Agenda item

This report updates the committee on the South East Coast Ambulance Service Foundation Trust, with a focus on key developments since the Committee was last updated in June 2019. These key areas include: CQC reporting, award of the NHS 111 CAS contract, performance and performance recovery, and key senior appointments.

Discussion:

This report updated the Committee on the performance of the South East Coast Ambulance Service Foundation Trust (SECAmb) with a focus on key developments since the Committee was last updated in June 2019.

Three SECAmb representatives were in attendance for this item and the Associate Director of Operations gave an overview of their work and highlighted a number of key issues. These included SECAmb coming out of special measures in 2019, changes to the leadership team, the award of the 111 Clinical Assessment Service contract for a period of 5 years, an overview of performance including hospital handover delays. She also gave an update on staffing, clinical education, electronic record keeping and the Trust’s estate.

SECAmb representatives responded to Members’ questions and comments as follows:

111 Service – In response to questions regarding how SECAmb intended to improve the 111 service, the Strategy and Partnerships Manager stated that they would be taking on the service in Medway, Kent, and Sussex from April 2020 for a period of 5 years and that it would be possible to develop seamless 111 and 999 services as they both used the NHS Pathways triage tool and together with other changes he was confident that the public would see an improved service.

Management Structure and staffing – In response to a question regarding the regular changes to the management structure and staffing and the need for continuity in supporting improvement, the Associate Director of Operations stated that she had been in post for four months and she was committed to being part of a cohesive leadership team and putting a strategy in place for the next 5 years. She stated that the recent review of the structure was in part related to the aim of achieving an excellent rating from the Care Quality Commission.

In response to a question seeking clarification as to whether the restructure had included new posts and/or new personnel, the Strategy and Partnerships Manager confirmed that the recruitment had been to existing posts.

In response to a question regarding turnover of staff generally, the Senior Operational Manager confirmed that this was a challenge owing to a number of reasons including, for example, agencies paying inflated sums for Paramedics.

Watling Street Ambulance Station – In response to a question seeking an update on the future of the site, the Senior Operational Manager stated that this site was now under Medway Council’s ownership as part of the One Public Estate programme. He referred to work underway to recommission the outpost in Commercial Road, Strood, whilst work was ongoing regarding the planning application for a new station in Medway.

Bullyingand harassment – In response to questions expressing disappointment that the issue of bullying was not covered in the report and the lack of public accountability, SECAmb representatives undertook to include this information in the next report to this Committee. The Associate Director of Operations advised the Committee of the steps of taken by the Trust to eradicate bullying and harassment. These included the provision of a “Freedom to Speak Up” lead and advocates who were available for staff to speak to. In addition, she had personally spoken with staff about their experiences. She stated that the leadership team were reviewing practices and processes to deal with bullying and harassment. She also stated that the leadership team were examining what more could be done on the issues of minority groups and diversity as well as succession planning to help more women into leadership.

The Senior Operational Manager and the Strategy and Partnerships Manager also provided further details including staff survey results and confirmed that these would be included in the next report to Committee.

In response to a question regarding the lack of continuity and the need for the new leadership team being aware of what had gone on before in respect of bullying and harassment, the Associate Director of Operations advised the Committee that she was fully aware of the issues that had faced SECAmb as set out in the Duncan Lewis report and the work which had been undertaken by the Trust since then. She also stated that the Trust’s Leadership Team now included a mix of staff with front line experience as well as Leaders from other parts of the public sector.

Coronavirus(COVID-19) – In response to a question regarding SECAmb’s preparedness for dealing with Coronavirus, the Associate Director of Operations advised the Committee that SECAmb was following Public Health England guidance and was working with partners on a range of workstreams. She stated that SECAmb had put a number of contingency measures in place across the Trust to respond to this issue. She referred to the Trust having good measures in place to protect staff, good infection control and she had also attended a meeting of the Kent Resilience Forum with Medway’s Director of Public Health earlier in the day. In addition, the Senior Operational Manager provided some examples of the steps being taken by the Trust on a day to day basis, for example, the deep cleaning of ambulances.

She also referred to SECAmb’s involvement with the Strategic Command Group for Kent and Medway with partners as well as a Tactical Command Group.

Hospital handover delays – In response to a question detailing the issues facing SECAmb with regards to hospital handover delays at Medway Maritime Hospital, the Senior Operational Manager stated that there were some system issues and that between 125-135 patients had been arriving at the hospital by ambulance per day during December-January compared to the typical 90-100 patients which had contributed to the delays, however, he praised the ambulance crews for their work whilst recognising that more work was needed to improve patient flows into the hospital.

It was also queried as to the impact that improvements to the local roads infrastructure had made.

The Strategy and Partnerships Manager advised the Committee that the issue of handover delays had not been over emphasised in the report because things were improving and there had been scrutiny and pressure on the hospital from NHS England and a Group which had been formed to look into this issue.

The Senior Operational Manager clarified the difference between mean response times and 90^th centile response times.

Joint Live Conveyance Review – in response to a request for a copy of the review once published, the Senior Operational Manager undertook to include the review as an appendix to the next report to the Committee.

Private ambulance crews – In response to a question regarding the introduction of 117 new ambulances and whether there was still a need for private ambulance crews, the Strategy and Partnerships Manager advised the Committee that there was a rolling replacement of ambulances, however, there was still a need for private ambulance crews because of a lack of sufficient staffing levels. It was confirmed that this provision of this package included an ambulance and crew.

Clinical Education – In response to a question regarding the provision of clinical education, the Senior Operational Manager gave an oversight of the provision including a 12 month apprenticeship programme which was due to start in April 2020.

MHS Housing Foyer planning application – In response to a question regarding whether SECAmb would be making representations in respect of this planning application, the Senior Operational Manager confirmed that this planning application would be referred to SECAmb’s Central Repository for response.

Response times – In response to a question as to why SECAmb was not performing better, the Associate Director of Operations advised the Committee there were a number of reasons for varying performance levels, for example, the amount of rural areas the Trust covered and the work being undertaken to improve decision making regarding the despatching of ambulances as well as the location of stations. With regards to the treatment of calls classified as C3 or C4, the Strategy and Partnerships Manager confirmed that whilst C1 and C2 calls were prioritised, the 111 service would deal with C3 and C4 calls which may result in ambulances not being required and hence re-classified.

Decision:

a)    The Committee noted and commented on the update report provided.

b)    The Committee requested that the following information be included in the next SECAmb update report to Committee: Joint Live Conveyancing Review and further information relating to bullying and harassment.

c)    The Committee requested a briefing note on the £50,000 which had been spent on improving the roads infrastructure adjacent to Medway Maritime Hospital.