For well over a year now, we have campaigned against the closure of the walk-in centre at Eastbourne station. By the time the final decision was annouunced in early December we had amassed nearly 5000 signature from local people against the closure. Our population were fantastic and we found that when we were collecting signatures outside the station between 80 and 90 % of those we stopped were more than happy to sign. Many of you also told us of very unique and personal circumstances that have arisen where our walk-in centre has literally saved your life or the life of someone close to you.
Our campaign was also supported by many different local organisations including Eastbourne Chamber of Commerce, Eastbourne Hospitality Association, Eastbourne Access Group and our local council. But sadly this was not enough and our CCG has taken the decision to close the centre. They have not only ignored public opinion but they also ignored the many logical arguments we had made against the closure.
We had met with the Health Overview Scrutiny Committee’s review board from the County Council and also with people from the CCG. But we were left feeling that the review board were simply trying to patronise us and had no intention of paying attention to what we were saying. The CCG seemed to be equally indifferent to our arguments and responded with the usual rhetoric and propaganda we had come to expect. Here is the written response we received from the CCG after the meeting we held with them. Text written in blue is our thoughts on what they have said. I think its important we all understand how this decision was made. We need to look at why this campaign was not successful in order to adapt how we work in the next campaign.
We had presented our arguments against the closure under four main headings. We had called for the CCG to meet with us as we felt that despite all our efforts nobody had given us any sort of response to these arguments, The four headings were:- (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 which will mean we need more GPs to accommodate a larger population. (iii) We gave a number of reasons why we believe 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. We believe that our town needs to keep hold of GPs wherever possible.
The CCG responded to these arguments in a letter which was set out as a series of questions followed by theiir answers.
Questions and responses
Why would proposals to close healthcare facilities be considered in a pandemic when there is likely to be increased demand for services and a rise in hardship? At the start of the COVID-19 pandemic the NHS saw a worrying decline in people accessing services. This was for a number of reasons, not least some people felt they didn’t want to ‘burden’ the NHS at a time of such national emergency, and also worries about how COVID-19 secure services were.
We had said that we knew people had avoided seeking treatment during the pandemic but we also knew that many people had had treatment delayed, paused or even cancelled as the NHS struggled to deal with the pandemic. This included some cancer patients. We also pointed out that some people had been left with long term health complications after suffering from Covid 19 and that mental health problems had escalated right across our society. The pandemic will also certainly leave us with an increase in hardship that will lead to more ill health.
The CCG ran a comprehensive communications campaign to reassure local people that services were still open, but that accessing them would be a bit different from normal. It also encouraged people to keep their appointment and to contact health services if they were worried about any sign or symptom. After the restoration of many services, health and care services are now reporting a return to near normal levels of demand.
Our hospitals did return to trying to catch up on treating non-Covid conditions after the first lock down but now we are back in a situationn where they have no choice but to prioritise dealing with Covid 19.
We are acutely aware that this may increase further in the future and we include these type of considerations in our forward planning.
Nobody knows how long this pandemic will last and how bad the nation’s health will be by the end of it so how can the CCG include this consideration in their forward planning?
Services for those suffering from hardship and mental health issues are already in place and available to access via a number of different ways. Health in Mind, for example, is a free 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, and there is access to videos, resources, online therapy and courses. The Sussex Mental Healthline also provides telephone support and information via a freephone number 24 hours a day, 7 days a week. Care and support is available, and it is increasingly not tied to certain buildings or locations, hopefully making them easier and more convenient for people to access.
For many people with mental health problems speaking on the phone or even in an online video conversation can be very difficult. While understanding that face to face contact may not be possible at the moment there needs to be a recognition that anything other than face to face contact is less satisfactory.
Mental health services were in crisis before the pandemic and much more funding needs to be put in place to even attempt to deal with the demand now.
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 the whole of Sussex on 1 October 2020. When a person rings 111 they are connected to a health advisor who uses a clinical decision tool called ‘NHS Pathways’ to understand their symptoms to determine the most appropriate support for them.
Health advisers who answer 111 calls have no clinical training at all
This could be a referral to another service by a booked appointment, a home visit, advice, or the call being transferred to a clinician. The type of clinician a patient is referred to will depend on the patient need. The skill-mix of CAS includes GPs, paramedics, nurses, mental health professionals, midwives, and pharmacists. If during the call it becomes apparent that the patient needs emergency treatment, NHS 111 CAS can book an ambulance, which will then be dispatched via 999 to the patient.
When we asked the public how they would rate the 111 service over 95% said they would rate it as unsatisfactory. The service was enhanced from 1 October it is still far too soon to be assessing if it has improved enough to be satisfactory.
Digital Appointment Booking / Directly Bookable Appointments Directly bookable appointments are a key factor in allowing patients to be seen by the most appropriate health professional when required, while maintaining social distancing and improving the management of patient flow into services. In many instances, the enhanced NHS 111 CAS will be able to manage patients’ needs. If, after assessment, patients require further face-to-face consultation, appointments can now be booked into the following services: (i) Urgent Treatment Centres – all UTCs in East Sussex can now receive appointments booked via NHS 111 CAS. This reduces patient waiting time within the hospital. (ii) GP practices – in-hours bookable appointments are currently being rolled-out across all 174 GP practices in Sussex, with the aim 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 at both Eastbourne District General Hospital (EDGH) and Conquest Hospital in Hastings in October 2020. This approach allows patients who call NHS 111 CAS, and who need emergency care but do not need to be conveyed by an ambulance to a hospital, to be given an appointment slot at their local A&E department. This avoids patients waiting for long durations within the A&E setting and reduces the potential risk of vulnerable patients exposed to COVID-19.
Primary Care Improved Access (PCIA) developments This service offers additional appointments in the evenings, weekends and bank holidays, and 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%, which means that 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), which are groups of practices working together to focus on local patient care, 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
Primary Care Networks are an enormous issue facing our NHS at present and warrant a blog post of their own to discuss why they are considered by many to be a hornets nest of problems. Please watch out for a blog post whch will be published on this website shortly.
With regard to increased demand for mental health services and from people with complex needs the following services are in place to provide help, treatment and support: with complex needs, and those on low incomes and disabilities, will benefit from additional support available in local GP practices and from additional resources currently being recruited to 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 further services across Eastbourne that 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 that are impacting 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, 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 in evenings and weekends who respond 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 but mental health has suffered severe cuts to funding since 2012 and one in three mental health inpatient beds have been lost. We need to see an injection of funding into the mental health services.
Our population has been used to approaching their GP when they first have health concerns for many years now. We fear that for many people changes to the system will be happening too fast and may result in them not being able to access appropriate care.
How are we planning for increased population in the town? The CCG works closely with its local government colleagues at both county and district and borough level across the county with regard to planning proposals and their 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 new centre will provide a home for the Bolton Road, Green Street and Enys Road surgeries, which formally merged in October 2020 to form a single new practice.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, accommodating both existing patients and the projected growth in population. It will provide improved services and be better placed to attract new staff to replace retiring GPs and nurses. In addition, Victoria Medical Centre has developed plans for a branch surgery in Eastbourne town centre for those 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 GP partners, and two further GPs are set to join the practice next year. These additional GPs will work alongside the existing GPs and primary care staff in the new medical facility 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, the impact that these will have on existing services, and any opportunities for new funding as a result of these plans.
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, and currently, at a time when the NHS has seen significant change as a result of the COVID-19 pandemic, there is even 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, such as lock down and social distancing, very seriously throughout the consultation and we followed national guidance throughout. Once national lock down was introduced on 23 March we paused the consultation as we recognised this would impact on how people would be able to engage with the process and have their say. The pause was kept under active review and we reassessed whether the pause should continue or whether other action should be taken in both April and May. Another review, taken in early June, indicated that having paused for two months, and with a changing situation at the time with regard to lockdown measures, the time was right for a decision to be taken about restarting the consultation, 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 to understand whether the underlying proposition had been impacted by COVID-19 and whether it continued to be valid, and reviewed the process of the consultation to understand if a continuation would be meaningful. Satisfied with both of these –that the proposal was still valid and that consultation could be continued in a meaningful way –the CCG took the decision to re-start the consultation into the future of Eastbourne Station Health Centre on 3 August 2020.
We had also paused our town centre campaign events prior to the first lockdown as we felt concerned about keeping both ourselves safe from Covid 19 and the public who we had been approaching. We resumed these town centre campaigns briefly before the second wave. It was clear that the pandemic had caused many people to be preoccupied by Covid 19 and therefore less likely to engage either with us or with the consultation. We were asked a few times how somebody could get hold of a consultation document as they were not online and able to access it through the internet. 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?
It has become clear over the course of this year that we need to adapt to the ‘new world’ in which we are currently living. It is likely that 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 still yet to see any compelling reason why the walk-in centre could not have been given a reprieve from any threat of closure at least until we had returned to some sort of new normal. We hope very much that we don’t return to the old normal as that normal was partly responsible for the scale of this pandemic in the first place.
Opinion Research Services, the independent organisation appointed by the CCG to analyse and report on the consultation, made the following statement on the quality and robustness of the consultation process in its final report: “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, including pausing and subsequently extending the consultation period.”
The consultation document was far from being an unbiased reporting of facts that left the public free to make their own minds up. It was a desperately slanted document that sought simply to justify the case for closure and persuade its readers to support closure.
We think that there has been a reduction in healthcare professionals locally with GPs leaving the service so why would we close a service?
We do in fact know that recruiting GPs locally has been difficult. The surgery at Hampden Park had to close when the number of GPs reduced from four down to one and they couldn’t attract anyone to replace those lost. Several people we spoke to told us that they had tried to sign on with a different practice but were being told frequently that surgeries has stopped registering new patients.
We acknowledge that primary care has its challenges and pressures, which 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 but we didn’t even get a reply to that request.
Also, since 2018 people in Eastbourne have been able to book improved access appointments 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 really that the aim of setting up PCNs was to cut 30m outpatient appointments from English hospitals. PCNs offer GP practices who were starved of resources the chance of more money and more 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, thus further improving patient access. Locally, all Eastbourne PCNs will benefit from additional 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, practices are creating multi-skilled and multi-professional times and are also able to review their workload and 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
- Health and Wellbeing coaches
- Care co-ordinators
- Nurse associates
- Mental health practitioners
Our views on all these changes to primary care have been shaped by speaking to doctors and hearing what they say about the new structures coming into place. We have also looked at the success of these primary care hubs in America where this idea has been copied from. We were left with the feeling that 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 tha have already 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 which is twice as expensive as ours to run and half as efficient.
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 still not able to get a GP appointment when they need it because we spoke to the people. We also heard many often moving stories about why an individual’s own unique set of circumstances left them in a position where they needed the walk-in centre and nothing else would have been appropriate. Many people told us the walk-in centre had saved their life or the life of somebody close to them.
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) to include pharmacists, paramedics, mental health practitioners, and other clinicians to whom patients can be referred following contact with their practice. 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 to receive health and care support, and tackle isolation and loneliness. Patient response to online contact during the pandemic has been positive and we would emphasise that anyone who is assessed as needing a face-to-face appointment, following ‘virtual’ contact via phone or online with their surgery, will receive 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, while ensuring that patients are offered a choice of ways to access services, not just digital. 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, and 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%, which means that 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
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 patients and visitors 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.
Additional communication would be undertaken to 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 and can contact any local practice to find out how. They can also call NHS 111. People can also go to the Urgent Treatment Centre at Eastbourne District General Hospital, which is open from 10am-10pm every day of the week. 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 and the Borough Council among many other local organisations who supported our aims. These are all groups who will be 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 anyone can access for those visitors. We spoke to many teachers from the language schools who all told us that they relied on being able to tell students to go to the walk-in centre if they felt ill. Many spoke about their fears that language students may not seek help if the walk-in centre closed and their concerns about people who are not very familiar with English language 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 and the impact on this group if Eastbourne Station Health Centre were to close. Rough sleepers were identified as being vulnerable to changes to services within the HOSC Review Board Report, as they can be reluctant to engage with mainstream services, due to their complex needs. Currently, homeless people and rough sleepers have access to: The Rough Sleepers Initiative (RSI)which is designed to improve rough sleepers’ ability to gain access to services including 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: “Attend the RSI Outreach and Street Engagement sessions which allows members of the team to provide specialist targeted support to rough sleepers; Attend drop-in sessions run by Matthew 25 on Monday morning; Attend drop in sessions at the Salvation Army on Monday-Friday from 10:00am-4:00pm and Friday afternoon”. 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. In addition to the RSI, the Salvation Army also currently has a small room they use once a month for a voluntary GP drop-in service, although it is not fully equipped. As part of the local response to COVID-19, the CCG commissioned a Care and Protectservice from June 2020 provided by the South Downs Health and Care GP federation 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 offered by GP practices, triage and assessment, remote support and care continuity at accommodation sites where rough sleepers have been offered accommodation; and supporting homeless discharges from the hospital. The Care and Protect Service is a temporary measure put in place due to the global pandemic, therefore a longer term, appropriate solution is required to meet the needs of rough sleepers if ESHC were to close.
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) to understand the needs of rough sleepers and identify potential service models to support this cohort. The CCG are committed to providing appropriate town centre services for rough sleepers in Eastbourne and providing support to mitigate against the impact of the closure of the ESHC, were this to happen. 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
This letter, and the final decision, has demonstrated clearly that public opinion is not really something that decision makers care about. Even if you look at the findings from the organisation running the consultation public opinion was obviously supporting the centre staying open. The CCG may appear to be the people making decisions but they are guided by the decisions taken by NHS England. As many of the people who are on CCGs do not have the relevant training and expertise to do the job they are supposed to do we also have commissioning support services. These 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 were left feeling that in this respect the review board set up by East Sussex County Council’s Health Overview and Scrutiny Committee (HOSC) failed us all by ignoring 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 now we are facing the prospect that come April or May we may see many of the services currently run by East Sussex Healthcare Trust in our hospitals be taken on by a trust created by the merger of Western Sussex Hospitals NHS Foundation Trust and Brighton and Sussex Universities Hospital Trust. 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 all sorts of people who have shared with us 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.