Agenda item

Report by South East Coast Ambulance NHS Foundation Trust which updates the Committee on progress made by the Trust since the November 2018 Care Quality Commission inspection that judged it required improvement.

The report also includes an update on 999 performance.

30.1   The Committee considered a report by South East Coast Ambulance Service NHS Foundation Trust (SECAmb) that was introduced by Joe Garcia, Executive Director of Operations SECAmb who told the Committee: -

·         As well as a Care Quality Commission (CQC) rate of ‘Good’ overall, SECAmb had been judged as ‘Outstanding’ for being well-led in caring and the control room

·         There had been changes to the leadership and senior management to aid improvement

·         Whilst there were a lot of measures in place to improve performance, rural areas were still a challenge

·         SECAmb wanted to strengthen the role of community first responders

·         Staff numbers had increased by nearly 200 meaning that there were 6,000 more operational hours per week versus the same time last year

·         The longest hospital handover delays were at St Richard’s hospital, Chichester based on lost hours per incident> 30 minutes turnaround

·         From 25th November staff have access to an app that would help them find treatment pathways for patients whilst with them

·         Onecall helped enhance patient outcomes

·         There was focus on more local urgent care hubs

·         Response times for lower category incidents were challenging as the focus was on meeting the highest life-threatening category calls

·         An unmarked street triage car had been introduced in Crawley to help with mental health patients emergency response.

·         The Tangmere ‘Make Ready’ centre was being developed and would help with quicker response times and more efficient operation

30.2   Summary of responses to the Committee’s comments and

questions: -

·         Paramedics still went through a three year degree course – 140 new paramedics had been employed since August

·         Morale seemed high in stations with good feedback received on wellbeing procedures - this and the outstanding judgement for well-led indicated that the bullying problem was being addressed

·         There has been a 7% increase in service demand due to an increase in access routes, groups of GP surgeries closing at the same time, increased older population, increased incidents of chest pain and respiratory problems in young adults

·         The ‘Demand and Capacity Review’ set a target for whole time staff predicated on anticipated growth, not actual growth

·         Staffing levels are 245 below target but 41 whole time equivalents (at time of report) ahead of trajectory – shortfalls are made up by using staff overtime and private providers

·         All sub-contractors went through a rigorous selection process and had to have passed CQC inspection with staff vetted and identified as working for SECAmb

·         No further Make Ready centres were planned for West Sussex in addition to those at Worthing and Tangmere. Ambulance Community Response Posts were used to station ambulance crews awaiting an incident, including one in the north of the county near the border with Surrey to take advantage of the Guildford centre

·         SECAmb uses community first responders to support  reaching people in rural areas as quickly as possible

·         There was a pilot scheme in the Horsham and Mid Sussex area whereby paramedics rotated working in GP surgeries and the ambulance service.

·         Staff at the wellbeing hub in Crawley worked across the Southeast Coast region

·         A ‘Front Door’ audit had been carried out at St Richard’s hospital, Chichester over several shifts to identify causes for handover delays and how these could be addressed – the report was due out soon, in the meantime front door triaging had been introduced

·         Handover delays were shorter at Worthing hospital, partly due to the new layout at A&E where there is now no room for ambulances to queue

·         Ways to reduce handover delays, includes seating patients that were fit enough instead of keeping them on trolleys and developing better communication  and understanding of needs between acute hospitals and the ambulance service

·         In addition to a whistleblower system, SECAmb had introduced a ‘Freedom to Speak-up Guardian’ who listens to complaints in private – this might avoid issues going straight to the formal grievance stage

·         The guidance SECAmb provided to nursing homes would in future contain information on handling injury and non-injury falls, but care home staff would still need the right training and equipment to be able to deal with falls instead of calling for an ambulance

·         Training had continued despite the Clinical Education Centre being closed and SECAmb would re-introduce its apprentice scheme in conjunction with further education colleges

30.3   Resolved – that the Committee: -

1. Congratulates South East Coast Ambulance Service NHS Foundation Trust on its most recent Care Quality Commission inspection rating and the improvements that have been made
2. Is encouraged by the work that is being done to improve staff morale and therefore improve the culture of the organisation
3. Asks to receive a written update on the work being done at
   St Richard’s hospital, Chichester to improve handover delays when available