This report updates the Committee on the progress being made by the South East Coast Ambulance Service (SECAmb) to improve its CQC rating, Executive leadership development, the Demand and Capacity review and resulting Service Transformation and Delivery Programme, alongside other strategic performance updates and local performance for Medway.
South East Coast Ambulance Service (SECAmb) had recently had its core services inspected by the Care Quality Commission (CQC). The inspection had been brought forward as the CQC had recognised that SECAmb was on a significant improvement trajectory. A separate well led inspection was due to be undertaken in the second week of July, with an inspection of the NHS 111 service in Ashford due to take place in the first week of July. There was confidence that the inspections would show significant improvement with it being anticipated that the caring inspection domain would receive an excellent rating. The latest staff survey had been undertaken in September 2018. The number of responses received had increased compared to previous surveys with survey results showing that staff considered performance in the majority of areas to have improved. The Chief Executive of SECAmb had left the Trust in April to take up a post at the North West Ambulance Service. A new Chief Executive had been appointed and was due to start in September. The Director of Human Resources had also left the Trust. An interim was currently in post pending the recruitment of a permanent replacement.
A Demand and Capacity Review had been undertaken throughout 2017, having been finalised in 2018. In order to deliver Ambulance Response Programme standards, an additional 2,413 staff would be needed compared to 2018 staffing levels. 256 entry level staff had been recruited in the last year and 160 staff trained from entry level to become Associate Ambulance Practitioners. There was now a nationally recognised apprenticeship scheme. This enabled staff who had completed the apprenticeship with one ambulance service to transfer without having to repeat similar training. 82 internal staff had been educated to paramedic level. Assessment centres were taking place to recruit newly qualified paramedics who had completed university courses. There were 146 places available to be filled in the current recruitment campaign. A single assessment centre had resulted in 32 of the 33 attendees being offered jobs. The recruitment completed so far meant that a further 2,034 staff were still needed.
93 new vehicles had been added to the ambulance fleet in the current year with a further 50 vehicles due to be added over the next two years, taking the total ambulance fleet to 386 vehicles. A non-emergency transport tier had been introduced. This operated in a similar way to the separate patient transport service not operated by SECAmb, but with the difference that the SECAmb staff operating these vehicles were trained in emergency driving and could provide a greater clinical input in relation to patient treatment. The non-emergency transport tier was used for patients assessed by a clinician as not requiring emergency transport. This had been piloted in East Kent and was due to be rolled out to Medway.
Questions asked by Committee Members were responded to as follows:
Bullying and harassment and categorisation of patients – Members asked how work to address bullying and harassment was progressing, what had happened to perpetrators and how patients were categorised in view of disappointing Category 3 (urgent calls) and Category 4 (less urgent calls) ambulance response performance.
The SECAmb representatives considered that staff were now more willing to raise any bullying and harassment concerns. This was evidenced by the fact that the ‘Speak in Confidence’ initiative, which enabled staff to report concerns anonymously was now hardly used, with staff instead feeling confident to raise concerns directly. It was considered that the previous culture of bullying had been addressed. Extensive work had been undertaken with managers. A six day management development programme made clear expectations of the types of behaviour considered to be acceptable. The outcomes of individual cases of bullying and harassment could not be shared but in cases where there was more than circumstantial evidence of bullying or harassment, those individuals no longer worked for SECAmb. Addressing Category 3 performance was acknowledged to be a significant challenge with performance having been affected by the prioritisation of the most urgent categories, 1 and 2. Recruiting the required number of staff would be key to addressing performance as was the role of Community First Responders and the NHS Pathways tool which SECAmb was now using to help ensure that patient need was correctly assessed. Clinicians were based in the emergency operations centre to provide clinical oversight, also helping to ensure the correct categorisation of patients.
Staff Health and Wellbeing, patient transport and Fire Service support – In response to a question about the demographic breakdown of SECAmb staff, the development of wellbeing hubs, the scope for patient transport staff to move into emergency operations and support provided by the Fire Service, the Committee was advised that the Hub had been very successful in supporting staff to attend work who might otherwise be on sickness leave. A decision had been taken to continue funding the Hub following the end of the pilot. Overall, 51% of SECAmb staff were female and 49% male. The percentage of Black Asian and Minority Ethnic staff would be confirmed following the meeting but it was acknowledged that this figure was not as high as SECAmb would like. A number of staff had joined SECAmb from private patient transport service providers. The Fire Service continued to support SECAmb in attendance at some calls, for example, providing defibrillation for patients who had suffered cardiac arrest and assisting with patients who had suffered a fall. However, Fire Service personnel could not undertake medical assessments of patients so there needed to be close cooperation between SECAmb and the Fire Service.
48% of SECAmb employees were paramedics, with the aim being for this figure to increase to 68%. This would enable every SECAmb vehicle to be staffed with a qualified paramedic. On its current trajectory, this would be achieved by 2024. Achieving this figure sooner would require SECAmb to successfully recruit significant numbers of qualified paramedics from other trusts.
Performance in Key Theme Areas and appraisal performance – A Committee Member asked what was being done to address below average performance in a number of the ten key theme areas and what was being done to improve the quality of staff appraisals. Work was being undertaken to improve performance across the key theme areas. One example was reductions in overruns at the end of staff shifts. Previously, 50 to 60% of shifts were finishing over 15 minutes late, with the average being 40 minutes. Changes had been made to end of shift arrangements with the aim being for ambulance crews to return to the area close to their starting point before the end of the shift. This had helped to reduce overruns to approximately 30%, thereby helping to improve staff morale. The Trust had introduced secondary rest breaks for staff each shift in addition to their main break. Medicines management was another area highlighted where significant improvements had been made. There was a need to ensure that managers had sufficient time to undertake meaningful staff appraisals. This had included the allocation of 50% of manager time to the people management aspect of their role. This also helped to ensure that there was a manager available to meet staff at the start and end of their shift. There was confidence that these changes would be reflected in improved feedback when the next staff survey was undertaken.
Staff turnover – A Committee Member asked for figures relating to staff turnover, how this had changed, what the target was for future turnover, how figures compared with national averages and how the Trust aimed to retain staff. It was requested that information be circulated to the Committee.
The Committee noted and commented on the update provided and agreed that a further update be presented to a future meeting of the Committee.