Agenda item

The Committee will be provided with an update on the progress being made by the South East Coast Ambulance Service following the ‘inadequate’ rating given by a Care Quality Commission inspection undertaken in 2016, including implementation of a Recovery Plan and initial feedback following the recent re-inspection.

Discussion

The Chief Executive of South East Coast Ambulance Service NHS Trust (SECAmb) introduced a presentation to update the Committee on the Trust’s improvement journey. He was supported by the SECAmb Customer Account Manager for Kent.

The key points raised during the presentation were as follows:

·         The Trust had a new Chairman and Chief Executive and was currently advertising for other executive director positions.

·         Performance was fairly good in relation to the eight minute maximum target response for red 1 calls.

·         The Care Quality Commission (CQC) had inspected SECAmb around a year previously, rating the Trust as inadequate. It had been placed in special measures as a result.

·         A Recovery Plan was being implemented to address the concerns raised by the CQC. Areas being looked at included effective signposting to other services, strengthening of partnership working, reviewing ambulance responses and looking at call triage. The Plan was due to be delivered over five years with basic improvements being realised in year 1 and consolidation taking place in year 2.

·         A further inspection had taken place from 15 to 18 May which had focused on whether services were safe, well led, effective and caring. It had looked at key parts of the organisation including 999 and 111 services and urgent care. Initial findings suggested that there had been significant improvement since the previous inspection. The CQC had identified that staff were caring and often went above and beyond what was expected of them.

·         Areas that needed to be addressed included medicines management and making patient records electronic.

·         Other quality areas being strengthened included use of software system Datix, risk management and safeguarding. SECAmb was delivering safeguarding level 3 training compared to other ambulance services who only provided this training to level 2.

·         SECAmb had been experiencing difficulties with recording some 999 calls due to static on the line. This was being addressed with 99.6% of call recordings now being of an acceptable quality.

·         The Trust had relocated its headquarters from Banstead to Crawley with the Lewis emergency operations centre also having moved to Crawley. The emergency operations centre in Banstead was also due to be relocated with the centre in Coxheath being retained.

·        The Trust had a £7.1 million deficit. The deficit target for the current year was £1 million. A £15 million cost improvement programme was being delivered.

·        There was currently a ratio of 50:50 of ambulances to medical cars in the emergency response fleet but it was considered that 70:30 ratio was required.

·         Winter pressures were acknowledged to be challenge. SECAmb would be working in partnership to forecast demand for the next winter and to ensure sufficient capacity. It was noted there had been improvements over the last winter compared to previous winters.

·         There had been some adverse media attention in relation to bullying and harassment of staff. An in-depth study had been commissioned with a report due to be published by the end of July. There had already been increased staff engagement with staff having taken part in focus groups.

Questions and points raised by the Committee were responded to as follows:

Mental health provision: A mental health nurse specialist had been appointed who would review services for patients with mental health needs. This would include considering whether increased specialist provision was required in operation centres. In response to a  Member question, it was confirmed that there had not previously been a mental nurse health specialist post.

Partnership Working: Work was taking place with the police and other partners to ensure a seamless response to calls. Call handling processes were being reviewed to ensure good levels of service. Work was also taking place across the healthcare system in relation to home care packages.

Rollout of IPads: Comprehensive training would be provided for staff being provided IPads. Rollout was due to have taken place by 31 March but had been delayed to July. This delay had been partly to ensure the quality of training provided. The rollout of electronic record keeping would enable records to be shared more quickly and easily, including with general practitioners.

Financial challenges: In relation to the £15 million savings requirement for the Trust, robust plans were in place to enable achievement of this. Work would take place with commissioners to ensure that control totals were met. Quality Impact Assessments would be undertaken to ensure that quality was balanced with the need to make savings. In response to a Member question, it was confirmed that £15million amounted to 10% of the SECAmb budget.

Emergency ambulances and medical cars: It was considered that an increased ratio of ambulances compared to medical cars was needed as cars did not have the ability to transport patients to hospital. It was also acknowledged that not every call required an advanced support vehicle to attend. It was anticipated that the integration of 111 and 999 provision would enable calls to be triaged more effectively.

Staffing: In response to Member concerns that demand led rotas could lead to undue pressure being placed on staff, it was confirmed that close working was undertaken with frontline staff. Shift overruns had been reduced and an increasing number of staff were able to take a break during their shift. Directors had been encouraged to work with frontline staff to get their ideas for areas of improvement. Redundancy figures were not available at the meeting. It was requested that these be circulated to the Committee separately.

Bullying: A Committee Member raised concerns about the prevalence of staff bullying at SECAmb. It was acknowledged that this was an issue and that there needed to be a cultural shift with senior staff being given the right leadership skills. It was anticipated that the aforementioned in-depth study would help this work to be taken forward.

Winter Pressures: In relation to concerns that persons who had no medical need for an emergency ambulance were increasing pressure on the system, the SECAmb Chief Executive said that winter pressures were often related to alcohol consumption. Partnership working was exploring how this could be managed. A number of frequent caller leads were working with operational unit managers and call centres to look at how repeat calling could be managed. It was noted that there were some patients who had requested an ambulance on hundreds of occasions. The possibility of charging repeat callers was a national policy issue and was therefore not something that SECAmb could consider currently.

Decision

The Committee considered and commented on the update provided.