Agenda item

Geraint Davies (Director of Business Development, South East Coast Ambulance Service NHS Trust), Geoff Catling (Director of Technical Services and Logistics, South East Coast Ambulance Service NHS Trust), and Darren Reynolds (Head of Business Development South East Coast Ambulance Service NHS Trust) were present for this item.

(1)       Prior to the meeting, Members of the Committee had had the opportunity to visit the Thanet Make Ready Depot and the Coxheath Emergency Dispatch Centre.  All Members who were able to attend found the visits highly informative and the Chairman thanked the South East Coast Ambulance Service (SECAmb) on their behalf for arranging these valuable opportunities.

(2)       The offer was made to provide further opportunities for Members to spend time at Coxheath at a future date.

(3)       Although some reservations had been expressed at the previous meeting on this subject, Members expressed the view that the logic behind the move to Make Ready Depots was inescapable and that it was a better use of resources and staff if paramedics were not expected to clean and stock their ambulances.  Community response posts to enable ambulances to be located where they are most needed are usually easy to find, though one was still being sought on the Isle of Sheppey.  Locations for Make Ready Depots were not as easy to locate.

(4)       The depots were appropriate for the way the modern ambulance service had changed over the years to where it now offered a mobile health service and often avoided the need for taking patients to an Accident and Emergency Department.

(5)       Make Ready Depots also allowed for an improvement in infection control measures, although rates had never been too bad in the service, as ambulances would be able to be deep cleaned every six weeks.  In between calls, universal precautions such as hand washing and wiping down the ambulance were used unless they were notified of a reportable disease that required further measures.

(6)       The nature of paramedic training was also developing with paramedic practitioners able to deal with a wider range of situations at the scene and critical care paramedics who were able to stabilise patients for transfer to a specialist centre, such as the primary angioplasty service at William Harvey Hospital.  In coming years there will also be an increasing range of technology available for use on ambulances such as portable x-ray machines, but improvements need to be made such as in this instance becoming smaller and chargeable.

(7)       The Emergency Dispatch Centre in Coxheath had a new Computer Aided Dispatch System installed earlier this year.  Sussex already had the same system and it had been installed in Surrey three days prior to the meeting.  This meant that the whole region was covered by the same system and the different dispatch centres could communicate efficiently to each other.  The system meant that 80% of the time, it could be predicted where ambulances needed to be deployed.

(8)       The gaps and inefficiencies in the organisation were often in rural areas, and it was here that Community First Responders had a key role to play.  These trained lay responders were trained to use defibrillators.  In the case of a Category A incident such as cardiac arrest, for each minute that passed the chance of recovery decreased by 11%, and if treatment is received within 4 minutes, there is an 80% chance the heart attach can be reversed so the Community First Responders could often buy time and save lives.

(9)       SECAmb explained that they felt that the next stage in streamlining the service was through a Single Point of Access.  It has been recognised that accessing the NHS for non-emergency services can be seen as chaotic with a range of different avenues such as NHS Direct, Minor Injuries Units, GP Out of Hours services.  It is estimated that 40% of attendances at Accident and Emergency Departments are unnecessary.  However, there is currently no live directory of what services are available where and when and, as importantly, what services were not available as an alternative to Accident and Emergency.  This is being worked on and when it is available, it will enable people to be directed to the right place at the right time.

(10)     A number of Members expressed reservations about the wider issue of bringing in a single non-emergency, 111, number to complement 999 on the grounds that it would confuse members of the public and that if the same system and same call centre was going to receive and triage all the calls, it was felt that just one number would make access even easier. 

(11)     Representatives from SECAmb replied by saying that the issue of phone numbers was important but shouldn’t distract from the broader benefits.  The North East Ambulance Service was already operating a Single Point of Access.  More than 2 million calls had been through the system and the initial response from the public had been positive.  The system in use there mean the ambulance service could book a caller an appointment with a GP out of hours service.  SECAmb are dealing with a 5% compound increase in activity each year and are looking to the Single Point of Access to help them manage this at a time of increasing financial pressures.  Geraint Davies, Director of Business Development for SECAmb, offered to bring data on the performance of the system in other areas back to the HOSC for a fuller discussion on the pros and cons of the concept. 

(12)     Another area that was being developed within SECAmb was that of Passenger Transport Services.  There was a sense that this was often misunderstood by the public and part of the reason for this was that it did differ across the South East Coast region.  SECAmb provided the service in Sussex, private providers covered Surrey and in Kent in differed by Acute Trust.  SECAmb were hoping to be in a position where the services could be integrated. 

(13)     Several Members raised points about the interaction of the Ambulance Service with Acute Trusts.  Representatives from SECAmb explained that the target was for a thirty minute turnaround at hospitals, fifteen minutes for the handover and fifteen minutes to prepare the vehicle for further use.  This could vary according to the nature of the incident.  Concerning a specific incident involving an older person being left outside their home at night with no keys following discharge from a hospital and conveyance by an ambulance mentioned by a Member of the Committee, the Trust explained that this should not have happened and offered to speak to the Member about this outside the meeting.

(14)     The Ambulance Trust explained that they had a zero tolerance approach to attacks on staff, which were often carried out by onlookers and members of the patient’s family.  If a prosecution was successful this would enable someone to be flagged on the system so an appropriate response could be made.