Agenda item

Geraint Davies (Acting Chief Executive & Director of Commissioning, SECAmb), Terry Parkin (Non-Executive Director, SECAmb), Patricia Davies (Accountable Officer, NHS Swale CCG), Dr Fiona Armstrong (Chair, NHS Swale CCG) and Helen Medlock (Director of 999 & 111, NHS Swale CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Parkin began by giving the apologies of Sir Peter Dixon, the new Chair of the Trust appointed by Monitor. He stated that the Trust welcomed the opportunity to present the report and be subject to additional scrutiny from the Committee. He noted that the events detailed in the reported took place over a year ago and there were now systems in place to prevent it from happening again.

(2)       Members of the Committee then proceed to ask a series of questions and make a number of comments. A Member enquired about governance. Mr Davies explained that at the time of the pilot there was high demand with a growth in activity, handover delays and responding to the Ebola virus at Gatwick Airport. There was also an influx of activity transferring from 111 to 999 particularly at the weekends. He stated that the pilot was introduced to meet clinical need following discussions with the Trust’s commissioners but acknowledged that it had been implemented with poor governance, risk assessment and assurance.  Ms Medlock noted that the NHS England review of the pilot stated that early assessment was good practice; there were now formal national standards which included a clinical assessment when calls were transferred from 111 to 999.

(3)       A number of comments were made about the public and their expectations for immediate access to healthcare. Ms Davies acknowledged that there was an expectation of immediate access particularly at A&E where patients could be seen and treated within four hours but stated that this was not sustainable. She highlighted work being carried out in NHS Swale CCG and NHS Dartford, Gravesham and Swanley CCG to understand patient behaviour and work being carried out by the borough councils to signpost the public to appropriate services. Dr Armstrong noted that GPs in Swale were looking to improve access to general practice by working with other professionals such as paramedic practitioners to reduce pressure on SECAmb and out-of-hours services. Ms Medlock stated the importance of paramedics assessing patients’ needs and determining if they could be met in a non-hospital environment. Mr Davies reported that the Trust’s growth in activity had increased from 5-6% last winter to 11-12% this winter; the Trust had witnessed changes to behaviour in accessing the system. He stated that he welcomed the development of a system based approach through the Sustainability and Transformation Plans.

(4)       A number of questions were asked about commissioner oversight. Ms Davies explained that since the pilot the contract management arrangements had changed so that there was a coordinating commissioner for each contract area: Patricia Davies, Accountable Officer, NHS Swale CCG for Kent and Medway; Julia Ross, Chief Executive, NHS North West Surrey CCG for Surrey; and Geraldine Hoban, Accountable Officer, NHS Horsham and Mid Sussex CCG for Sussex which had led to more coordinated, robust and sustainable scrutiny of the Trust’s performance. She stated that those processes had to be balanced against the Trust’s needs to be responsive and innovative. Ms Medlock noted that the sharing of commissioning responsibilities between contract areas had enabled a greater depth of scrutiny and quality assurance. She explained that proposed Trust projects and pilots were now presented to the commissioners bi-monthly for scrutiny and approval. The proposals were required to be documented and the decision formally recorded and signed off. She noted that the commissioner’s quality leads were working with the Trust to undertake quality reviews. Mr Parkin noted that whilst the Board was responsible for scrutinising the Trust, he was grateful for the robust approach taken by commissioners. He stated that there had been a failure of process and procedure by the Trust with the implementation of the project and it had now put systems and structures to prevent it from happening again. 

(5)       In response to a specific question about the Trust’s responsibilities to its commissioners and regulators, Mr Davies explained that this was one of the key learnings undertaken by the Trust’s Board and Executive Team. He stated that he had made a commitment to the commissioners that the Trust would treat them as their primary audience and there had been significant improvement in engagement between them particularly around proposed projects and pilots. He noted that the introduction of the national ambulance response programme would facilitate dispatch on disposition and enable ambulance trusts to retriage calls. He stated that this would only be introduced by the Trust after the appropriate governance process and sign-off.

(6)       RESOLVED that the report be noted and SECAmb and Swale CCG be requested to share the findings of the Patient Impact Review and the principles of the ambulance response programme at the Committee’s July meeting.