Agenda item - Royal Sussex County Hospital: Acute Floor Reconfiguration

Report of the Chair, Health Overview & Scrutiny Committee (copy attached)

6.1      This item was presented by Nigel Kee, University Hospitals Sussex NHS Foundation Trust (UHSx) Chief Delivery Officer; Nikki Mead, Transformation Programme Manager; Craig Marsh, Head of Nursing, Acute Floor; and Stephen Mardlin, Royal Sussex County Hospital (RSCH) Hospital Director.

6.2      Mr Kee told members that the acute floor at RSCH needed to be reconfigured to improve capacity and bring services up to modern standards. Ms Mead added that the reconfiguration would provide an improved environment for all patients, including people with dementia, people with learning disabilities and neurodiverse people. There will be more quiet areas and a 76% increase in individual cubicles, which will reduce noise and provide for adjustable lighting to help patients feel comfortable. The capacity and the footprint of waiting areas will be increased and they will be spilt into different sections so not everyone has to wait in the same space for treatment. Earlier clinical triage will help identify those who need additional support to wait. Colour will be used to split the area into zones, helping patients orientate through the department. There has also been a focus on the materials used, recognising that some vulnerable patients struggle with glare from walls or similar issues.

6.3      Mr Marsh told the committee that staff and patient feedback has informed the reconfiguration plans. For example, the creation of separate waiting areas will allow patients to progress in their waits, moving from general to more specific areas once their needs have been identified. This is something that many patients value. Close attention has been paid to ensuring that the new environment works for staff, with additional staff facilities and equipment storage.

6.4      Mr Kee added that there are other significant, but less visible, elements of the reconfiguration, including an upgrade of digital services and improvements to ventilation systems. The new acute floor will provide more privacy and dignity for patients, more capacity, better infection control and better trauma care. Ms Mead outlined the timeline for completion of the Phase 2 enabling works and of Phases 2 and 3 of the build. The work is expected to complete in 2030.

6.5      Cllr De Oliveira stated that system pressures such as discharge delays and a lack of mental health acute beds meant that improvements to the acute floor would not necessarily address the local crisis. Mr Kee responded that it was important that, in addition to the reconfiguration, there are better pathways for patients, recognising that some people do not need to be treated in the emergency department. The trust is working closely with partners to tackle the system pressures identified by Cllr De Oliveira. Ms Mead added that she agreed that additional capacity is not a panacea; people presenting at A&E who require a mental health bed, and discharge flow are identified as major project risks.

6.6      Mary Davies (Older People’s Council) praised the Phase 1 facilities that have already been opened. She asked whether an Equality Impact Assessment (EIA) could be shared with the committee. Ms Mead replied that an EIA for Phases 2 and 3 was being developed as part of the project business case. Once complete, this can be shared with the committee. ACTION

6.7      Cllr Parrott questioned the degree to which patients had been involved in the reconfiguration plans. Mr Kee responded that he welcomed the challenge around patient voice. The trust recognises the importance of involving patients at all stages of the reconfiguration. Mr Marsh noted that it is particularly difficult to capture patient views of emergency services. He works closely with nursing staff and via an Emergency Department Patient Forum to get information. Mr Mardlin added that he had recently attended the West Integrated Community Team (ICT), to discuss how to use ICT and GP practice-level data on admissions to better understand patterns of admission and where best to intervene to reduce unnecessary admissions. This is a key element of improving the experience of those people who do need to use emergency services.

6.8      Geoffrey Bowden (Healthwatch) queried whether there was sufficient capital funding to deliver the programme of changes. Ms Mead replied that the programme is in a strong position. There is contingency funding and some aspects of the programme have already been delivered within budget.

6.9      Cllr Evans told members that she had recently attended A&E on a weekday afternoon and had found it chaotic, with far too many people waiting in an unsuitable environment. She contrasted this with the reception at the Louisa Martindale Building, where a very large space is underused. Cllr Evans questioned whether it was possible for the trust to maintain clinical capacity and sufficient waiting space for the duration of the works and queried the 2030 end date. She also asked about engagement with staff and unions, making the point that staff in some hospitals report that permanent staff are treated differently to staff working temporarily or on rotation. Mr Kee replied that relations with staff are good. The trust does not discriminate between permanent and temporary staff. UHSx is confident it can meet the 20230 target for completion of works. However, there is always the possibility that this may be impacted by geopolitical factors beyond the trust’s control. Mr Marsh added that recent weeks had been very challenging, with the trust going into business continuity at one point. Patient pathways need to be improved, and this work should not wait for the reconfiguration to be completed. If people are waiting in A&E for many hours to be seen, then they probably should not be in A&E and would be better served being directed elsewhere for treatment. Mr Marsh explained some of the measures taken to engage staff. Mr Mardlin explained that the recent heat wave had impacted hospital services, both because some equipment did not function properly in the high heat and humidity and because South East Coast Ambulance Service was overwhelmed with demand. This meant that it took them longer to reach and convey patients, leading to patients arriving in hospital with their conditions more acute than they should have been. Whilst the weather had subsequently cooled somewhat, the heatwave had a knock-on effect which was still being felt in the following week.

6.10    Nora Mzaoui (CVS representative) asked about access and wayfinding to A&E and about the use of sub-waiting areas. Mr Kee replied by acknowledging that more needs to be done in terms of improving wayfinding. In terms of sub-waiting areas, some patients do dislike this, but there are real advantages in being able to progress patients to less crowded waiting areas that are appropriate for their medical needs. Ms Mead added that sub-waiting areas should only be used for different stages of a patient’s treatment journey – patients should not simply be moved from waiting area to another. Wayfinding is a challenge. However, the staff at the Louisa Martindale reception are excellent and can help direct and sometimes accompany patients to A&E.

6.11    Cllr Winder asked about the role of GPs in improving A&E. Mr Kee responded that the business of A&E inevitably makes it harder to deliver good clinical outcomes and positive patient experience. GPs have a key role to play in avoiding unnecessary A&E attendance and admissions and the trust is committed to working with local GP practices via city ICTs to reduce unnecessary attendances.

6.12    Cllr Hill asked questions about RSCH performance in terms of corridor care and ambulance handover times. Mr Kee replied that the trust is working hard to reduce incidents of corridor care and is receiving national support for this. Mr Marsh responded that, unlike many other trusts, UHSx has a policy of not delaying ambulance handovers by making patients wait in ambulances when there are no beds available for them. However, this can mean that more people have to be accommodated in corridors.

6.13    Cllr Hill asked a question about out of hours capacity at the early pregnancy unit. Mr Kee agreed to take away this question. Mr Kee subsequently confirmed that the Early Pregnancy Unit is open 24/7 and can be accessed by patients self-presenting as well as via the Emergency Department.

6.14    Cllr Simon asked about the lack of natural light in the ED. Ms Mead replied that the use of lightbox skylights has been successfully trialled in the AMU and will be rolled out across ED.

6.15    Cllr Simon asked about people waiting in the ED for a mental health bed after presenting at A&E. Mr Kee replied that Sussex Partnership NHS Foundation Trust (SPFT) has an improvement plan to reduce these presentations, and UHSx is working in partnership with SPFT on this. Ms Mead added that the current area used for people waiting for a mental health bed is not replicated in the reconfiguration plans. This is an issue that needs to be addressed by the entire local health and care system.

6.16    Cllr Simon asked about work with the most deprived communities around admission prevention. In response, Tanya Brown-Griffith (NHS Surrey & Sussex) outlined neighbourhood health improvement plans, including the development of neighbourhood hubs. Mr Mardlin added that the trust is committed to working closely with ICTs across the city to understand and address local community needs.

6.17    Cllr De Oliveira asked how confident the trust could be in its modelling. Mr Kee responded that UHSx uses national tools to model capacity and demand. Ms Mead added that the modelling for the reconfiguration project was based on a 10 year forecast for demand which uses current activity as a baseline and allows for significant demographic growth.

6.18    Mr Bowden raised the issue of police bringing people in mental health crisis into A&E as a Section 136 place of safety. Mr Kee replied that there will be SPFT presence at the reconfigured site, but not a dedicated space to house people waiting for admission into acute mental health beds as is currently the case. UHSx will continue to work with Sussex police to manage the issue raised by Mr Bowden.

6.19    Cllr Parrott noted that providers across the local health and care system face significant challenges, including performance problems at UHSx, SPFT and council adult social care. This is important context when thinking about reconfiguration project risk and risk mitigations.

6.20    Cllr Wilkinson asked about reconfiguration project risks in a scenario where discharge delays worsened and further put pressure on ED. Mr Kee replied that there is no loss of ED bed space during reconfiguration, so this is not necessarily a greater risk during Phase 2 and 3 than it is currently. However, UHSx operates a number of acute sites and spare capacity in other hospitals can potentially be used to relieve pressure on RSCH.

6.21    Cllr Wilkinson asked about plans to engage with particularly vulnerable groups, including people with learning disabilities, people with autism and people with dementia, in advance of Phases 2 and 3 of the reconfiguration. Mr Kee responded that engagement plans are in place. Ms Mead added that the main disruption will be from mid-2027 onwards so there is still some time to focus on community engagement.

6.22    RESOLVED – that the report be noted.