Agenda item

The report updates the Committee on South-East Coast Ambulance Service NHS Foundation Trust’s planning for Winter 2022-23, the current Urgent Emergency Care transformation initiatives and the ongoing improvement journey to respond to the 2022 Care Quality Commissioner inspection findings and recent NHS Staff Survey feedback.

36.1     The Committee considered a report by South-East Coast Ambulance Service NHS Foundation Trust (SECAmb) (copy appended to the signed minutes).

36.2     Summary of responses to committee members questions and comments:

·         Handover delays are a whole system flow issue that needs investment in social care and community services to help reduce them

·         51% of ambulance callouts result in conveyance to A&E

·         Patients that have to wait more than one hour for handover experience some level of harm, 53% low, 23% moderate and 9% severe

·         The proportion of delays over one hour has increased from 1% in 2018 to 18% for October 2022

·         The average handover time, against the 15 minute target, was 30 minutes in October 2021 and has increased to 42 minutes in October 2022. The 90th percentile, for average handover time was 35 minutes in 2020 and as at October 2022, is 1 hour 21 minutes

·         Nationally an estimated 44,000 people suffered some level of harm due to delays in the last month with 5,000 suffering severe harm when 23% of ambulance capacity was lost to handover delays compared to 7% in October 2019

·         In West Sussex handover delays in the last year have risen from 0.17 hours (10 minutes) to 0.19 hours (11.5 minutes)

·         The agreed handover process framework is  being reviewed with Worthing Hospital, St Richard’s Hospital (Chichester), Royal Sussex County Hospital (Brighton) and East Surrey Hospital (Redhill) to help reduce handover delays

·         SECAmb is working with commissioners to standardise appropriate pathways across all hospitals in the West Sussex and East Surrey place footprint

·         The Same Day Emergency Care conveyance pathway is critical to supporting non-Emergency Department presentations

·         More overtime is not the answer to reducing response delays

·         Crews have one to one meetings with managers, review rest and meal breaks and a wellbeing hub

·         The Trust provides a variety of services for all staff to support mental and physical health

·         There is a trauma risk management response (TRiM), which includes trauma risk assessments and support from associated TRiM practitioners and external counsellors where required

·         Rollout of the Make Ready Centres programme is continuing

·         SECAmb has a recruitment plan in place, which employs people from the UK and is exploring international opportunities, specifically from Ireland and Australia

·         Workforce numbers are reviewed monthly – the Trust is on track meet its workforce planning forecast, however attrition rates are currently higher than planned and present a risk to the Trust’s workforce projection

·         Currently 6% of the Trust’s frontline operational hours is sourced from private ambulance providers

·         The Care Quality Commission (CQC) report focussed on the response to covid when difficult decisions had to be made i.e. suspending core training. This period has put a strain on frontline clinicians

·         The Trust is looking at improvement by focussing on people and quality of service

·         The improvement journey focusses on the four warning notices and the four improvement pillars established to address this are Quality Improvement, People & Culture, Responsive Care and Sustainability & Partnerships

·         Although the warnings have since expired, the Trust needs to adhere to compliance regulations

·         Improvement will be measured by follow-up visits by the CQC

·         Alternative pathways other than A&E include Urgent Treatment Centres and community services e.g. two hour community response, but they need be appropriate for the patient needs at the time of call

·         The Trust is working within NHS guidelines to further improve its response to people in mental health crisis and already provides 24/7 access to mental health practitioners via the emergency operations centre for 111 and 999 calls, which supports an immediate response to patients as well as crews on scene

·         SECAmb is also trialling a revised response model, liaising with the Blue Light Triage team within Sussex Partnership NHS Foundation Trust, to fully utilise specialist Mental Health Practionners and their local patient knowledge to support a higher incidence of treatment on scene and reduce A&E conveyance

·         The Trust is working closely with all Community Services providers to provide an enhanced frailty response via the standardised Urgent Community Response services - this is provided by Onecall in West Sussex

·         This work includes the development of systemwide single point of access to support joint clinical decision-making and when relevant, provide support to patients via the provision of a virtual ward bed, of which frailty is the number one priority provision for this winter

36.3     Resolved – that

             i.        An assurance was received that areas identified by the Care Quality Commission and concerns raised previously by the committee are being addressed

            ii.        The committee receives more information on “make ready centres” at an appropriate time

           iii.        The committee receives further information that evidence transfer times and waiting times are reducing

          iv.        An update to be provided to the committee on the improvement journey at an appropriate time