Agenda item

A presentation will be given to the Committee by Geraint Davies, Acting Chief Executive of South East Coast Ambulance Trust (SECAmb). The main focus of the presentation will be on the Care Quality Commission’s (CQC) inspection findings, published on 29 September 2016, which gave the Trust an overall rating of ‘inadequate’ and work that the Trust is undertaking as part of its Recovery Plan to address the issues identified.

Discussion

The Chairman advised the Committee that the visit to the NHS 111 Call Centre that had been due to take place on 10 November had needed to be postponed. This and a proposal to establish a regional sub-group to undertake scrutiny of South East Coast NHS Ambulance Trust (SECAmb) had been included as part of the Work Programme item on the agenda (item number 11).

The Acting Chief Executive of SECAmb, introduced a presentation to the Committee, which had been included in the agenda. The main focus of the presentation was on the Care Quality Commission’s (CQC) inspection findings, published on 29 September 2016 and work that the Trust was undertaking as a result. The inspection had given the Trust an overall rating of inadequate. As a result, it had been placed in special measures. The individual areas of ‘Are services at this trust safe?’ and ‘Are services at this trust well-led?’ had also been rated as inadequate. Two areas, ‘Are services at this trust effective?’ and ‘Are services at this trust responsive?’ had been rated as ‘requires improvement’, while ‘Are services at this trust caring?’ had been rated as good.

SECAmb recognised its failings and was already delivering a Recovery Plan, which it was anticipated would address the issues that been identified by the CQC. The Plan had been submitted to NHS Improvement and had been endorsed by the CQC. The Trust would be re-inspected within six months. The Acting Chief Executive considered that a realistic target was for this to give the Trust a rating of ‘requires improvement.’ The expectation was that SECAmb would be able to come out of special measures within 12 months. Six health scrutiny committees and 22 clinical commissioning groups covered SECAmb’s geographic operational area. These organisations would all be seeking assurance in relation to the improvement journey ahead. It was noted that the Trust had agreed an overall budget deficit of £7.1 million.

The Acting Chief Executive also advised that a Patient Impact Review published in relation to a Red 3 Pilot had found no evidence of patient harm which could be attributed to the pilot. In relation to public access defibrillators, the SECAmb Board had agreed to undertake a review into the impact of system issues.

The Committee raised a number of points and questions as follows:

Management of the Trust: In relation to Member concerns about management at the Trust, the Acting Chief Executive advised that the previous Chief Executive and Chairman of the Trust had resigned in March 2016 when its failings had become apparent. Interviews for a new permanent Chief Executive were due to take place on 16 November 2016 and it was anticipated that there would be a four to six month transition period.

Other Staffing Issues: A Member raised concerns about the 44% staff turnover at the Trust, that approximately one third of call handler job posts were vacant and that the staff appraisal completion rate was 60%, which she considered meant that there was a low chance of poor performance being picked up. The Member questioned how the situation had been allowed to become so bad, especially in view of the fact that paramedic courses were oversubscribed. The Acting Chief Executive acknowledged that there were staffing issues, stating that recruitment was being undertaken to address these. It was anticipated that vacant call handler posts would be filled by the end of the year. Recruitment of paramedics was also being undertaken. However, staff retention was a challenge. This was partly because jobs in higher pay bands were available in primary care and other parts of the NHS and there were not currently the resources available to pay ambulance service jobs at a higher level. It was also important to get good quality feedback from staff who were leaving to fully understand their reasons.

Bullying and Harassment: The Acting Chief Executive acknowledged that bullying of staff was a cause for concern and stated that policies and procedures needed to ensure that staff concerns were listened to and that they felt able raise concerns with confidence. Work was undertaken with the person raising the concern and disciplinary procedures were used as appropriate. An appropriate manager, who could listen to concerns of staff,  was always on duty. An annual staff survey was undertaken and work was undertaken with trade unions to ensure acceptable conditions for staff. However, changing working cultures was something that would take time.

Role of Healthwatch: It was confirmed that Healthwatch had held a meeting with the Acting Chief Executive of SECAmb and was actively engaged with the organisation. The Acting Chief Executive thanked Healthwatch for their support and it was noted that a mystery shopping activity had been undertaken by Healthwatch.

Funding: A Lightfoot capacity review undertaken three years previously had identified that SECAmb had a £7million structural funding deficit. For the current year, SECAmb’s contract only provided 75% of what was considered to be the required level of funding for red 1 responses (the most time critical patients) and 70% of the required level for red 2 responses. Engagement would be needed with service commissioners in relation to this funding challenge.

Innovation: The Acting Chief Executive considered that the Trust had got into difficulties due to it having focused on innovation, as opposed to getting the day job right, although a Member of the Committee was not convinced that there had been significant innovation. The Chief Executive explained that the CQC had recognised innovation undertaken by the Trust. This had included SECAmb being the only ambulance trust to have developed a postgraduate paramedic qualification.

Winter pressures: In response to a Member question that asked whether the service would be able to cope effectively with the extra demand during the winter months, the Acting Chief Executive said that work had been undertaken with Medway Foundation Trust to reduce handover delays. This was against a backdrop of demand being 5% higher than that specified in the contract and handover delays having increased 38% year on year. However, there were concerns about the ability of services to manage winter pressures. A meeting was due to take place on 23 November to discuss winter pressures further. In response to a Member question that asked why this meeting had not taken place in the summer, it was confirmed that an initial meeting had taken place in June. However, it had taken time for clinical risks to be fully understood and for all the key partners to be brought together.

Incident Reporting: In response to a Member who asked for clarification of how incidents were reported, the Acting Chief Executive said that a new data system was being implemented and that staff were encouraged to report incidents of concern. Staff levels were also being increased.

Patient Conveyancing: SECAmb had a patient conveyancing rate, which was the percentage of patients taken into hospital, of 50%. This was the second lowest rate of any ambulance service and compared favourably to an 80% figure for London. The number of qualified paramedic practitioners was being increased and SECAmb was looking at the support of other care pathways, as alternatives to accident and emergency admission.

Patient Feedback: In response to a question about patient feedback, it was confirmed that patient satisfaction levels were over 90% and that few patient concerns were being raised with Healthwatch. The number of complaints received by SECAmb was also low.

Decision

The Committee:

a)    Considered and commented on the update provided in relation to SECAmb’s inspection findings.

b)    Agreed that SECAmb be asked to attend the Committee to provide an update in a further six months.