Agenda item

This report updates the Committee on progress being made by the South East Coast Ambulance Service following it’s CQC rating of ’inadequate’, key actions undertaken by the Trust in its Unified Recovery Plan, and the findings of the Professor Duncan Lewes report into the culture of Bullying and Harassment at the Trust.

Discussion

The report was introduced by the Regional Operations Manager - East for South East Coast Ambulance (SECAMB). The Care Quality Commission (CQC) inspection undertaken in May 2017 had given SECAmb a rating of inadequate. This was disappointing but it was pleasing that the organisation had been rated good for caring. The CQC had been concerned that progress made since the previous inspection in 2016 had been insufficient, particularly in relation to governance and structural challenges. SECAmb had taken steps to address the issues facing it since the May inspection. This included the ongoing delivery of an organisational plan to address the 10 key areas that needed to be most urgently addressed. A new Chief Executive had started with SECAmb on 1 April 2017, with the Chief Executive and majority of the executive team being new to the organisation.

In early October 2017 the CQC had arrived at six SECAmb locations for a surprise inspection. This had included a review of progress made to address the serious concerns raised in the May inspection with regards to medicines management.

SECAmb had voluntarily commissioned Professor Duncan Lewis to produce a report looking at bullying and harassment of staff within the organisation. It had been considered to be important for these findings to be made public. Significant work had taken place on the organisational structure of the Trust. There was now significant interaction between the executive team and frontline staff. This included a programme of listening events to generate organisational learning.

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

CQC inspection rating: In response to Member concerns about the inadequate inspection rating and lack of progress made, the Regional Operations Manager advised that additional staff were needed to meet demand. The staffing level for paramedics and ambulance staff was adequate with the Trust being in a better position than a number of other trusts. Adequately staffing call centres was more of a challenge as this was a difficult job that was not well paid, with equivalent work elsewhere tending to be better paid. It was not possible to increase the pay for these roles as salaries had to be in accordance with the NHS pay framework. It had been agreed to recruit more staff than required into these roles to allow for turnover and staff subsequently moving into other roles. Adequate numbers of clinicians were needed within the call centres to analyse calls and determine how urgent a response would be required.

A new computer aided dispatch system had been implemented during 2017. This had replaced an old, unreliable system. The transition to the new system had been smooth and had been welcomed by staff. It had been challenging to train control room staff given that the control room had to remain operational. A national Ambulance Response Programme was due to go live on 22 November. This would enable calls to be prioritised more effectively. An update on this would be included in the next report provided to the Committee.

With regards to medicines management, a significant amount of work had taken place since the May CQC inspection. Operational staff had been issued with IPads and supervisors were now able to carry out daily audits of medicines. Compliance was now amongst the best of any ambulance trust.

Ambulance Response Times: A Member shared a concern in relation to ambulance response times. The case of a child who had fallen over and hit his head was highlighted. It had taken over three hours and multiple calls for a medical car to arrive. The paramedic had not been made aware of the child’s heart condition, which should have resulted in a priority response.

Another Committee Member highlighted a recent personal experience when they had injured themselves and called 111. The ambulance staff had not been informed by 111 staff of the seriousness of the case and had considered that the call should have received a 999 response.

The Regional Operations Manager agreed that the case highlighted in relation to the injured child was dreadful and could not be defended. It was suggested that both incidents be formally reported so that they could be fully investigated. A number of factors affected ambulance response times. This included ambulances having to wait at hospitals until the hospital was able to remove the patient from the vehicle. The Ambulance Response Programme would help to ensure sufficient capacity in the system through call responses being prioritised more effectively. Calls received went through a triage system which should determine the seriousness of the case and ensure a time appropriate response.

Medway Data: In response to a Member request it was agreed that data specific to Medway would be provided in the next report to the Committee.

Other concerns raised by the CQC: A Member considered that while there were some positives arising from the inspection, such as being good for caring and frontline staff generally being very good at their jobs, there were significant failings with regards to appraisals, staff communication and engagement and the culture of bullying present at the Trust. It was extremely worrying that the executive team had been found not to have sufficient understanding of risk in relation to call recording failures. Medicines management and storage of clinical records were also serious concerns identified.

The SECAmb representative said that the Lewis report into bullying at the Trust had been voluntarily commissioned. The executive team was largely new to the organisation and did not comprise the people who could be held accountable for previous organisational culture. The executive team were making significant changes. The CQC had recognised that there had already been a cultural change although a lot more progress was required. In relation to medicines management the recent visit had found that the issues identified by the May inspection had been significantly addressed. Regular staff workshops were being held with the executive team becoming increasingly accessible and engaging with staff.

Bullying at the Trust and workplace environment – A Member felt that publication of the Lewis report had been a brave step. The report showed that there were serious issues to address and that staff had been treated very badly. It was questioned whether the perpetrators of bullying and harassment had been disciplined and also what was being done to improve working relationships and reduce staff turnover.

Another Committee Member highlighted other staff related issues facing the Trust. This included staff feeling that they had unmanageable workloads and impossible deadlines, which was likely to result in significant staff turnover.

The Regional Operations Manager said that the first step taken had been to get the Lewis report produced to fully set out the problems. The second step was to engage with staff, which was a significant piece of ongoing work. Feedback was being analysed which would inform the next steps. It was important to create an organisational atmosphere that made people want to work for SECAmb. Ensuring effective leadership and that supervisors led by example was a key part of this. A culture where staff felt supported and able to report poor behaviour needed to be created. Disciplinary action had been taken in relation to some individuals responsible for unacceptable behaviour and there was no tolerance of such behaviour. Further information on this could be provided to the Committee.

Stroke and Vascular Service Reconfigurations: A Member was concerned that the proposed reconfiguration of stroke and vascular services in Kent and Medway was based upon ambulance response times to transport patients to hospital. Without reliable response times, it would be difficult to effectively design and deliver services based upon a smaller number of centres of excellence.

The Committee heard that the future configuration of services would be based upon providing the best possible treatment to patients and that transporting patients to centres of excellence would result in more effective outcomes than taking them to the nearest hospital. It was acknowledged that there needed to be effective prioritisation of calls to ensure an ambulance response within required timescales.

Varied working practices – In response to a Member who had heard that meal breaks and other working practices could vary between operational areas, the Operations Manager advised that all staff were entitled to a standard length meal break and that work was taking place to ensure that staff were always able to take such a break and to reduce avoidable shift overruns.

Attendance at Committee: Committee Members expressed disappointment that no one from the executive team had been able to attend the meeting. The Operations Manager advised that the Chief Executive had been unavailable and that he would pass on the concerns raised

Decision

The Committee noted and commented on the update provided and agreed that SECAmb be asked to provide an update to the Committee in January 2018.