Agenda item

In attendance for this item: Daryl Devlia, Strategic Partnerships Manager - Kent & Medway, (SECAmb), Matt Webb, Associate Director, Strategy & Partnerships (SECAmb)

1. The Chair welcomed the guests and invited questions from Members.
2. Members requested a break down per area of category 2 and 3 call outs.
3. The Chair asked about the pilot hubs in East Kent and West Kent. Mr Webb spoke of SECAmb’s improvement journey, with a Strategy to launch in the next few weeks. Sending an ambulance to see if a patient required an ambulance delayed care - clinical outcomes showed that only 13.25% of SECAmb’s patients required a double crewed ambulance (i.e. two clinicians) with emergency intervention. Under the current model, double crewed ambulances were sent to 90% of calls. The Trust had therefore been looking at new models of working, considering:
   1. Group A patients – high acuity. Want to ensure a standardised emergency response.
   2. Group B patients – lower acuity, but typically more complex. Want to ensure a personalised and tailored service, which may include a virtual response.
4. Under the new model, approximately 35% of the Trust’s 999 activity would be responded to physically with a double crewed ambulance. For 55-60%, the initial response would be virtual (using lessons learnt from pilot hubs).
5. Mr Webb provided an overview of the West Kent (‘post dispatch’) and East Kent (‘pre-dispatch’, also called the Ashford Hub) models. Evidence showed that intervening in a patient’s pathway as soon as possible (i.e ‘pre-dispatch’) significantly improved their clinical outcomes.
6. For those patients not requiring a double crewed ambulance for their care:
   1. 30% of activity was from 20% of the most deprived communities.
   2. 20% activity was from frequent callers/ those with co-morbidities.
7. Virtual response call handlers were to be located in the local area, so they understood local pathways and demographics. A physical response was still possible following a virtual assessment, but in a planned way which would allow SECAmb to better manage resources. Getting patients on the right pathway would also positively impact hospital discharge which in turn would reduce the number of ambulances waiting to transfer their patients into an acute setting (which had no beds available as patients awaited discharge).
8. Mr Webb recognised the vital contribution of volunteers, and the Trust wanted to ensure they maximised the benefit of this resource. He went on to explain the Trust was creating a Volunteer Strategy alongside other blue light providers – the Committee asked to see this once available.
9. A Member was concerned that the new model would mean some high acuity patients did not receive a physical ambulance response quickly enough. They were concerned the needs of all patients were being put before the needs of the individual patient. They questioned whether the Trust was prepared for the 15% demand growth forecast over the next five years, and asked for detail on why the existing service model was insufficient to address that challenge (particularly in terms of staff retention). Mr Devlia recognised the priority of getting high acuity patients treated quickly and the new model didn’t change that response. A multi-disciplinary team reviewed calls to ensure ambulances were available to be sent to those patients requiring double conveyance, as opposed to ambulances being dispatched to all calls. Data showed the pilots were having a positive impact on response times in the county. Mr Webb reassured the Committee that the new model would benefit individual patients by ensuring they received the response that best suited their clinical needs. For example, there would be frailty expert practitioners. As for the case for change - to maintain the current model of care, the Trust would need to recruit an additional 600 whole time equivalent staff members just to respond to category 1 and 2 calls. Staff retention was impacted because of frustrations within the system, such as sitting in an ambulance waiting to transfer a patient instead of treating more patients.
10. A Member asked about the response provided to frail patients and those that had fallen. Mr Webb said the strategy had been co-designed with others in the system. He said thought was needed over the role of an emergency ambulance service in responding to frailty patients, taking into account the whole health system. Urgent community response (UCR) teams were able to deliver care from within the home to avoid an acute admission where possible. Mr Devlia explained that frail and elderly patients were the largest cohort of callers, with a high concentration in East Kent. It was important to manage these patients in the safest and most appropriate way. East Kent was quite short of frailty patient pathways, but the pilot Hub had a dedicated team that contacted patients directly to support them. SECAmb would still support those that had fallen and required a physical assessment. 
11. RESOLVED that the Committee consider and note the update.