Agenda item

Purpose of the report: This report updates the committee on the South East Coast Ambulance Service, with special focus on changes since the last report of 8 March, especially in the areas of performance, the recent Care Quality Commission (CQC) report, executive leadership development and other strategic operational updates, or local performance and development initiatives of interest for Surrey.

Witnesses:

Ryan Bird, ePCR Operations Manager, SECAmb

Peter Carvalho, Senior Contracts Manager (Ambulance Contracts & IUC), Surrey Heartlands

Bethan Eaton Haskins, Executive Director of Quality & Nursing, SECAmb

Kate Scribbins, Chief Executive, Healthwatch Surrey

Nick Markwick, Co-Chair, Surrey Coalition of Disabled People

Key points raised during the discussion:

1. The Executive Director of Quality and Nursing gave a summary of the report, including the following points.
   1. The report looked at performance, executive development and future plans. Despite advances having been made, the service still required radical improvement. SECAmb examined its own performance from a quality perspective, not a financial perspective.
   2. The incoming HR director of SECAmb could be announced as Ali Mohammed. Details of new executive leadership, including the new Chief Executive, were covered in the report.
   3. SECAmb’s top priority was sustaining and improving response times.
   4. SECAmb received an outstanding rating in the caring category, which was a good morale boost for staff. They also received an outstanding rating in the well-led category.
   5. For category 1 and 2 calls (the most urgent), the service was close to or exceeding targets. However, SECAmb remained challenged with regard to category 3 and 4 calls, due to the lower priority level.
   6. There were struggles in recruiting paramedics, which might worsen when paramedics started working in primary care, as this would make the job offer less attractive to some.
   7. Hospital handover delays were also an area of concern. There needed to be system-wide change to tackle this.
   8. Ofsted found two out of the three areas inspected in the clinical education department less than satisfactory. Members were assured that education programmes were still being run, but were no longer allowed to be called apprenticeships. An independent review of this had been commissioned.
   9. Whatever the outcome of Brexit, mutual aid had been agreed upon in order to mitigate potential negative impacts.
2. A Member asked for more information on performance issues in rural populations. The Executive Director explained that there was a strategy to ensure that essential framework remained in place in rural areas. The ePCR Operations Manager added that rural areas were mainly where category 3 and 4 delays were seen. The Senior Contracts Manager (Ambulance Contracts & IUC) remarked that collaborative work was being done with regard to system resilience and accessing local care pathways that could not currently be accessed.
3. A Member requested clarification regarding SECAmb’s acquisition of the NHS 111 contract. The Executive Director answered that the commissioning for the 111 and 999 services were separate, and that currently SECAmb ran the 999 contract but until now had not run the 111 service. Qualified healthcare professionals would handle 111 calls where necessary.
4. Members emphasised the importance of SECAmb staff having special training regarding mental health and learning disabilities. For example, explaining the situation to patients with autism was essential for alleviating anxieties that could be more likely for autistic patients. The Executive Director explained that there were mental health clinicians in the assessment centres and this had had a significant impact on improving outcomes. Members suggested that mental health-friendly ways of working be put in place as a default for all patients.
5. A Member enquired whether the eight posts that formed part of the operational restructure were new posts or just existing posts with the name changed. The Executive Director responded that some were new posts, such as the Deputy Director of Operations, but the majority were not and were rather just slightly different from before.
6. A Member asked how paramedics dealt with delays at hospitals, and whether hospitals with the longest waiting times were reported. The ePCR Operations Manager stated that delays within a targeted area were not currently examined; however, paramedics did send out messages to other paramedics about alternative pathways available if delays were being encountered.
7. A Member enquired if there were some hospitals that were generally worse in terms of delays. The ePCR Operations Manager replied that this was the case. Ashford and St Peter’s Hospital had made marked improvements recently.
8. A Member expressed concern about the reasons for handover delays. The Executive Director informed members that there had been a national project about particularly challenged services, and that steps had been taken to reduce delays, such as pathways having been changed.
9. The ePCR Operations Manager observed that paramedics ‘on the ground’ were sometimes frustrated about access to pathways and having to go to A&E rather than doing a direct referment, due to lack of capacity in the system.
10. A Member enquired if councillors could attend A&E to observe handover delays and discover what problems were causing handover delays. It was agreed that this would be helpful.
11. The Co-Chair of the Coalition asked how cases were categorised and remarked that a resident might have been injured for a number of hours before they made the phone call and this should be taken into account. The Executive Director responded that a triage (priority assessment) tool was used, and was very strict and there was absolutely no deviation from it. It was being ensured that trained clinicians would be available to provide advice over the phone, and where patients had to wait for some time for an ambulance welfare calls were conducted every 30 minutes to check on the patient’s condition. If the patient’s condition had worsened, the category might be changed accordingly. Moreover, the Executive Director confirmed that the waiting time pre-call was taken into account.
12. The Co-Chair of the Coalition asked how the system and response times were being improved in the long term. The Executive Director responded that the two most important factors in this were increased staff and an increased fleet of ambulance vehicles.
13. The Chief Executive of Healthwatch Surrey requested more information about the patient engagement strategy. The Executive Director replied that historically SECAmb had been poor at patient engagement but that SECAmb had scrapped their old strategy and started a new piece of work in which Healthwatch had been heavily involved.
14. A Member asked what SECAmb’s strategic planning was for the long term. The Executive Director responded that in 2019 SECAmb had started an initiative to determine strategic direction, including staff consultation. The next step was to initiate wider consultation; the findings would be published in the next calendar year.
15. A Member asked if waiting times at A&E were measured starting from when the ambulance arrived at the hospital, or when the patient entered the hospital itself. Members were informed that the latter was the case, which could be problematic because patients could be waiting in an ambulance for some time without it being taken into account.
16. A Member requested statistics and more information on abandoned and hoax calls, and asked how the Select Committee could help with reducing these issues. The Executive Director informed the Select Committee that there was a plan and a process around these. The ePCR Operations Manager added that locating some frequent callers was challenging because they often were of no fixed abode.
17. A Member queried what went wrong with clinical education in SECAmb, and what plans were being put in place to address the immediate issues with clinical education. The Executive Director replied that there was now a robust plan for improvement, and a review was being conducted to understand what had gone wrong.
18. A Member commented that issues with staffing in CCGs and with regard to paramedics would affect SECAmb’s staffing issues, and emphasised the importance of working with CCGs to improve recruitment for all parties.

Recommendations:

The Select Committee:

Actions/further information required:

1.    For SECAmb to provide details on the potential impact on the service of halving the number of wasted hours;

2.    For SECAmb to provide statistics regarding abandoned and hoax calls, and frequent callers.