Agenda item

Purpose of the report: Scrutiny of Services

The Board will consider the response of the Trust to NHS England recommendations resulting from a project carried out to re-triage 111 calls in 2014 and the current response to winter pressures.

Witnesses:

Paul Sutton, Chief Executive

Geraint Davies, Director of Corporate Affairs and Service Development

Key points raised during the discussion:

1.    The Board inquired about the re-triage process and the performance up-dates and challenges. The Chief Executive informed the Board that the process saw clinicians taking up to an extra 10 minutes to further assess calls that had come across from the non-emergency 111 service to 999. The re-triage process finished mid February 2015. The Board were informed that fourteen clinical decision makers were given 10 more minutes to re-triage the call and as a result a third of calls did not have an ambulance dispatched. 

2.    It was highlighted that in 2014, the Ambulance Trust was under pressure due to the lowest survival rate and the time lost at Accident and Emergency (A&E). Peak weekend call activity on the 111 phone line was impacting 999 responses, so it was suggested irresponsible to respond without proper triaging. The Chief Executive explained that the Trust had been working hard to improve call taking and accuracy at 111 to ensure the re-triage process was not needed in the winter of 2015.

3.    The Chief Executive explained to the Board that Red 1 calls are those known to involve people in cardiac arrest and are always a challenge in winter. He informed the board that if a patient goes into cardiac arrest, this is potentially reversible if they were defibrillated and this is where the eight minute target originates from. Due to the ongoing pressures faced by the trust, the trust used a Resource Allocation Action Plan (REAP) which saw management, including the Chief Executive, involved in the field.

4.    Members were informed by the Chief Executive that the winter months were the most challenging for the NHS. It was stated that 35% of 999 calls within North East Kent did not need an ambulance. It was stated that there was further support from other organisations in the health system but the project rationale was not communicated well with patients and Health Scrutiny bodies.

5.    The Chairman of the Board asked the witnesses about the handover aspect of the ambulance service, and how this fits in with the different parts of the health system. It was stated by the Chief Executive that the NHS as a whole work well together with good engagement and an increased level of engagement within the last year, especially with those who had critical illnesses.

6.    A concern was raised about the Trust’s culture including doubts following recent whistle blowing issues. The Chief Executive and Director of Corporate Affairs and Service Development both agreed that this matter was very serious and the staff survey showed that there are issues. Member’s questioned the reasoning behind the whistle blowing incident which was said to be a result of culture, poor communication and negative attitudes. The Chief Executive admitted that they do need some external support to understand the issues but that their diligent culture worked well in emergency circumstances.  

7.    A Member raised the issue of providing defibrillators within her community. The South East Ambulance Service advised that it could help. It was stated by the Chief Executive that members of the public had a tendency to be reluctant to use the devices, however, he completely supported increased access for the public. He stated he is currently working on influencing Parliament to change Health and Safety legislation to ensure all public sector bodies have defibrillators in their buildings. A member stated that young people should be trained on how to use defibrillators in schools and colleges.

8.    The Chief Executive explained to the Board that they were the third or fourth best ambulance trust service in the country. Members questioned the witnesses regarding how they could improve for the future by looking at other services to learn from. It was stated that the South East Service had more patients and calls nationally than any other service however they will continue to improve their operation.  It was added that 45% of patients with the South East Service receive treatment where they do not need a hospital admission whereas in London 80% of patients are taken to hospital.

9.    It was highlighted that the key challenges for the Trust are handover delays at hospital and managing demand. It was highlighted that SECAmb are working with Royal Surrey County Hospital and Ashford and St Peter’s Hospitals to improve transfers.

Graham Ellwood left at 13:09.

Recommendations:

·         Requests that the trust communicates the outcomes of the patient impact, governance and clinical reviews with the scrutiny board and reports on any changes to its services as a result.