution Home Treatment

Urgent Care Lounges at Eastbourne DGH and Hasting Conquest Hospital. Both facilities are open 24/7 staffed by registered mental health practitioners

A&E Mental Health Liaison -available 24/7

Police Street Triage -mental health nurses working alongside dedicated police officers.  This is for evenings and weekends and in response to 999 calls where there is a mental health need

Rough Sleepers Initiative (RSI) –includes the provision of mental health community support officers

New intiatives for delivering mental health support are desperately needed.  Mental health has suffered severe cuts to funding since 2012 and one in three inpatient beds have been lost. We need to see an immediate injection of funding into the mental health services.

Our population is accustomed to first speaking to their GP when health concerns arise. We are concerned the system of primary care is changine too fast.  We also feel concerned about the lack of informationavailable about these changes.

Increased population

How are we planning for increased population in the town? The CCG works closely with its local government colleagues across the county with regard to planning proposals and  local plans. One of the most significant changes in primary care in Eastbourne for several years is the building of a brand-new facility –Victoria Medical Centre. The centre will provide a home for the Bolton Road, Green Street and Enys Road surgeries, which merged in October 2020. We expect the new facility to open by Spring 2021. At this point, the three practices will relocate to the new Medical Centre.

This practice currently has 23,265 patients and will have the capacity to support 30,000 patients.  It will  accommodate both existing patients and the projected growth in population. It will provide improved services and be better placed to attract new staff . In addition, Victoria Medical Centre has developed plans for a branch surgery in Eastbourne town centre.  This will accommodate patients who would still prefer town centre services. New patients joining the practice would also be able to make use of the town centre facility. The merger into a bigger practice helped Green Street to recruit two new GPs.  Two further GPs are set to join the practice next year. These additional GPs will work alongside the existing staff in the newfacility and in the planned branch surgery.

Victoria Medical Centre is a primary care hub. These hubs are an integral part of the concept behind primary care networks so please refer to our forthcoming blog post on PCNs.

In addition to these significant developments, we work regularly with our local authorities to understand new housing plans.  We will consider the impact that these will have on existing services, and opportunities for new funding as a result of  plans.

More about the timing of the consultation and its validity

This has taken place during a pandemic.  Should more time be taken to consider the proposals? We recognise that there are natural concerns about any changes to NHS services. Currently, when the NHS has seen significant change as a result of the pandemic, there is greater concern about access to health care. In light of this we have taken the impact of COVID-19 and the implications it had on our communities. We have  followed national guidance throughout.

Once national lock down was introduced on 23 March we paused the consultation.  We recognised this would impact on how people would engage with the process and have their say. The pause was kept under active review and we reassessed whether the pause should continue  in both April and May. Another review, taken in early June, indicated  a changing situation at the time with regard to lockdown measures. It was felt the time was right for a decision to be taken about restarting the consultation. This was consistent with the CCG’s statutory duties to its local people and communities.

Before making a decision, the CCG reviewed the pre-consultation business case and our proposal.  We aimed to understand whether the underlying proposition had been impacted by COVID-19.  And whether it continued to be valid. We reviewed the process of the consultation to understand if a continuation would be meaningful. Satisfied with both of these the CCG took the decision to re-start the consultation  on 3 August 2020.

We paused our town centre campaign events prior to the first lockdown to keep ourselves safe from Covid 19 and the public. We resumed these town centre campaigns briefly before the second wave. It was clear the pandemic had caused many people to be preoccupied by Covid 19.  The public were less likely to engage either with us or with the consultation. We were asked a few times how somebody without internet access could get hold of a consultation document. It was only by going online that we found out a phone number people could call to request a brochure. Did the CCG not recognise that many people do not have access to the internet?  Were they not aware of the general anxiety and preoccupation with Covid 19?

It has become clear over the course of this year that we need to adapt to the ‘new world’ we live in. It is likely we will have to take precautions such as social distancing for some time.  So postponing decisions until things are back to ‘normal’ is not a possible or appropriate option. This leads to uncertainty for local people and our provider of the service.

We are yet to see any compelling reason why the walk-in centre could not have a reprieve from the threat of closure. At least until we had returned to some sort of new normal. (The old normal was partly responsible for the scale of this pandemic so we need a new normal.)

Opinion Research Services, the organisation appointed to analyse and report on the consultation, made the following statement.   “As an established social research practice with experience of analysing and reporting outcomes from public engagements and statutory consultations across the UK, ORS confirms that the formal consultation process undertaken by NHS East Sussex CCG meets the required standards.

Were these standards good enough?

It was open, accessible and followed ‘good practice’ guidelines in both its scale and the balance of elements used. The CCG took appropriate action to ensure that the potential impacts of the Coronavirus pandemic on the consultation process were appropriately mitigated.  This included pausing and subsequently extending the consultation period.”

The consultation document was not an unbiased presentation of fact.  It was a desperately slanted document that sought  to justify the case for closure and persuade its readers to support closure.

Issues regarding workforce

There has been a reduction in healthcare professionals locally with GPs leaving the service so why would we close a service?

We do know that recruiting GPs locally has been difficult. The surgery at Hampden Park had to close when they lost three of their four GPs and could not find replacements.  Clearly recruiting new GPs is not easy. Several people we spoke to told us that they had tried unsuccesfully to register as a new patient with other practices.  Many Eastbourne GP surgeries had for some time stopped registering new patients.

We acknowledge that primary care has its challenges and pressures.  This is the case not only in Eastbourne but right across Sussex and the entire country. Our ratio of GPs to patients in Eastbourne is better than the national average. There are 64.5 full time equivalent (FTE) qualified permanent GPs across Eastbourne. This equals 2,130 patients per each permanent FTE GP (excluding locum staff, GP registrars and other training posts). The national average for the exact same GP group is 2,287 patients per FTE.

We had requested that a primary care needs assessment be carried out for the town before any decision was taken.  We didn’t even get a reply to that request.

Also, since 2018 people in Eastbourne have been able to book improved access appointments.  These can be anytime from 6.30pm-8.30pm on weekdays, from 8am-2pm on Saturdays and from 9am-1pm on Sundays and Bank Holidays. This means a minimum of 290 extra appointments per week are available for Eastbourne practices.

In addition to these improved access appointments, all Eastbourne Primary Care Networks (PCNs) provide additional extended hours appointments (in the early morning and evenings), which are available to patients registered with a GP practice in each of the PCNs:

ALPS Primary Care Network = 117 additional appointments per week

Victoria Primary Care Network = 54 additional appointments per week

Eastbourne East Primary Care Network = 105 additional appointments per week

Primary care has also been changing and developing, improving services and accessibility for local people. PCNs are groups of GP practices working together at scale to meet the needs of local populations. This way of working will improve the resilience of GP practices and primary care capacity. It also has the potential to benefit patients by extending the range of services available to them.

The truth is that the aim of PCNs is to cut 30m outpatient appointments from English hospitals. PCNs offer GP practices hungry for resources the chance of more money and staff. But in exchange they have to provide more services.

By working together, GP practices are able to attract specialist skills and improve access to wider and more specialist services (for example, first contact physiotherapists or specialist diabetes nurses). In a similar way to bigger practices, by working together as PCNs they can manage demand better,  improving patient access.

Locally, all Eastbourne PCNs will be offered  investment to recruit to additional roles under the Additional Roles Reimbursement Scheme (ARRS). The additional investment into the direct patient care roles under the ARRS, allows practices to focus GP time on complex cases in most need of their input. The plans for enhancing the primary care workforce in Eastbourne currently include the following roles, which will be phased in, from 2020-2023:

• Clinical pharmacists
• Social prescribers
• First contact physios
• Physician associates
• Pharmacy technicians
• Occupational therapists
• Podiatrists
• Health and Wellbeing coaches
• Care co-ordinators
• Nurse associates
• Mental health practitioners
• Paramedics
•  

Our views on all these changes to primary care have been shaped by speaking to doctors. We have also looked at the success of these primary care hubs in America where this idea has been copied from. These ideas are being forced through because that is what NHS England wants to see happen. Our CCG has simply followed the path of many other CCGs that closed their walk-in centres down. Our NHS is heading rapidly towards a privatised, American style insurance based system. We have copied the structures and ideas directly from America where they have the worst healthcare system in the developed world.  The US spends twice as much money as us on a healthcare system which is half as efficient. We don’t want or need that here.

Our population’s acccess to primary care

We understand that some people use the WIC when they can’t get an appointment with their own GP.  How will you ensure people have access to GP appointments?

We actually know people are not able to get a GP appointment when they need it because we spoke to people. We also heard from individuals  whose own unique circumstances meant they needed the walk-in centre.  Many of our residents would have died if the walk-in centre did not exist.

We recognise that sometimes people experience issues with making an appointment at their GP surgery. We are working with our local practices to address this by expanding the workforce across our Primary Care Networks (PCNs).  PCNs will recruit pharmacists, paramedics, mental health practitioners, and other clinicians to whom patients can be referred. This in turn will free up appointments with GPs for those who need them. Digital access –through, for example, mobile phone apps and computers –can also help many people.  This may be so they can receive health and care support, and tackle isolation and loneliness. Patient response to online contact during the pandemic has been positive.  Health professionals will always offer a face-to-face appointment if, following contact via phone or online, a patient is assessed as needing one.

SECAMB has stated that diagnosing over a telephone is more likely to result in error

We continue to work with GPs to ensure the positive aspects of advances in digital provision are maintained.  This is while ensuring that patients are offered a choice of ways to access services, not just digitally . As mentioned in response to a previous question, the Primary Care Improved Access (PCIA) service offers additional appointments in the evenings, weekends and bank holidays.  It is available for all people registered with a GP practice across East Sussex.

PCIA currently provides a minimum of 290 extra appointments per week for Eastbourne practices and patients. The current utilisation of the PCIA appointments is at approximately 56%, so there is spare capacity. This has been gradually increasing since the easing of the lockdown restriction in July 2020. In addition to the PCIA, all Eastbourne PCNs provide additional extended hours appointments in the early mornings and evenings. These appointments are available to patients registered with a GP practice in each of the PCNs. As a minimum, the following additional capacity has been made available in each of the local PCNs:

• ALPS Primary Care Network = 117 additional appointments per week
• Victoria Primary Care Network = 54 additional appointments per week
• Eastbourne East Primary Care Network = 105 additional appointments per week

Services for visitors, tourists, students and the homeless

What health services will be in place for tourists to Eastbourne and the surrounding area?

We would ensure that transport and travel plans and access options to alternative services for all are a core element of our communications and sign-posting services.  With a specific focus on patients from vulnerable groups and visitors/tourists to the town.
We will ensure that people who are eligible for non-emergency patient transport service and/or the NHS Healthcare Travel Scheme are aware of the schemes. We would work with services to promote appointment choice to patients to enable them to make an informed choice about their consultation type (remote or face-to-face). Tourists are already able to register as a temporary patient at a local GP practice for a period of up to 3 months. They can also call NHS 111. People can  go to the Urgent Treatment Centre at Eastbourne District General Hospital, which is open from 10am-10pm every day. Community pharmacies also offer good advice and services and there are a number near to Eastbourne Station Health Centre:

Arlington Road Pharmacy, 1 Arlington Road, Eastbourne BN21 1DH

Boots Pharmacy, The Beacon, 97 Terminus Road, Eastbourne

Boots Pharmacy, 53 Grove Road, Eastbourne BN21 4TX

Day Lewis Pharmacy, 2 Furness Road, Eastbourne BN21 4EY

Kamsons Pharmacy, Bolton Road, Eastbourne BN21 3JU

We had the backing of Eastbourne Chamber of Commerce, Eastbourne Hospitality Association,  the Borough Council and others with this campaign. These are all groups concerned about our town being able to attract tourists and language students. Eastbourne is a town that relies on visitor numbers and it would make sense to provide a healthcare facility in a central locations that visitors can access.  Many  language schools teachers told us that they relied on the walk-in centre to care for their students. They spoke about concerns that language students may not seek help if the walk-in centre closed.  People who are not familiar with English language would struggle if trying to use the 111 service.

What service would homeless people be able to use? A key theme highlighted in the public consultation feedback and the HOSC Review Board Report was regarding the needs of rough sleepers. The Board identified rough sleepers  as being vulnerable to changes to services. Particularly, as they can be reluctant to engage with mainstream services, due to their complex needs. 

The Rough Sleepers Initiative (RSI) is designed to improve rough sleepers’ ability to gain access to services.  This includes statutory support services, temporary accommodation, and long-term housing solutions. The Rough Sleepers Initiative currently has 39 open cases in Eastbourne.The RSI has a multidisciplinary team providing a holistic service and medical assistance to rough sleepers in the following ways:-

They can attaend anyone of these services

1. The RSI Outreach and Street Engagement sessions which allows members of the team to provide specialist targeted support to rough sleepers
2. Drop-in sessions run by Matthew 25 on Monday morning
3.  Sessions at the Salvation Army also on a drop-in basis on Monday-Friday from 10:00am-4:00pm and Friday afternoon.

They will  help rough sleepers register with a local GP and encourage appropriate appointments with the GP. Prevent missed appointments by cancelling, rescheduling or accompanying a patient to an appointment.

The Salvation Army provides a small room once a month for a GP drop-in service.

As part of the local response to COVID-19, the CCG commissioned a Care and Protect service from June 2020 provided by the South Downs Health and Care GP federation.  This is to accommodate and support rough sleepers across East Sussex. The service includes supporting rough sleepers with registration at GP practices to ensure they have access to a GP and range of services.  The service provides triage and assessment, remote support and care continuity at accommodation sites. They will also support homeless discharges from the hospital. The Care and Protect Service will last for the period of this pandemic.  We will seek a longer term solution if ESHC closes.

The CCG recognises the need to put in place suitable services to support rough sleepers if ESHC were to close. Therefore, as recommended in the consultation feedback, the CCG has worked with the Rough Sleepers Initiative and the East Sussex Primary Care Networks (via the Clinical Directors).  We have aimed to understand the needs of rough sleepers and identify potential service models to support this cohort. The CCG will provide appropriate town centre services for rough sleepers in Eastbourne and support to mitigate against the impact of the closure of the ESHC. This could include a GP drop-in clinic for homeless people and rough sleepers, along with community nurses to provide additional support to access to services and help with admission/discharge processes.

Yours sincerely, Jessica Britton

Executive Managing Director East Sussex CCG On behalf of Sussex NHS Commissioners

Our conclusions

This letter, and the final decision, has demonstrated clearly that public opinion is of little interest to decision makers. Even the public consultation showed public opinion supported the centre staying open.  NHS England dictates the actions of every CCG.  It is a fallacy to think CCGs control local services . Many of the people who are on CCGs do not have the relevant training and expertise to do the job of commissioning.  Commissioning support services are private sector agencies who are there to ‘assist’ the CCG.  Although many suspect that the reality is more that they tell the CCG what to decide.

We rely on our local councillors to keep a check on what is happening to local NHS services. We feel that in this respect the review board set up by East Sussex County Council’s Health Overview and Scrutiny Committee (HOSC) failed us all.  They ignored the opinions of the people who elected them. For this reason I will be standing as an independent candidate in this May’s county council elections. My campaign will be a single issue campaign on health and our NHS, although most of what our council’s are responsible for will impact on health or the NHS.

We must move forward as  come April or May we may see many of the services now run by  East Sussex Healthcare Trust taken on by a new trust. Western Sussex Hospitals NHS Foundation Trust and Brighton and Sussex Universities Hospital Trust are due to be merging to form this new trust on 1 April 2021. We will be campaigning against this merger. More will follow in future blog posts on this website.

For now, we must thank all the people who helped with our walk-in centre campaign. We have had so many conversations with people who have shared their passion and personal stories.  It is through these conversations that I hold onto hope that we can save our NHS. So many people care about it in our town, and indeed elsewhere.

Lucette Davies