Agenda item

This report updates the committee on progress being made by South East Coast Ambulance Service (SECAmb) 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 report detailed progress made since the CQC inspection undertaken in 2017. It was considered that significant progress had been made since then.

Since September 2017, there had been monthly deep dive inspections in relation to key themes with one of the key areas of success being in relation to medicines governance. Learning had been undertaken in conjunction with a lead NHSI pharmacist and this would be used as an exemplar process for other ambulance services. A key area of concern was bullying and harassment. Significant work had been undertaken to address this including  behavioural development training for the leadership team, with first line supervisors now also receiving this training. Areas of concern identified in the staff survey were being addressed. This had included delivering meaningful appraisals and objective setting to 92.5% of staff in the last year. Results of the latest staff survey had been more positive than for the previous year with a further staff survey due to be undertaken later this year.

The Ambulance Response Programme was a national initiative. Since November 2017 response times for all ambulance services were being measured in a different way. The Programme breaks responses down into four key categories: Category 1 - immediately life threatening, Category 2 -emergency, Category 3 - urgent and Category 4 - less urgent. SECAmb’s performance for categories 1, 2 and 3 was in line with performance of peer services across country. The target response time for a Category 1 call was 7 minutes. SECAmb was narrowly missing achieving this target. Performance was within the upper quartile nationally for category 2 but there were significant challenges regarding Category 4 performance. This was due to SECAmb prioritising categories 1 and 2.

A Demand and Capacity Review had identified that SECAmb had significant gaps in its ability to deliver against national targets. A plan was being put in place to address this which would increase the number of double crewed ambulance vehicles in the SECAmb fleet by between 50 and 100. The workforce would be increased by over 200 whole time equivalents. Over 1,000 additional staff would need to be recruited by 2020/21, including 150 staff in Medway. The Review had identified a need to deploy specialist paramedics and paramedic practitioners, who would work in zoned or targeted areas in order to provide senior clinical oversight.

A number of questions were raised by Members of the Committee which were responded to as follows:

Staff survey and bullying and harassment – It was recognised that the response rate to the staff survey of 44% and the 45% satisfaction with the handling of bullying and harassment was disappointing. SECAmb was going through a process of rebuilding staff trust. The appointment of a full executive team would help this process with there only having been one substantive executive team member in place in September 2017. Additional support had been brought in to address concerns raised. Dedicated 1^st line supervisors would be entirely staff focused with 50% of their time dedicated to managing their team. There was confidence that staff now felt able to report bullying directly instead of relying on anonymous reporting. Allegations of bullying and harassment were not always supported by evidence, which made it difficult for action to be taken. Cases where evidence existed were pursued with a number of staff having resigned as result. Managers had been made more visible and it was considered that staff had increasing freedom to speak up while at the same time the number of allegations were decreasing, which suggested that the problem was being addressed. A Committee Member highlighted the importance of continuing an investigation after a staff member had resigned as concerns could be shared with future employers.

Ambulance and paramedic provision – It was recognised that the proposed changes to stroke services in Kent and Medway would present new challenges for patients. SECAmb had trained 320 paramedic practitioners in the last 10 years who would be better able to recognise a stroke and respond accordingly. A bespoke service had been commissioned with SECAmb providing paramedic practitioners who undertook a number of placements, including eight weeks in an ambulance response capability. 62% of SECAmb activity was either life threatening or an emergency. Work was being undertaken to ensure an appropriate response for each category of patient whilst ensuring that mobile intensive care units were always available for higher category patients. SECAmb had invested in 101 new vehicles in the current year. As their supplier had not been able to build engines quickly enough to meet demand, a number of second hand vehicles had also been sourced in order to increase vehicle capacity ahead of winter.

Performance compared to West Midlands – Response times by West Midlands Ambulance Service were amongst the best in the country due to it having the correct size of fleet to meet demand. It had 100 extra vehicles compared to SECAmb. The Demand and Capacity Review had identified the need for 1,000 extra operational hours compared to current provision. This equated to between 40 and 50 additional ambulances and a number of additional cars being available each day compared to the current fleet. It had been agreed with commissioners that this standard would be delivered by April 2019. This would require 2,200 staff rotas to be changed by April, which would be extremely challenging. This response was based on a forecast 3.9% year on year growth in activity.

Financesand Partner Support – In response to a Member question about how financial efficiencies had been realised without there having been a detrimental impact on service and how other organisations could support SECAmb, the Committee was advised that there had been significant inefficiencies that had been relatively easy to overcome. One example was meal break payments, which had reduced from £220,000 a month in January 2017 to £7,000. 999 calls made by external care organisations on behalf of patients were problematic as some of these calls were not emergencies and the organisation making them was often not able to answer key questions about the patient. This resulted in an ambulance being dispatched when it may not be required. It was suggested that there may be a need to better regulate how such organisations operated. The no lift policy of most nursing and care homes also put an additional strain on the service. There was a need to educate the public about alternative options to making a 999 call.

Ambulance handovers – Significant work had been undertaken to address delays in the handover of patients from ambulance to hospital staff, including close work with hospitals. There had been significant improvements nationally but Medway Maritime Hospital had not made the improvements anticipated.

Fall Responses – SECAmb had an established programme with Kent Fire and Rescue for the fire service to attend some calls, particularly during the winter period.

Decision

The Committee noted and commented on the update provided.