Agenda item

This report updates the committee on the South East Coast Ambulance Service NHS Foundation Trust, with a focus on key developments since the Committee was last updated in November 2020.

Discussion:

Members considered a report which updated the Committee on the South East Coast Ambulance Service NHS Foundation Trust (SECAmb), with a focus on key developments since the Committee was last updated in November 2020.

The following issues were discussed:

·       Change in activity profile and acuity of calls – whether the Trust had failed to plan for this was questioned. Members were advised that a review had identified a shortfall in the Trust’s 999 funding. Since then the Trust had recruited more front-line staff and, as a result, there were more ambulances available, although ensuring they were available at the right time and in the right place was complex. Covid had presented unique challenges such as staff absences and reduced activity as many members of the public were reluctant to add to the service’s pressures or did not want to be taken to hospital. Covid had also led to difficulties in forecasting levels of activity and had impacted on how patients accessed care, with greater numbers using the 111 service. The Trust was looking at the level of resources needed for the predicted levels of demand. In terms of the increase in Category 1 and 2 calls, much of this was due to elective care delays and this had placed more pressure on Category 3 and 4 calls, leading to longer wait times. There had been a shift in activity profiling with an increase in category 2 calls, which required a quicker ambulance response time, for which the Trust was not set up for.

·       Staffing -in terms of whether an underinvestment in staff had led to high levels of staff absence, the Trust felt the environment of the Emergency Operations Centre (999)  in Coxheath and the NHS 111 Operations Centre in Ashford sites had not affected staff wellbeing but did impact on efficiency. The new centre in Medway would mean that the staff from the 999 centre (Coxheath) and the NHS111 staff (Ashford), as well as the Medway ambulance crews were co-located, which would increase efficiency and joint working.

·       111 Service – differing views were expressed about the effectiveness of this service, ranging from it was failing the public to it being generally appreciated.  The Trust accepted not every patient was dealt with in a timely way. There was a shortfall in 111 staff and the Trust was recruiting call handlers in advance of receiving funding for this. The Trust advised it received very little negative feedback from the public on the 111 service.

·       Medway Make Ready Centre – whether the new site was large enough to accommodate the planned number of staff was queried. An assurance was given that there was sufficient space and the new site could accommodate all the staff re-locating there. The site would be on 4 levels and staff were located in one room, making communication much easier than before. There was a dedicated floor for training, welfare rooms and a space for occupational health. An update on this would be provided in the next report to the Committee. Members expressed an interest in visiting the new site when it became operational.

·       IT critical incident – in response to whether the findings were available, Members were advised that these had been shared with NHS England. There had been some architectural issues with the IT system, which were being addressed. Further details on the incident would be shared with Members.

·       Report on delayed hospital handovers - it was noted that the finding that 53% suffered some level of harm was a national figure and not specific to SECAmb. The Trust confirmed that was the case and that they carried out regular harm reviews to improve patient care.

·       Financial position of the Trust – in response to how confident the Trust felt about its financial position, Members were advised there would an update on finances in the next report to the Committee.

·       Performance – a request was made for future updates to include data specific to Medway. The Trust advised this could be difficult given the way services were commissioned. Ambulances often crossed local government areas, but the request would be looked at. A point was made that the move to the new Integrated Care System (ICS) might make it more difficult to access Medway specific data, but this would be reviewed with the establishment of the ICS.

The Trust acknowledged these changes would bring challenges but each ICS would have a place element and the aim was to devolve as much as possible.  The ICS will also make it easier to understand data and improve its quality as it would be based on local council boundaries. The challenge for the Trust would be how to deliver according to the needs of individual places when it operated as a regional service.

·       Ambulance handover times at Medway Maritime Hospital  – noting this had been criticised by the Care Quality Commission following an inspection in December 2020, whether this had improved was queried. Members were advised this inspection reflected a point in time and there had been significant improvement since then. The CQC had found that delays had not been caused by the ambulance service. The Trust was working on admission avoidance as well as identifying more appropriate pathways and looking at discharge and flow through the emergency department. The south east region in the last 3 weeks had been the second least impacted in terms of hospital handover delays. There had been a reduction in very lengthy waits due to SECAmb working with MFT and agreeing, where necessary, to divert appropriate patients to neighbouring hospitals. Medway Maritime Trust was joining a pilot on improving flow at arrival and through the hospital. 

·       Senior Management -  in response to a comment about the significant turnover in the senior leadership team and whether this impacted on the Trust’s ambitions, the representatives from the Trust commented several of them had been in post for a number of years. Some turnover was inevitable and it could be difficult to strike the right balance between continuity and opportunities for improvement.

·       Frequent callers – in terms of the Trust’s approach to this issue, Members were advised that mental health practitioners and specialist nurses could be called upon. The teams were trained to handle calls sensitively and to work with GPs to develop care plans.

·       Ambulance availability – as to what the main challenges were, the Trust advised that the main one was the level of demand and not enough crew available to respond. The Trust was looking to improve clinical assessments in order to reduce the number of ambulances dispatched.

·       Call abandonment figures -  noting levels were high, how these were captured was queried. The Trust advised audits of people who had called 111 and 999 multiple times would happen occasionally but an accurate analysis was difficult as some callers would choose to access primary care or another part of the health system.

·       Electric vehicles – the logistics of using electric vehicles, which took longer to charge than refuelling did, was questioned. The Trust responded they were committed to the NHS net zero strategy. Funding had been received to trial electric vehicles and the suitability of prototypes would be assessed. The Trust was also working with other partners, e.g., local police forces, who were trialling electric and hybrid vehicles to understand how they performed as emergency vehicles.

·       Safeguarding – the Director of People commented that SECAmb were often the “eyes and ears” for the council on safeguarding for children and adults.  However, with the new Integrated Care System there would need to an agreed, streamlined safeguarding process as at present it was not as it should be.

Decision:

The Committee agreed to note the report.