Agenda item

Geraint Davies (Director of Commercial Services, South East Coast Ambulance Service NHS Foundation Trust), Chris Stamp (Senior Operations Manager, South East Coast Ambulance Service NHS Foundation Trust), Helen Medlock (Associate Director of Urgent Care and Trauma, NHS Kent and Medway) were in attendance for this item.

(a)       Representatives from South East Coast Ambulance Service NHS Foundation Trust (SECAmb) apologised for the lateness of the report submitted to the Committee. The main issue which the Trust wished to bring to the attention of the Committee was recent performance against their key performance indicator of responding to all Category A calls within 8 minutes 75% of the time. Across Kent and Medway, only 74% of Category A calls were being reached within 8 minutes. The key challenges to overcome in improving this were twofold.

(b)       Firstly, there was the rural nature of the Weald. This was being addressed by strategically looking at demand and ensuring the right resources were available at the right places. An additional 28 paramedics and technicians had been recruited and a further 28 were being sought. There had been an increase in the number of community first responders in the Weald and Single Responder Vehicles (SRVs) were being put in places like the White Rabbit in Maidstone as Maidstone and Tunbridge Wells were areas of higher demand. Carrying these plans out had seen a performance improvement over the first eight weeks. However, the three weeks immediately preceding the meeting has seen an unexpected rise in demand.

(c)        The other factor was the time taken for clinical handover at Pembury Hospital. It was stressed that handing over patients with accurate clinical information was the priority but that compared to other acute hospital sites in Kent, there was an issue at Pembury. This was being addressed in part with the presence of a SECAmb manager going into Pembury. Nationally, this was an area which was getting a higher focus. The recent document from the NHS Commissioning Board, ‘Everyone Counts’, set a handover target of 15 minutes with the possibility of fines for failure.

(d)       Separately, there was a specific issue with Darent Valley Hospital (DVH). DVH had always received ambulances from SECAmb and the London Ambulance Service (LAS), but the number of ambulances arriving from LAS had increased recently. SECAmb and DVH liaised regularly throughout any given day but the day before the meeting there had been a nearly continual conversation between the Trusts. There was a need to get more information from LAS in a timely fashion. This would prevent four ambulances from both Ambulance Trusts arriving at DVH near-simultaneously. In response to a question it was reported that there was consistency of clinical practice in both Ambulance Trusts. There was the same training and evidence base used by both. Equipment did vary, but would be used the same way.

(e)       Connected to this, the full impact of the Trust Special Administrator’s (TSA) report into South London Healthcare NHS Trust was yet to become clear. In response to a specific question, SECAmb representatives present were uncertain whether SECAmb replied formally to the TSA consultation, but would check. What was important was for SECAmb to be aware of and involved in discussions around future commissioning of accident and emergency services by the CCGs in South East London.

(f)         Beyond responding to these specific challenges, SECAmb had to balance a variety of different concerns around skill mix and patient demand when planning services. Investment was being made to increase the number of SRVs which was part of their Front Loaded Service Model which meant more paramedics and paramedic practitioners in cars. These SRVs were able to convey patients to minor injuries units. SECAmb did not have any motorbike paramedics as these tended to topple over carrying the appropriate equipment.

(g)       Different ways of working were also being considered, such as working with the Fire and Rescue Service as the number of calls to this service was decreasing. A project was underway in Edenbridge where the Fire and Rescue Service would respond first to calls if they were closest. Elsewhere, standby fire fighters were being trained as community first responders.

(h)        One Member asked a question about areas of Kent on county borders as there was sometimes the impression given that SECAmb only sent ambulances from within Kent to Kent calls and only took them to hospitals in Kent, when there could be ambulances and hospitals closer in Surrey or Sussex. The response was given that all ambulances across the whole SECAmb area were tagged and mapped so that it would be the nearest appropriate ambulance, wherever it was located, which would respond and the most appropriate hospital to which patients were then transferred if needed. For some areas of Kent, this hospital would indeed be in a different county, such as East Grinstead.

(i)         A number of Members provided anecdotal evidence of calls to the ambulance service which had taken an inordinate amount of time, or did not have paramedics on board. SECAmb expressed the willingness to investigate any specific example if provided by Members. More broadly, the Trust responded by explaining how the Trust operated.

(j)         To begin with, it was reported as not being necessary for there to be a paramedic on an ambulance. There were four types of worker on an ambulance – emergency support worker, technician, paramedic and paramedic practitioner or critical care paramedic. An ambulance with a technician and an emergency support worker was capable of responding to an emergency call. A technician was the ‘older style’ of worker, had all the relevant clinical training and still made up a high proportion of the workforce. It was only 3 years ago that SECAmb required all new recruits to be graduates. SECAmb needed to be registered with the Care Quality Commission and keeping detailed training records was part of the requirements of this.

(k)        All calls received at the Emergency Despatch Centres (EDC) by SECAmb were triaged using a system called NHS Pathways. The same questions were asked of all callers, even when the caller was a health professional as 1 in 6 callers was. The outcome of the call and priority given by the EDC depended on the information provided. In times of high demand, this might result in an ambulance being sent across the county to respond to a call if this was the nearest vehicle. All calls were recorded and audited. Staff identified as outliers in performance were provided with the appropriate additional training. Recently, 3 GPs had come to the EDC to help the triage process. The reports on this project after the first 3 months were positive. Information was being gathered on which GP practices most requested ambulances and referred people to accident and emergency, and was being shared with GP practices. This information was not in a form for wider publication at present.

(l)         The new 111 system coming in March would use the same triage system so would enable calls to be transferred to the 999 service, and vice versa. The intention of the 111 system was to enable people to be directed to the most appropriate service available at the time of the call. The system was not live yet and NHS commissioners commented that getting the timing of the publicity was a difficult judgment. The biggest challenge was given as effecting a cultural change where calling 999 ceased being the default option for many. One Member commented that it was often difficult for health professionals to know when to call for an ambulance, let alone a member of the public. However, SECAmb also stressed that they did not wish to become a service people avoided calling; the issue was dealing with all calls appropriately. Hoax calls were not a major issue for them and the vast majority of calls on New Years Eve had been appropriate; SECAmb mentioned the ‘We are not a taxi’ poster which was on the side of some ambulances.

(m)      One Member commented on the information contained in the report and SECAmb responded by saying they were always looking to improve reports. Information on performance against the clinical quality indicators was readily available in SECAmb board papers.

(n)        In response to a question about the military, SECAmb representatives responded by saying that a number of staff had military backgrounds and this was still an area of active recruitment. SECAmb also trained with the military at Manston.

(o)       The air ambulance service was discussed and it was reported that there were three services which could be called on, two charity air ambulances and the police helicopter service. The charity air ambulances were tasked by the SECAmb EDCs and the staffing was changing to replace doctors from the Royal London with local doctors. Both charities were in discussions with the Civil Aviation Authority to allow night flights and a positive outcome was anticipated. The police service could fly at night but was being extended from covering Surrey and Sussex to include Hampshire. With fewer police helicopters, there was going to be a need for better communication between helicopter services. In extremis, SECAmb was also able to call on the Coastguard.

(p)       Members of the Committee were invited to the existing Make Ready Depots in Ashford and Paddock Wood. Sites were also being sought by SECAmb in Thanet and Medway. Members were also invited to see the 111 system in operation.

(q)       In response to specific questions it was confirmed that ambulance commissioning would continue to be done collaboratively, with Swale CCG leading on this. There was currently a national currency for ambulance services, which SECAmb adopted early. A national tariff would be complex and had not yet been confirmed.

(r)        Finally, one Member asked whether it would be an idea to teach all schoolchildren first aid. NHS representatives responded favourably to the idea and mentioned there were countries were the diffusion of first aid training was much wider. Closer to home, all staff at Gatwick Airport were trained to use defibrillators. The response was given that if HOSC were to request a report on the implications of this suggestion, they would look into it.

(s)        The Chairman proposed the following recommendation:

·        That the Committee thanks its guests for their contribution and the information provided, and looks forward to updates in the future.

(t)         AGREED that the Committee thanks its guests for their contribution and the information provided, and looks forward to updates in the future.