Agenda item

To consider the Quality Account and an update on current issues

Tim Butcher, Assistant Director for Performance Improvement, North West Ambulance Service (NWAS), presented the draft Quality Account.  He explained that the Quality Account provided an opportunity for NWAS to talk about the wide ranging role of NWAS rather than just focusing on response times. 

He outlined the main highlights of the year including:

      Exceeding the national quality target for responding to the most serious life threatening emergencies within 8 minutes following a 999 call;

      They were the first ambulance trust in England to achieve Level 2 compliance against NHS Litigation Authority’s Risk Management Standards;

      They were awarded the Health Service Journal Clinical Redesign Award for the Paramedic Pathfinder project, a toolkit to ensure that patients were treated and cared for safely and in the most appropriate place following an emergency call.

The Care Quality Commission had conducted an inspection in March 2012 and had given a very positive report on NWAS compliance with the CQC standards of quality and safety. 

This year NWAS was seeking authorisation as a Foundation Trust which would involve enhanced arrangements for public and staff involvement. 

In relation to the five priorities for improvement as identified in the previous year’s Quality Account, progress was as follows:

      End of Life Care – NWAS had developed a Rapid Discharge Procedure with ten organisations across the North West.  This had enabled an integrated discharge pathway to ensure patients could end their lives with dignity and in their own home.  This year 87% of transfers had been completed within 2 hours of the request being made;  NWAS had also produced a “how to” guide for ambulance services to improve services offered to people at the end of life; NWAS had introduced a system where patients at home had personalised care plans wherever possible and staff were alerted to this when attending the patient’s home address;

      111 and Frequent Callers – NWAS had stated they would begin the process of a single point of access for urgent and emergency care.  They also wanted to work with local commissioners to address the issue of people who made frequent 999 calls.  A pilot had been set up of the 111 number for urgent care needs.  Work had also taken place with each PCT regarding frequent callers who were often vulnerable people who were not aware of alternative help and support;

      Chain of Survival and Complementary Resources – NWAS had a two year plan to increase community access to life saving equipment and skilled volunteers – the “Complementary Resources” Strategy.  During 2011/12 NWAS had worked in partnership with the British Heart Foundation, and introduced 20 new Community First Responder Schemes, 50 new staff responders (volunteers) and 125 additional Automated External Defibrillators (AEDS) installed in public places.  There were a number of Community First Responder schemes in Cheshire East including Holmes Chapel, Knutsford, Poynton and Alsager, with new schemes introduced in Bollington and Middlewich.  The presence of Community First Responder schemes had helped with response time targets.  NWAS had achieved the target for the region but was just below the target for the Central and Eastern Cheshire Primary Care Trust area; however, they had shown an improvement on previous years.  For Category A8 calls NWAS was the 3^rd best performing Trust;

      Acute Stroke Care – NWAS was committed to embedding the improvements made to services for patients with a stroke ensuring staff undertook the right assessments and immediate actions and that patients were transported to the most appropriate hospital as quickly as possible. NWAS consistently performed above the national average.  A national clinical quality indicator said that suspected stroke patients should be transferred to a “hyper acute” Stroke Centre within 60 minutes of a 999 call; again NWAS performed above the national average;

      Heart Attack – NWAS was committed to embedding improvements made to the treatment and care of people who had a heart attack; ensuring staff undertook the right assessments and immediate actions and that patients received the correct emergency treatment as quickly as possible.  NWAS had improved the overall assessment and care offered to patients suspected of having a heart attack but performance had varied throughout the year and was below the national average.  NWAS now needed to improve the pain assessment of heart attack patients and increase the number of pre-alert calls to heart attack treatment centres – this would be the focus for 2012/13. 

Tim highlighted a number of points including that the Trust had further developed Clinical Leadership and Education to ensure that patients were treated by highly trained professionals which meant outcomes were likely to be better.  NWAS had focused on safeguarding including making specific appointments and introducing mandatory training and Quality Checks.  Infection prevention and control had been improved with over 70 staff acting as Infection Control Champions, introducing weekly service audits of the cleanliness of vehicles and random manager spot check audits of the cleanliness of vehicles and stations.  He also asked the Committee to note the introduction of a new system for the treatment of patients suffering major trauma that was being introduced from April 2012 across England.  This was because there was clear evidence that these patients showed better outcomes in terms of survival and recovery if they were treated at a Major Trauma Centre where necessary services and expertise were on site with highly skilled staff.  These changes would have implications for the ambulance service as staff would have to make judgements on where to take a patient who had suffered a major trauma.

In discussing the Quality Account, members made the following comments:

      That the progress with last year’s five priorities for improvement be noted and the additional work to address any issues be supported;

      Clarification was sought on the 111 pilot in terms of timescales, analysis of outcomes and targets for responding to calls.  In response, Tim explained that the pilot was currently running and the service was out to tender for a provider, he did not have details of how the pilot would be assessed as once it ended the contract for the service would begin.  NWAS was a pilot provider and would be bidding for the contract.  Members felt that the pilot should run and the results analysed prior to the contract being let.  Tim agreed to provide more information on this in writing after the meeting;

      The various graphs throughout the Account were rather confusing with baseline information unclear and more narrative explanation needed;

      An explanation as to the PALS service should be provided within the main body of the Account;

      The Committee was pleased to see some improvement in response times in Cheshire East and the positive impact of Community First Responder Schemes.  It was also pleasing to note that a Co-Responder Scheme was in existence in Nantwich and was expanding;

      Who was responsible for learning disabled patients and those with dementia?  In response, Tim explained that NWAS would respond in the case of a 999 call but if 111 was called it would be a call response system.  He explained that NWAS had carried out a lot of work on cultural and disability awareness and used patient story videos to show the patient experience of services;

      Members were supportive of centres of excellence for specialised treatment but queried how it was decided where a patient would be taken.  In response, members were advised that the paramedics would make a clinical judgement about the best destination depending on the diagnosis; taking into account that outcomes were better if a patient was taken to the most appropriate place;

      Members were pleased to see that complaints had reduced but queried the reason for the increase in April.  Tim felt this may be due to seasonal pressures with an increased demand for services over the winter months leading to a backlog of complaints in April.

RESOLVED:  that the comments made be forwarded to the North West Ambulance Service for inclusion in their Quality Account.