Agenda item

a) Tim Butcher, Assistant Director for Performance Improvement, will present the North West Ambulance Service’s Quality Account (attached) on which the Committee is invited to comment; and

b) Sarah Smith will present the current performance figures (attached).

Tim Butcher, Assistant Director for Performance Improvement, North West Ambulance Trust (NWAS) presented the NWAS Quality Account on which the Committee was invited to comment.

The vision of NWAS was “Delivering the right care, at the right time, and in the right place”.  NWAS provided a range of services:

      999 paramedic emergency service;

      Patient transport service;

      Emergency preparedness;

      Urgent Care.

The Service had 3 emergency control centres and dealt with 1.1 million 999 calls a year and carried out 2 million Patient Transport Service journeys.

The organisation focused on Quality; Performance and Finance which reflected the importance of not just focusing on response times but also ensuring the right action was taken for the patient, once an ambulance arrived.

The service faced a number of challenges including overwhelming demand for urgent care via 999, overwhelming demand for unplanned on the day patient transport and an increase in health challenges in the North West. 

The Emergency Care service needed to ensure that the national performance standards were met, it delivered against the new clinical and system indicators, minimised the number of extended waits by patients and the Control Centre infrastructure was strengthened,

The Patient Transport Service now comprised one single North West contract and a robust booking and call taking system had been introduced; eligibility criteria had been developed and applied and a bureau concept was being developed to look at the use of any available transport. 

The service had a major role in emergency situations and had to ensure it was prepared to respond to any major incidents.

In relation to Urgent Care, the service had introduced, or was involved in, a number of initiatives including Hear and Treat (advice over the phone), See and Treat, an Urgent Care Desk (where a trained paramedic would phone the caller back), the 111 national scheme was to be piloted in Blackpool (for people needing urgent, but not emergency care, to call) and the NWAS Kitemark (where centres would be awarded the kitemark because NWAS knew what service was provided there and would transport a patient there rather than Accident and Emergency, if this was more appropriate).

The Committee was aware of the response time standards which had been outlined at previous meetings and these were now to be replaced by 2 categories:

      Category A (red calls) which required a response in 8 minutes with a 19 minute transport standard; and

      Category C (green calls) which were broken down into Green 1, 2, 3 and 4 with response times and telephone assessment times to be agreed. 

There were also 13 new Quality Indicators covering various items including “outcome from cardiac arrest”, “outcome from stroke”, “time to answer call”, “service experience” and “time to treatment”. 

Tim then introduced the NWAS Quality Account.  Looking back to last year, five areas had been identified for delivering improvements: End of Life care; Frequent Callers; Chain of Survival and Complementary Resources; Acute Stroke Care and Heart Attack.  The Account outlined action taken under each heading to achieve improvement – in relation to Complementary Resources,  a Complementary Resources Strategy had been adopted that had provided the basis for additional resources including 20 Community First Responder teams and 150 Automatic External Defibrillators, which had over 1000 people trained to use them.  During 2011/12, an Extended First Responder role was to be introduced where individuals would be trained to higher levels to be able to deliver a broader range of immediate care until ambulance personnel arrived on scene. 

In 2011/12, the Trust would measure and manage quality through the Department of Health’s introduction of 13 new quality indicators; the development and implementation of the Trust’s Quality Strategy and further developments of clinical leadership and education, which meant all new paramedic staff would undertake a graduate programme and all existing paramedic staff would be supported to undertake part time diploma and degree programmes.

Looking back to 2010/11, the Trust had identified a number of indicators to report on the quality of care:

      Patient Safety – this included both safeguarding issues and clinical safety. The Trust had specific staff undertaking Safeguarding roles and had introduced a centralised safeguarding referral pathway for both adults and children.  All clinical and patient safety incidents were recorded and assessed for trend and cause analysis.  The Medical Director also fulfilled the role of Director of Infection Prevention and Control and had support staff responsible for training and supporting staff and providing assurance that stations and vehicles were clean through independent audits.  There were also more than 100 staff acting as Infection Control Champions.  All vehicles would undergo a Deep Clean;

      Clinical Effectiveness – the Trust had developed a set of measures that identified how close staff were to performing a set of prescribed actions that were applicable in each of six clinical situations – asthma; cardiac arrest management, hypoglycaemia (low blood sugar) management, pain management, Patient Report Form completion and stroke management.  The expected interventions for each clinical condition were grouped into sets of required clinical interventions known as Care Bundles – clinical effectiveness was measured in terms of all the interventions in the care bundle being carried out on each patient.  A score of 50% meant that half of all patients seen with a condition had received the complete bundle of interventions required.  Progress was reported to each meeting of the Board of Directors and ways of encouraging improved performance in the future had been introduced including an incentive scheme that rewarded local budgets for good performance;

      Patient Experience – one measure of quality of care for ambulance services had always been response times and NWAS performance had improved but the Trust was disappointed that the Category A 8 had not been met for 2010/11 and the Category B target had not been met for a number of years; as outlined above response time targets were due to be changed for future years.  In relation to public engagement a key task for the year ahead was to recruit a large public membership that was representative of the region for Foundation Trust status.  A number of engagement events had been held and a Patient Experience programme launched.  The amount and type of complaints and compliments was listed as well as contacts with the Patient Advice and Liaison Service (PALS). 

The Committee also received the latest response time figures by Category and postcode area.

Following the presentation, Members were given the opportunity to ask questions or raise issues and the following points were made:

      With the permission of the Chairman, Councillor Silvester addressed the committee in relation to response times.  He raised the issue that response times were still unmet in a number of postcodes in Cheshire East, particularly for Category A calls.  In response Tim Butcher explained that the principle duty of the ambulance service was to respond as quickly as possible and then provide effective care once the ambulance had arrived.  Managers had to take a balanced judgement as to where ambulances were located as it was a poor use of resources to have an ambulance stationed in an area where there were a low number of call outs.  Work was underway with the local authority on how the two organisations could work together to improve response times including sampling cases where alternative services to an ambulance may have been appropriate but lack of local knowledge meant this was not possible; this would be reported to the committee at a later date;

      Whether NWAS had ambulances that could carry obese patients?  The Committee was advised that NWAS had four specialised ambulances that could transport obese patients;  

      Whether, in an incident that was not classed as life threatening, the specific needs of the patient would be taken into account, for example, if the patient was elderly?  The Committee was advised that in such a case a higher level of response would occur;

      Were the cleanliness issues raised the previous year, now addressed?  Members were advised that all cleanliness issues had been resolved and the Quality Account outlined measures taken to ensure high standards of cleanliness were maintained;

      It was noted that response times in Poynton were below target and whether there were reasons for this when it could not be classed as a rural area?  In response, Tim explained that there may be possibilities to undertake cross border working with Manchester which could address specific issues in Poynton. 

      The Community First Responders undertook a very useful role but was additional support available?  In response, Tim outlined that Community First Responders (CFRs) were very effective and there were 17 such Groups in Cheshire East, as well as 5 Heart Start Groups and a number of points were there was public access to defibrillators.  Where CFRs were used there was always a back up response by ambulance ;

      Were any services sub contracted?  In response, the Committee was advised that some patient transport services were sub contracted to the Red Cross and St John Ambulance service; the Trust also used volunteer car drivers who received mileage payments;

      What cross border arrangements were in place and were there any financial impacts?  In response, the Committee was advised that NWAS did work with other Trusts, and ambulances from other areas would respond if they had vehicles nearer to the incident than those of NWAS; there was no payment made to other Trusts as NWAS ambulances may respond to other areas’ incidents so there was mutual benefit.

RESOLVED:  that

(a) the Quality Account be accepted, the content welcomed and the good work undertaken by NWAS as set out in the Account be recognised;

(b) the following additional comments on the detail of the Quality Account be made –

      NWAS must ensure that good clear communication will occur with patients and carers;

      the section on page 15 on Clinical Performance Indicators (CPIs) be reworded to explain more clearly the process of incentive and reward systems to be introduced with the aim of improving staff performance;

      it was noted that the reference to participation in clinical audits was a requirement;

      that a glossary of terms be included when the Quality Account is finalised; and

(c) NWAS be invited back to a future meeting to update on cross boundary work, including in the Poynton area, and the work of Community First Responders;