Agenda item

This report updates the committee on progress being made by South East Coast Ambulance Service to improve its CQC rating through its Delivery Plan in line with CQC expectations, as well as the organisational developments that have taken place since the Committee was last updated.

Discussion

The Chief Executive of the South East Coast Ambulance Service (SECAmb) introduced the report. The Operations Unit Manager and Regional Operations Manager of SECAmb were also in attendance.

The latest Care Quality Commission (CQC) inspection of the Trust had found the 999 emergency service to be inadequate overall. The NHS 111 service had been judged to be good, with the 111 service having received an outstanding rating in the well led domain. The Trust was working to ensure that it had a comprehensive improvement plan in place to address the areas identified by the CQC and it was considered that good progress had been made. Priority had been given to recruiting the leadership team and a comprehensive action plan had been agreed with the CQC

Since the CQC’s unannounced inspection visited in October 2017, previously issued improvement notices in relation to medicines management and 999 call recording had been lifted. A further inspection was likely to take place in Summer 2018.

A programme had been put in place to address the concerns raised by the Lewis report into bullying and harassment at the Trust. Engagement had been undertaken with staff and arrangements made to help staff voice concerns. A Learning from Honest Mistakes programme had been implemented and a Wellbeing Hub established. This brought together a range of staff support services into a central place. It was noted that there was a zero tolerance approach to inappropriate behaviour.

A new computer aided dispatch system for ambulance had gone live in summer 2017 and there had been a reduction from three to two emergency operation control centres. The Ambulance Response Programme had gone live on 22 November. This included increasing phone triage time to ensure that the most appropriate response was provided to the patient. In relation to ambulance response times for the sickest category 1 and category 2 patients, there had been good performance in Medway. However, performance was not good for response times for less seriously ill category 3 and 4 patients. Work was taking place with local clinical commissioning groups to address this.

SECAmb’s overspend had been £7million in the previous year. For the current year, it was on track to achieve its £15.1 million cost improvement programme and an agreed cost deficit of £1million, with the deficit being eliminated by the following year.

Members of the Committee asked a number of questions which were responded to as follows:

Ambulance Response Times Performance data – In response to Member questions about why a data table in the report was based on percentages while another was based on response times and concerns about some of the response times, the Committee was informed that the Trust was working to ensure that there were the resources available to meet demand, particularly for non life threatening patients, where performance was currently the most challenging. The data tables were based upon national reporting requirements. Percentages had now been replaced by times, as specified by national reporting standards. It was confirmed that the times stated were average response times. Data was also captured for the 90^th percentile in order to show the longest response times more clearly. Concerns were raised that some response times outside Medway were being missed by a significant margin. It was agreed that guidance for staff in relation to the Ambulance Response Programme would be circulated to the Committee.

Delays in ambulance crews being able to handover patients to hospital staff were a challenge across the UK. Locally, a Handover Director had been appointed to work with the healthcare system to help address this. The equivalent of 10 ambulances a day were lost in the SECAmb service area due to handover delays. It was recognised that there was a need to ensure that patients were not being taken to hospital unnecessarily and also that paramedic time was not taken by cases that did not require paramedic response. A comprehensive demand and capacity review was being undertaken which would be a key step towards improving response times.

Appointment of Executive Team– There had only been one substantive director in post when the Chief Executive had been appointed in April 2017. Appointment of a new team was almost complete with the new Director of Nursing and Quality due to be announced in the next week. This would complete the executive team. The Medical Director post was currently a fixed term contract which was likely to be made permanent.

Bullying and Harassment– The Freedom to Speak Up and Speak Up in Confidence schemes were available for staff who had concerns in relation to bullying and harassment. Externally, Professor Duncan Lewis could be contacted with concerns. A variety of engagement was being undertaken with staff to understand what was working well and it was anticipated that the  NHS annual staff survey results, due to be published in February 2018, would show improved satisfaction amongst SECAmb staff. The Chief Executive operated an open door policy for staff to suggest improvements and senior staff were involved in a programme of meetings and visits to engage with staff to look at organisational culture. Based upon his engagement with staff, the Chief Executive considered that the culture of the Trust was improving. A Member requested specific figures for the number of staff who had had disciplinary or legal action taken against them due to bullying or harassment.  Figures were not provided during the meeting, but the Committee was advised that some staff had left as a result. The Chief Executive considered that bullying had been addressed as far as possible, but it was not possible to eradicate it completely from a large organisation

Recruitment– Recruitment remained challenging with most ambulance trusts struggling to recruit paramedics. It was now a graduate occupation and the workforce was much more mobile. Paramedics were being lost to other organisations, such as in the primary care sector and emergency departments. It was acknowledged that more needed to be done to support retention of paramedics and also of 999 call handlers.

Planning for Hyper Acute Stroke Provision – It was confirmed that the ambulance service was fully engaged in the proposed reconfiguration of hyper acute and acute stroke service provision in Kent and Medway.

Engagement Activity – The Chief Executive apologised that he had been unable to attend the November meeting of the Committee. Engagement with the Committee was important but it was challenging to attend every meeting requested due to the large area that SECAmb covered. The Chief Executive undertook to make attendance at future meetings a priority.

Private Ambulances – SECAmb did currently make use of private ambulance contractors. It was hoped that this could be reduced and would be considered as part of the Demand and Capacity Review and other strategic planning.

Decision

The Committee noted and comment on the update provided and agreed that a further update should be presented to the Committee in August 2018.