Agenda item

This report updates the Committee on the South East Coast Ambulance Service NHS Foundation Trust, with a focus on the planning and preparation for winter 2022/23, performance across both the 999 and NHS 111 services, the Care Quality Commission recommendations and subsequent Improvement Journey, and ambulance handover delays since the Committee was last updated in March 2022.

Discussion:

Members considered a report from the South East Coast Ambulance Service (SECAmb) NHS Foundation Trust, with a focus on the planning and preparation for winter 2022/23, performance across both the 999 and NHS 111 services, the Care Quality Commission recommendations and subsequent Improvement Journey, and ambulance handover delays since the Committee was last updated in March 2022.

Members discussed the following issues:

·       Current position – a Members asked whether the Trust considered itself to be in crisis. SECAmb representatives responded that crisis was difficult to define. The Trust was in an extended recovery phase. The instability in the executive team was acknowledged but progress had been made in the last 12 months.

·       Current sickness levels – Members were advised that thesickness target was 7% and levels were currently at 10.5%. This was not dissimilar to last year and the Trust was not an outlier. There had been a general increase in burn out across the NHS.

·       Care Quality Commission inspections – disappointment was expressed at the conclusions of the recent CQC reports. The Committee had been assured on several occasions on issues such as bullying, staff morale and senior management stability yet the CQC reports showed little progress. There had been comments from the Trust’s Chief Executive about high levels of employee relations issues and reports of staff feeling burnt out and not getting breaks. SECAmb commented that they were disappointed in the findings of the CQC report. The Trust took staff well being seriously. The CQC recognised that staff provided an excellent service. There was a detailed improvement journey which the Trust was working on at pace. The Chief Executive’s comments had been in relation to the national landscape. Trust in leadership was low and there was a lack of a clear vision. Some training had been cancelled due to the pandemic which had affected break patterns. The latest inspection from the CQC in summer 2022 had changed the rating to “requires improvement”. This and the lack of any additional warning notices would hopefully assure Members the Trust was moving in the right direction.

The Trust acknowledged it was not in a healthy place culturally butculture changes took time. There would be a focus on quality of care and people in next 12 months.

In response to a comment that the cultural issues pre-dated covid, SECAmb acknowledged this but felt covid had been an exacerbating factor.

·       Leadership and Management – an assurance was sought that senior management understood what changes needed to be made and how to ensure staff felt valued and also eradicate poor behaviour. A point was made that e-bulletins and video updates for staff should be in person instead. SECAmb responded that financing was a key challenge. Recruitment was on target but there had been an increase in attrition since covid. The Trust was working with commissioners to get sufficient staff to meet its targets. In terms of the visibility of leadership team, the CQC inspection took place at a time when staff were advised to work from home and communications were mainly virtual. The E-bulletin had been received positively as staff spent little time in stations. The Trust was looking at how it could optimise communications with staff as part of the improvement journey, particularly getting better at listening to staff.

·       Ambulance conversion programme -  why the Trust had paused the conversion of the latest batch of Fiat ambulances while it undertook a review of the design specification due to staff concerns was queried. Members were advised that the Trust was moving to Fiat as part of a national specification. It had quickly become clear that staff did not think the programme was fit for purpose so it had been paused to allow further work with Fiat. The Trust was now introducing adapted vehicles based on staff feedback.

·       999 Category 4 performance – an undertaking was given to share this data with Members.

·       Planning to meet demand – whether the Trust should be better at planning to meet higher demand was queried. SECAmb advised that ideally they would  plan to have the capacity to meet higher demand but attrition could prevent this. However, the Trust was now in a better place. It was not always appropriate to send physical resource to an incident.

·       Suicide Postvention Group – SECAmb clarified that this group was not advertised through the Trust and should not be seen as an acceptance that suicides were inevitable. The focus was on proactively and at an early stage identifying people who were struggling. The Trust had learnt lessons from police forces, fire services and armed forces.

·       Staff retention - SECAmb  advised they had introduced joint response units as one means to keep experienced paramedics engaged. Exit interviews improved the Trust’s understanding of why people were leaving. A retention plan had been approved but turnover at contact centres was 40% and this needed to be tackled. The Trust was looking at its recruitment processes to ensure the right people for each role were recruited.

·       SECAmb Board – in response to a query, Members were advised that the Trust was exploring the possibility of a staff representative on its Board and patient representatives on Board sub groups.

Decision:

The Committee agreed to:

a)          note the report.

b)          request a briefing paper on safeguarding.

c)          note that information on performance, including Category 4 999 calls would be sent to Members.