Agenda item

To consider a presentation from North West Ambulance Service NHS Trust (NWAS) on recent performance information.

To consider the needs of the Borough and how services might be developed in the future, including first responders.

The Committee gave consideration to a presentation from North West Ambulance Service NHS Trust (NWAS) regarding its recent performance information and ongoing service development in Cheshire East. Mike Moore, NWAS Sector Manager for South Cheshire, and Julie Treharne, NWAS Head of Communications, provided the presentation and took questions from the Committee. Jim Britt, West Cheshire Clinical Commissioning Group (CCG), also attended the meeting as lead for joint commissioning of ambulance services for Cheshire CCGs.

The presentation provided contained performance information for response times and volume of activity for both Eastern Cheshire and South Cheshire CCG areas. The information illustrated the following points:

·         There had been an overall rise in activity of approximately 10% across both CCG areas.

·         In both CCG areas there were fewer G1 responses however significantly more R2 responses which suggested that more cases were being given the more severe R2 rating when previously they may have been G1. This had a significant impact on response time performance as R2 required a response within eight minutes whereas G1 was 20 minutes. There was a similar pattern with fewer G4 responses but significantly more G3.

·         There was more R1 and R2 999 calls received from mid December 2014 to end of January 2015 than there had been the previous year. It was suggested that this may be due to colder weather this year and higher levels of illness, particularly amongst older people.

·         Patient handover and ambulance turnover at both Macclesfield District General Hospital and Leighton Hospital was particular good compared to targets. This was attributed to good working practices and relationships between ambulance crews and hospital staff.

The presentation also included an overview of initiatives being put in place and the development of NWAS services to cope with increases in demand and specific challenges in Cheshire East, particularly in rural areas. The following points were made:

·         Community First Responders were teams of volunteers who lived and worked in communities, trained by NWAS to response to certain calls to ensure a quick response and provide care and support until emergency ambulance arrives. 1275 emergency calls were responded to by Cheshire East first responders in 2014/15

·         The Cheshire Co-response initiative involved eight firefighters operating in the Nantwich area who were trained by NWAS to provide rapid life saving interventions. 166 emergency calls were responded to by the Fire Co-responders in 2014/15.

·         The ambulance service’s role had changed from the traditional role of picking patients up for treatment at hospital to more treatment being administered at the scene with fewer cases being taken on to hospital. The skills set and decision making responsibility of paramedics had evolved since they were introduced in 1981.

·         As demand for health services increased there was a motivation across the NHS to change where and how patients were treated to reduce pressures on hospitals and emergency departments. This included ambulance services dealing with 999 calls in different ways and directing patients to the most appropriate service.

·         Educating the public and health and care service partners about services and their appropriate use was an ongoing challenge. Reducing the gap between public expectation and the services on offer would help to reduce unnecessary demand for services and improve patient outcomes.

During the Committee’s discussion about the presentation the following points arose:

·         NWAS tracked people with long term conditions who regularly called 999 to access with partners whether there were issues which needed to be addressed to reduce demand on 999.

·         Peaks and Plains had worked with NWAS and Macclesfield District General Hospital to support patients who were injured as a result of falls to see if adaptations to homes could be made to reduce incidents and ensure homes were suitable for a patient to be discharged. Members wanted to see this initiative continued and expanded across the Borough with other housing associations and health services.

·         NWAS had been working with nursing and care homes to ensure their staff knew how to deal with falls and other incidents to reduce demand from homes for ambulance services and hospital visits. All care homes had a responsibility to ensure they made the correct choices for their service users to achieve the best outcomes.

·         It was noted that in Eastern Cheshire CCG area there was a GP linked to each care homes who checked up on residents and support staff in making choices during incidents.

·         NWAS performance was worst during December 2014 when only 40% of acute responses had been made within the eight minutes target. During the 2014 winter months the NHS had struggled nationally to cope to unprecedented demand and targets had not been reached by many trusts.

·         The rise in demand for ambulance services had been approximately 10% which was unprecedented. CCGs had only commissioned services for a 1% rise in demand and the service struggled to cope with demand due to limited resources.

·         As well as providing 999 and ambulance services, NWAS hosted the North West NHS 111 service. This provided an opportunity for synergy between 999 and 111 services. It was suggested that the Committee should receive a presentation on 111 services at a future meeting.

·         999 and A&E were the most well know and publicised health services in the country. If demand for these services was to be reduced more needed to be done to promote all other services to ensure the public was knowledgeable enough to choice the most appropriate services when they needed them.

RESOLVED – That the presentation be noted and an item on the NHS 111 service be added to the work programme.