Agenda item

To receive a report on the East Midland’s Ambulance Service NHS Trust. The report outlines the achievements in relation to key national performance standards.  The report also sets out the challenges faced in 2013/14 and the actions taken, together with outlining the two risk summits in 2013/14 and the progress made with the EMAS Better Care Patient Care Quality Improvement Programme. It also outlines the findings of the Care Quality Commission inspection and the actions taken to address the areas of shortfall/non-compliance.  The report also identifies the Trust’s performance both within the context of the City and specifically compared to the East Midlands as a whole.

Sue Noyes, Chief Executive and Paul St Clair, Assistant Director Operations, East Midlands Ambulance Service NHS Trust will attend the meeting to present the report.

East Midland’s Ambulance Service NHS Trust submitted a report that outlined their achievements in relation to key national performance standards.  The report also set out the challenges faced in 2013/14 and the actions taken.  It also contained details of the two risk summits in 2013/14 and the progress made with the EMAS Better Care Patient Care Quality Improvement Programme. It also outlined the findings of the Care Quality Commission inspection and the actions taken to address the areas of shortfall/non-compliance.  The report also identified the Trust’s performance both within the context of the City and specifically compared to the East Midlands as a whole.

Sue Noyes, Chief Executive and Paul St Clair, Assistant Director Operations, East Midlands Ambulance Service NHS Trust attended the meeting to present the report and made the following comments:-

·         The service had now stabilised and had moved from Phase 1 – Stabilising to Phase 2 - Transition in the Better Patient Care Programme.  Phase 2 of the Programme started in April 2014.

·         Performance in the last quarter had been good, although July had been challenging with the increased levels of patients with respiratory conditions. 

·         A diagram showing the processes for responding to 999 calls is attached as appendix to these minutes.

·         The response performance to Red 1 (immediately life threating) and Red 2 (life threatening but less time critical) and Red 19 (a patient carrying response on the scene within 19 minutes) had exceeded the performance standards for the first quarter and also July.   Red 1 and Red 2 each had a performance standard of 75% and the actual performance in Leicester was 88.66% and 84.90% respectively.  The target for Red 19 was 95% and the performance in Leicester was 97.09%.

·         The performance for less urgent responses (Green 1 and Green 2 – 20 minutes) was slightly below the target of 85% (81.23% and 84.16% respectively). However, the Green 3 (telephone assessment within 60 minutes) and Green 4 targets (telephone assessment within 60 minutes or a vehicle response within 4 hours) exceeded the standard of 85% with local responses of 92.17% for Green 3 and 100% for Green 4.

·         Further work was being carried out with the CCGs and GPs in relation to ‘urgent calls’ where GPs and other health professionals request ambulance transfers for their patients.  Although these are classed as ‘urgent requests’ a GP could request a timed response of two hours or more to carry out the journey.  The peak time for demand for this service was usually from 11.00am to 4.00pm, which put pressure on Ambulance attendance at University Hospitals of Leicester’s (UHL) A&E Department between 12.00 noon and 2.00pm.  

·         The service aimed to have 10 ambulances and hour at the UHL and this target was only usually exceeded by a small percentage point.   

·         A number of responses involve the treatment of patients at the scene and did not require the patient to be transferred to a facility for further treatment.  The target of 40% of ‘non-conveyance of patients’ was exceeded in Leicester.  Where appropriate some patients were transferred to the Emergency Care Centre at Loughborough to receive the appropriate level of care, which also reduced the pressure on the A&E Department at UHL. 

·         7% of the calls to the 999 service don’t require the need to despatch a response attendance, as the patient could be given tele-health advice from the qualified health professionals in the call-centre. Some patients could be treated at the scene and other patients sometimes refused to be taken to hospital.  There were also 3 GPs based in response cars in the City who could also attend the patient to provide assistance. In some instances, a patient could be also referred to their own GP for treatment. However, although all these responses contributed to reducing the need to convey patients to hospital, the overriding consideration still remained providing the right level of treatment for the patient’s needs.

·         In some instances, patients with heart conditions could be transferred direct to Glenfield Hospital and trauma patients would normally be conveyed to the University Hospital of Coventry or the Queens Medical Centre, Nottingham.  Also, some patients could be conveyed to A&E department at Kettering General Hospital or to the Emergency Care Centre at Loughborough.  All these patients would not be included in the analysis of patients treated at the UHL A&E Department.

·         UHL were also looking to admit some patients direct to hospital wards rather than be admitted to the A&E Department to further reduce the pressure on A&E.            

·         The Assistant Director Operations had been in post since January 2014 and had responsibility for the service in Leicester and Leicestershire.  Improvements had been achieved through the staff engagement process of ‘Listening into Action’, which took concerns and ideas from front line staff and fed them into the system.  

·         There had been 41 staff vacancies in January and the service should be fully staffed by October. Although the skills mix was still not ideal this would be addressed through future recruitment processes. 

·         There had been a recent commitment to provide 46 new front line vehicles.

·         The service was working closely with all the relevant CCGs, Healthwatch and Scrutiny Committees to develop a more co-ordinated approach to joint working.

·         Although questions had been raised in the risk summit about the equality of data, the data had since been audited by KPMG who were satisfied that the data collection was robust and met required standards.

·         Complaints from patients had reduced by 26% compared to the previous year.

·         The Trust ended the financial year 2013/14 on a break-even point and at the end of the 1^st quarter in 2014/15 the Trust was showing a small surplus.  This showed the Trust now had stronger management and financial management controls.

·         The CQC had not yet undertaken their follow up visit, but the Trust Development Agency had taken the Trust out of the escalated measures and had reverted to the normal monitoring processes.

·         The Trust was working effectively to become a more open and proactive organisation.

In response to Members questions the following statements and observations were made:-

·         The service analysed complaints and correlated these with performance analysis.

·         The commissioning of non-emergency ambulance services was the responsibility of East Leicestershire Clinical Commissioning Group.

·         Staff turnover was approximately 3 staff leaving per month which prompted the initiatives to look at staff issues and morale.   There was now a robust and forward looking staff recruitment plan to keep the staffing levels maintained and to get the right skill mix profile for staff.

·         There was a national shortage of approximately 2,000 paramedics and 5 paramedics had recently left the service for promotion to join UHL.  Paramedics were required to undertake a 2 year foundation degree course and successfully undertake a ‘blue light driving’ skills course before being able to practice.

·         The service had an entry scheme to take Emergency Care Assistants (ECA) on a short term appointment during which they undertook their ‘blue light driving’ skills course.  Once the course was completed the ECAs could progress to be paramedics.  The cost of the course was then deducted from the paramedics salary over a period of time. 

·         The 5 Year Integrated Business Plan was currently in draft form and it was expected to be completed in September.  Although there was no requirement for a formal consultation process, the Trust would welcome views and feedback on the Plan at that stage.

Members made the following comments and observations;-

·         It would be useful if future reports could contain the following information:-

·         The various response categories of Red 1, Red 2, Red 19 etc should be explained in full to say what they are and which are the principle indicators.

·         The key indicators that the service is required to meet.

·         In relation to patient’s complaints, details of the numbers of complaints, the types of complaints, and an indication of where service users felt there were shortcomings in the service and a trend analysis over time.

·      The Commission would welcome being consulted upon the 5 Year Integrated Business Plan as they may be able to suggest other organisers and users group who would be able to make a contribution.

·      That whilst the Commission focus was primarily on the performance of the Trust in relation to the City, they were mindful that good performance in the City should not be at the cost of poor performance elsewhere in the region.

The Chair thanked the Chief Executive and the Assistant Director Operations for their full report and their openness in working to achieve a mutually beneficial outcome.