Agenda item

Richard Lyne, General Manager of the East Midlands Ambulance Service (EMAS) submits a report explaining progress made since the Care Quality Commission’s (CQC) inspection in February 2017 and outlining the key areas for improvement in the Trust Quality Improvement Plan. 

The report and supporting papers are attached as follows:

Report:  Quality Improvement Plan Update (Appendix E1)

Supporting information:

·         EMAS – Response time and handover:  considered at the meeting of the Leicester City Council Health and Wellbeing Scrutiny Commission  4 October 2017 (Appendix E2)

·         EMAS – Ambulance Response Programme – Pilot: considered at the meeting of the Leicester City Council Health and Wellbeing Scrutiny commission 4 October 2017 (Appendix E3)

·         EMAS – Presentation: considered at the East Midlands Health Scrutiny Network 27 June 2017  (Appendix E4)

·         The CQC Inspection report of EMAS can be found on the following link:

• http://www.cqc.org.uk/sites/default/files/new_reports/AAAG3547.pdf

Richard Lyne, General Manager of the East Midlands Ambulance Service (EMAS) submitted a report that provided an update on the Quality Improvement Plan that arose following their CQC inspection.

The Chair introduced the item and explained that the Leicester City Council’s Health and Wellbeing Scrutiny Commission had considered EMAS and the hand-over time at the Leicester Royal Infirmary at their meeting on 4 October 2017. The Committee had been given assurances that the new Emergency Department (ED) would increase capacity and the ability to deal with pressure surges from EMAS.   However there had been winter pressures since and reports of ambulances stacking up and delays in transferring patients into the ED; all of which impacted on the rest of the county. The Chair had also heard that EMAS had requested an additional £10m funding over the next two years and then £20m which represented a 12% increase in their annual budget. This was requested in order to meet the national target which included a seven minute response time (this was currently at 9%).

Mr Lyne presented the report and explained that since the last meeting they were now in a position to address some of the ‘could do’ actions arising from the inspection as the key actions had been addressed.   Points made included the following:

1)  Leicester was now the second county in the East Midlands region to adopt the pre-hospital treatment antibiotic therapy. The therapy had been rolled out earlier that month and was a very important development in managing life threatening sepsis.

2)   A leadership development programme had been put in place across all of EMAS’ leaders regardless of their level of management.

3)  Duty of Candour was now fully embedded which ensured that an acknowledgement and appropriate response was given when the service fell below the standard that was expected.

4)  A training needs analysis was now in place for all of the paramedics. Paramedics had been upgraded from a Band 5 to a Band 6 and a requirement of that upgrade was for all paramedics to have a training needs analysis.

5)  There had been a capacity and demand review which had identified a gap between demand and in what EMAS could provide, hence the request for investment to fund more front line clinicians and ambulances. In respect of this; negotiations with the CCG were currently taking place.

6)  There had been a very challenging winter with activity 6% higher than anticipated between December 2017 and March 2018. There had also been an increase in acuity with approximately 12 % of the calls involving life threatening conditions. Given the increase in calls, the delays at the Leicester Royal Infirmary were significantly lower than the previous year. The average handover time during that winter period was approximately 26-27 minutes compared to 31 minutes the year before.

A Member commented that she was pleased to hear about the improvements and questioned what determined the response target; whether it was the condition or the individual concerned. The meeting heard that a lady in her 90s had fallen onto cold concrete floor outside when it was snowing but the call-handler did not consider the incident was urgent. The lady waited for 10 hours before the ambulance came and her son had been told not to move her. Mr Lyne explained that the clinician’s assessment had been that the need was not urgent; but the clinician would have been in contact with the patient or their representative during that time and would have re-categorised the patient if the situation became more urgent. It was very unfortunate as it was very difficult to balance priorities.

Mr Lyne was asked whether the campaign to persuade people to visit pharmacies etc. before seeking medical treatment from a doctor might have resulted in higher incidences of acuity.   Mr Lyne explained that he believed that the very cold weather and the numbers of people suffering from respiratory disorders had led to the higher incidences of acuity, but he would take these observations back for further considerations. He did not however believe that people were leaving it later before they called for an ambulance.

A Member questioned whether co-locating vehicles along with the Police and Fire and Rescue Service, had resulted in improved response times. Mr Lyne did not believe that it had improved response times because the vehicles were just garaged together and once they went out to respond to a call, they stayed out rather than return back for stand-by. The system had however resulted in better team working with partners and the economies made enabled investment in the front line.

A member asked whether someone on calling 999, might be advised of the waiting time for an ambulance and told that if they could be moved, they might prefer to find their own way to hospital. If that was the case, it was questioned whether an option might be to use taxis or similar to transport people. Mr Lyne responded that the clinicians would give the expected response time and where feasible talk to the patient or the patient’s representative about finding an alternative way of going to hospital. They were looking a new ways of delivering the service to meet increased demand. There was also a new urgent care service which was dedicated to GP and health care professional referrals and this separated out those referrals from accident and emergency calls. This was a very new system but was already showing promising results.

A Member commented that many residents in Rutland went to EDs in Grantham, Kettering or Peterborough and questioned whether there were similar problems with ambulance transfer times there. Mr Lyne responded that the Leicester Royal Infirmary had one of the busiest EDs in Europe and so the problems experienced there were not usually experienced in those other hospitals.

A member asked whether the 15 minute turnaround target was achievable and Mr Lyne responded that if the resources and pathways were there, the target was achievable but given the pressures that existed across the whole system, especially within Adult Social Care, the target was something that needed to be worked on and would continue to present challenges.

The Chair asked how the additional requested investment would drive through the necessary improvements. Mr Lyne explained that much would be predicated on handover times and while they needed more clinicians and ambulances, they also needed to work with their acute partners to improve those handover delays and find different models of care and new pathways.

The Chair concluded the discussion and congratulated EMAS for the improvements that were being made.

AGREED:

that the report be noted and a further update be brought back to the committee in one year’s time.