Agenda item

Purpose of the report: to update the Committee on South East Coast Ambulance Service NHS Foundation Trust’s planning, timelines and preparation for the anticipated Winter 2023-24 pressures.

Witnesses:

Mark Nuti -Cabinet Member for Adults and Health (In person)

Matthew Webb, Associate Director, Strategic Partnerships and System Engagement (attended remotely)

Mark Eley, Associate Director, Operations (In person)

Helen Wilshaw-Roberts, Strategic Partnerships Manager, Surrey Heartlands and Frimley (In person)

Key points raised in the discussion:

1.    The Vice Chair asked about the anticipated challenges in relation to the winter pressures across a regional space made up of several Integrated Care Boards and local authorities and secondly, whether governance structures sufficiently involve the Trust in the planning of the winter requirements and what the plan would be to implement it and when did they expect to see this capacity available. The Associate Director, Strategic Partnerships and System Engagement explained that current forecasts are being reworked by the data analytics team to be outlined in the winter Plan before going to their Trust Board. They have introduced an aligned governance model which is a comprehensive structure allowing their Chief Executives to meet monthly. Two additional forums are on clinical quality where they jointly manage clinical safety risk from a clinical quality angle. The gap identified within this governance model concerned not having a formalised forum for discussing workforce constraints, financial challenges, and concerns. As a result, a strategic commissioning group was introduced to better support working with the systems when considering those financial and economic constraints. The Resource Escalatory Action Plan framework [REAP] is a medium-longer term outlook, reviewed weekly to consider factors such as demand constraints and changes in demand profiles. Industrial action is a key influence on this monitoring.

2.    A Member referred to long term issues with recruitment and wanted to know what specific changes have been put in place to identify and address those difficulties, and how effective those recruitment changes have been in resolving the issues. The Associate Director of Operations explained that they are not experiencing any ongoing problems concerning recruitment. The areas of challenge regarding recruitment are their call centres for both 999 and 111. 999 is impacted in their service area. There is a difficulty to recruit into the East of the region since the move. There are issues with recruitment in the Crawley area, but they expected to be able to improve recruitment in Kent.

3.    A Member asked about £2.5 million of additional funding has been received from NHS England to support 999 capacity, and asked if they could quantify those increases and explain how that has been implemented. The Strategic Partnerships Manager, Surrey Heartlands and Frimley responded that in terms of the front-line staffing increases there has been an improvement of 5% as a result of that funding. The Associate Director, Strategic Partnerships and System Engagement explained 2.5 million pounds of funding that has been offered to them as well as other ambulance Trusts is not winter funding and will not continue beyond October. They have utilised the funding by being able to apply a 60% increase in an additional ambulance fleet which resulted in an increase to their hours. They have also used it to enhance overtime for September and October. They will consider how they can access additional call handling support in the short-term which has been offered to all ambulance services ensuring they are jointly managing demand. They can provide further data from the data analytics team if required. The funding has enabled them to accelerate the delivery of the dual training course to their 111 health advisors, providing more flexibility with their resources across the 999 and 111 call taking services. The Member responded that they would find it useful to be provided with the additional data from their data analytics team.

4.    The Chair asked about collaborative working and the Mole Valley Wellbeing Responder which seemed to be successful in terms of its response to non-injury falls. How did they see this rolling-out across the rest of Surrey as falls account for one of the injuries that people can end up in hospital for if they are not dealt with quickly and correctly. The Strategic Partnerships Manager, Surrey Heartlands and Frimley explained that the Mole Valley Pilot and joint evaluation with the Mole Valley and Wellbeing Responder service has been successful in responding quickly, on average twenty-four minutes and twenty-one minutes from June 2022 to January 2023. The service has been funded for this financial year and has extended to cover the Surrey Downs places of incorporation with separate funding provided for Guilford and Waverley place. An additional service in Northwest Surrey was provided by Woking Borough Council but due to funding pressures the service was pulled since September. Discussions with the out of hospitals work stream lead who reports to the urgent community care committee, was that escalation up to NHSE has been suggested at a regional forum. A further response on how the regional forum progresses past the winter period can be provided at a later date. 

5.    The Vice Chair asked about cultural resilience in their workplace and what measures the Trust has taken to improve staff morale, what actions are being developed to evidence that. The Vice Chair also asked how processes have been improved to mitigate future near misses and other incidence reporting at the Trust and are lessons-learned being recorded. The Strategic Partnerships Manager, Surrey Heartlands and Frimley explained that people and culture are one of their four key strategic domains. Previous interventions have been mainly focussed on the individual with little change around structure and support. The first year of the programme is about rebuilding trust, re-engaging staff and addressing issues raised from the previous reviews. The Getting It Right For Our People Culture Action Plan sets out the aims with transparent plan updates accessible to all staff on their Intranet. The quarterly NHS pulse survey will reflect that consistency and delivery. The Strategic Partnerships Manager, Surrey Heartlands and Frimley confirmed the Quality Improvement Strategy will be rolled-out over the next three years. Quality key performance indicators are a key part of discussion at each Trust Board, forming a key part of the integrated quality report looking at serious incidents and patient experience. There were three breached safety incident reports with eleven active cases being investigated, their trajectories all fell within the due date. They continued to support an effective culture with incident reporting and the number of outstanding actions relating to serious incidents outside of the timescales have reduced significantly since December 2021.The Associate Director, Strategic Partnerships and System Engagement explained that the key component is the patient safety incident reporting framework. A programme manager is leading on this implementation which is a change on their approach to learning from serious incidents. The September 2023 report showed a 75% reduction in reported incidents relating to patients’ safety. The thirty-five-day target in responding to complaints is now at 96% which is an improvement. A quality assurance visit model has been introduced for the medical, clinical, and nursing directorates to visit their sites.

6.    The Chair thanked the Southeast Coast Ambulance Service team for a very full response to questions and referred to the recommendations which relate to the Care Quality Commission [CQC] recommended actions and to maintain the path to success that they are demonstrating.

RECOMMENDATIONS

The Committee notes the Trust’s improvement work and agrees with the Care Quality Commissions findings via inspection, therefore the Trust should:

1. Pursue the positive path of development described in the Southeast Coast Ambulance Service previous report, especially:
2. Continue to work with Emergency Departments to improve handovers.
3. Focus on delivering the contractual response times to attend patients.
4. Training of leaders to ensure they have the leadership skills required to ensure staff feel respected, supported, and valued.
5. Measure and report regularly on staff satisfaction and morale with publication of those reports to staff and the actions taken to resolve issues.
6. Measure and report regularly on the effectiveness of communications to staff of key information including roles, responsibilities and the ease with which staff can escalate issue issues.
7. Prioritise the welfare, professional development, and training of the staff at all levels.
8. Provide mental health and wellbeing support to all staff.