Declaration of Interests:
None
Witnesses:
Helen Wilshaw-Roberts, Strategy & Partnerships Manager
– West, SECAmb
Steve Emerton, Executive Director of Strategy and Business
Development, SECAmb
Andy Cashman, Regional Operations Manager: West,
SECAmb
Sumona Chatterjee, Executive Director of Strategic
Commissioning, Surrey Heartlands CCG
Matthew Parris, Healthwatch Surrey
Key
points raised during the discussion:
- The report
was briefly introduced by the Executive Director of Strategy and Business
Development who explained that the Trust had moved from an
Inadequate to a Requires Improvement Care Quality Commission (CQC)
rating.
- Witnesses were asked for an update on the new
executive team employed by the Trust. It was explained that the
previous Chief Executive, Daren Mochrie, had taken on a new role
and Dr Fionna Moore would be acting as the SECAmb Interim Chief
Executive. A new Chief Executive had been appointed and the
Executive Director of Strategy and Business Development would
update the Committee on the progress of this appointment in due
course.
- It was confirmed that following the Demand and
Capacity Review, it was recognised that a significant amount of
investment was required to see improvements in the Trust. A
contract variation agreed with the commissioners has placed a
significant investment in the Trust for 2018 / 2019 and continues
into 19/20 and 20/21. The investment in the Trust is dependent on
the current contract review process and would be around
£34-43million growth per annum over the next two
years
- It was
queried how much emphasis was given to triage by the Trust as it
seemed to work well with the Crawley Ambulance triage programme.
The Strategy & Partnerships Manager
– West explained that the Crawley
Ambulance triage programme had been successful in helping with the
current gap in crisis response teams and the ability for an
emergency response for people suffering a mental health crisis. The
model consists of an advanced mental health practitioner and a
paramedic that respond to calls. The result had been effective
assistance had been provided and the Trust was working with Sussex
Partnership and Foundation Trust to assess the most appropriate
model of care for people experiencing such emergency crisis - this
would then be assessed for wider rollout requirement further across
Surrey and Kent.
- It was
explained that the Targeted Dispatch Model would ensure the right
resources get to the right places and people. There was a concern
there will be a greater number of people being conveyed to the
acute centres as resources available to the Trust improve. It was
added that there were now midwives in the control centre
environment for the Surrey Heartlands area which would reduce the
number of conveyances to hospitals and this would be extended to
Sussex and Kent in due course.
Zully
Grant-Duff arrived at the meeting at 10.35am
- It was
queried what issues were stopping the Trust from improving
ambulance response times and how these were being tackled.
The Regional Operations Manager – West
explained that the investment secured had enabled the Trust to
secure additional resources and make improvements. The demands on
the Trust had been modelled from historic data and rotas had been
re-profiled for operational staff. Hospital handover work had been
done and has seen significant improvements in turnaround times but
continues to be an issue in winter periods. The introduction of the
national Ambulance Response Programme (ARP) has allowed the Trust
to think about how calls are triaged with more time being available
to make decisions. It was added that improvements are regularly
monitored with commissioners as part of an action plan. The
Executive Director of Strategic Commissioning stated that the
operational workforce trajectory was recognised as an important
factor for improvement and circa 2000 operational staff, including
over 1000 paramedics, would be operational in total to deliver key
standards. Resources will include those secured via private
ambulance providers.
- It was
confirmed that staffing had been included within the Demand and
Capacity Review and investment for this had been
agreed.
- There was a
discussion around the particular difficulties
the Trust was facing with trying to improve C3 and C4 ambulance
response times and the role of non-emergency transport vehicles in
this. The Trust recognised that it was unacceptable that there were
long delays with C3 and C4 calls. It was explained that lower
category calls into the control centre were regularly reviewed and
re-categorised if needed, and that call-backs were made where
appropriate and followed with situation updates. It was explained
that an audit of decisions taken by call takers was undertaken
regularly to ensure decisions taken were appropriate.
- A Member of
the Committee queried the ambulance quality indicators in Table 2a
of the report asking when the Trust would see an improvement of
performance for all call categories and, also, how the Trust was
addressing the ‘Must do’ actions raised in the CQC
report. It was explained that there was a great amount of activity
being undertaken to improve process, oversight of call handling and
the deployment of clinicians especially in the control centre
environment. There were plans to bring 38 nurses into the control
centre environment. There was currently a lot of work going on to
improve performance across the Trust.
- The
representative from Healthwatch Surrey
explained that there was a wide variation of patient experiences
with SECAmb services. They gave the example of a lady who had
fallen over and waited over four hours for an ambulance, which
highlighted the issues of long waiting times. They explained that
in contrast good feedback had been received on the conduct and
professionalism of ambulance staff.
- Members of
the Committee congratulated the Trust on the improvements to the
service.
- The
Executive Director of
Strategy and Business Development stated that compliance would be
delivered with Category 1,2,3,4 calls in Quarter 1 of 2019/20, all
things being equal. Weekly discussions are being held with NHS
commissioners to reflect on the challenges in achieving this.
The Executive Director of Strategic
Commissioning stated that work was being undertaken with SECAmb
regularly to ensure ARP standards were met. The issues of call
stacking will be addressed, as ARP standards were met.
- With
regards to how the Trust can give assurance it would be fit for the
future, it was explained that work was being undertaken with
commissioners and partners to shape the future of the Trust. The
five year strategic plan is currently being refreshed and allows
the Trust to think about shaping pathways for the
future.
Actions/further information to be provided:
None
Resolved:
For the Health, Integration and Commissioning Select
Committee to receive an update report on the performance of SECAmb
in September 2019. For this report to include an update
on:
- the Performance
of all Categories (1,2,3,4) of ambulance response
times,
- the work of the
new Chief Executive since joining the Trust and governance
arrangements,
- recruitment,
hospital handover times and any funding issues.