To consider the Quality Account and an update on current issues
Minutes:
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 3rd 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.
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