Agenda item

Geraint Davies (Acting Chief Executive, South East Coast Ambulance NHS Foundation Trust), Patricia Davies (Accountable Officer, NHS Swale CCG) and Helen Medlock (Associate Director of 999 and NHS 111 Commissioning for Kent and Medway CCGs) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Davies began by explaining that NHS Swale CCG was the lead commissioner for 999 and 111 in Kent and Medway. She noted that the Trust had been through a period of turmoil relating to quality, safety and performance. She stated that the Trust was developing a Unified Recovery Plan which would include clear and realistic targets. She noted that the changes being implemented by the Trust were moving in the right direction.

(2)       Mr Davies explained that following a CQC inspection in May 2016, the Trust received a warning notice from the CQC with regards to governance, leadership and operations at the Trust. A two year recovery plan was being developed to cover eight specific areas where improvement was required such as an improved culture, the roll out of electronic patient records and the move to the new headquarters. He stated that he would be the acting Chief Executive until a new substantive appointment was made; his focus during this interim period would be to take forward the concerns in the warning notice to ensure safe services. Mr Davies committed to bringing back the CQC inspection report once published.

(3)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A number of comments were made about staffing. Mr Davies explained that following an enhanced recruitment process the NHS 111 service was now fully staffed. The Trust had undertaken work to find out why staff were leaving and buddied new members of staff with experienced call takers as part of the training programme. A similar piece of work was being carried out in 999 as it was facing similar problems; the management of 111 and 999 were now sharing best practice.  He stated that the Trust needed to recruit 200 paramedics and was competing against nine other Trusts; the Trust needed to be seen as an attractive organisation to recruit and retain paramedics including a clear career structure and opportunities to become a paramedic practitioner and rotate into primary  and higher acuity care. He reported that there was currently a 14% turnover of paramedics.

(4)       Members enquired about the structure of the Trust, the role of the CQC and dispatching multiple ambulance vehicles. Mr Davies explained that the Trust was restructuring its operation system to better engage and support staff; an operations manager would now be responsible for 15 members of staff and would be on the same rota as those staff. There would also be a clinical lead as part of the team. He noted that if the ambulance service was county based, the same operations system would have to be implemented.  Mr Davies stated that the CQC played a valuable role; it was important for the organisation to receive external validation and work with commissioners to address concerns raised by the CQC. Mr Davies noted that the Trust sent more vehicles per call than other Trusts; the Trust was working to safely implement Dispatch on Disposition through the Ambulance Response Programme to enable clinicians to have time to triage the call and dispatch the correct resource. He highlighted that 999 performance was lower than performance standards and trajectory which the Trust needed to meet in order to be safe.

(5)       A number of comments were made about Hear & Treat and See & Treat, and bullying and harassment at the Trust. Mr Davies explained that Hear and Treat was telephone clinical advice provided by 999 call handlers which currently represented 10 – 12% of calls and was expected to increase. He stated that See and Treat was when a clinical decision was taken at the scene to refer to elsewhere or take to hospital. He noted that there was bullying and harassment at all levels of the organisation; the Trust had a Security Manager to protect staff against the public and had taken forward prosecutions. He reported that the Trust was working with the London Ambulance Service NHS Trust to share best practice and develop policies and procedures regarding values and behaviours. He stated that recruitment was based on values and that the Trust had a whistle-blower and raising concerns process were staff were able to directly email or call  senior staff including the Chief Executive.

(6)       In response to a specific question about handover delays, Ms Davies explained that from a commissioner’s perspective SECAmb could not tackle patient flow into the acute sector alone. She noted that West Midlands Ambulance Service NHS Foundation Trust had a policy where they walked away from a patient after 15 minutes of arrival as set out in the national standards. She noted that SECAmb had imposed a local policy of 45 minutes; NHS Swale CCG had commissioned a piece of work to look at improved flow and handover at Medway Maritime Hospital and Darent Valley Hospital.  Mr Davies noted that if the Trust invoked a 15 minute policy, such as the West Midlands Ambulance Service, it could undermine the ability of an Accident & Emergency to treat and admit patients. He reported that through a phased approach by the end of the financial year, the Trust would be implementing a policy to walk away from patients if they were not able to handover patients within 45 minutes on the grounds of wider patient safety.

(7)       Members enquired about finance and the use of technology. Mr Davies explained that the Trust had an NHS Improvement risk rating of 3 which meant that they were financially solvent. However in the current financial year, the Trust would need to go into deficit by £7.1 million to deliver the recovery plan which was allowed, under the terms of being a Foundation Trust, as a one-off. He stated that existing technology was already an important part of being a mobile healthcare provider; staff were able to use iPads to record electronic patient data and use videoconferencing to send video information to the burns unit at the Queen Victoria Hospital. Ms Davies noted that whilst technology led to quality and safety improvements, capital funding for technology would be challenging in the next financial year as the Trust was required to breakeven or produce a surplus.

(8)       In response to a question about blue light collaboration, Mr Davies reported that there had been collaboration between the Trust and the Surrey Fire Service in providing the fire staff with training to be Community First Responders if they arrived on the scene first. He stated that there was not a strategic fit for the Trust to be co-located with other blue light services as the Trust provided a clinical and NHS service. Ms Davies highlighted the importance of collaboration between the Trust with primary and out of hospital care in creating efficiencies and improving safety and wellbeing; paramedic practitioners had been working in Swale since September 2015 and have reduced the number of ambulances by two a day to Medway Maritime Hospital.  In response to a specific question about his biggest concern as acting Chief Executive, Mr Davies stated that it was having sufficient staffing to meet the demand facing the organisation.

(9)       RESOLVED that the report be noted and SECAmb be requested to share the findings of the Patient Impact Review and CQC Inspection Report upon publication.