Agenda item

To consider a presentation by Sarah Byrom and DaveKitchin of the North West Ambulance Service on:

      Response times in Cheshire East;

      Foundation Trust application;

      Serious and untoward incidents.

A summary document on the Foundation Trust application is attached for reference.

The Committee welcomed Sarah Byrom, Dave Kitchin and Ian Moses from the North West Ambulance Trust (NWAS) who were attending to discuss:

• Response times in Cheshire East;
• The Foundation Trust application;
• Serious and untoward incidents.

In relation to response times, the Committee had received figures showing response times by postcode area from April 2010 – February 2011.  The figures showed that response time targets were not being met in many areas.  Current targets categorised calls as follows:

·        Category A:    Serious and life-threatening

·        Category B:    Serious but not life-threatening

·        Category C:    Not immediately life-threatening or serious

with the Response times standards as follows:

·        75 percent of Category A calls within 8 minutes

·        95 percent of Category A calls in 19 minutes

·        95 percent of Category B calls in 19 minutes

·        95 percent of category C calls in 60 minutes (locally agreed target)

The Committee expressed concern over these figures and sought explanations as to why the response times were so low and what action NWAS was taking to address the issues.

In response, officers of NWAS explained that the low response times correlated to rural areas and to meet the targets would require far more vehicles and paramedics than current resources would allow.  There had been an increase in demand of 8% compared to the previous year but this had not been matched by an 8% increase in resources.

However, there were a number of measures that could be taken to ensure patients were treated as quickly as possible.  NWAS officers explained that specific winter pressures had been addressed through the use of additional resources from St Johns Ambulance, Red Cross and Mountain Rescue teams.  In relation to general performance and responding to calls, there was increasing use of Community First Responders, investigations into devising Co-Responder schemes (with the Fire Service), advice given over the phone and redirecting callers to existing community resources.  The increase in Community First Responder schemes had had a positive impact.

NWAS officers explained that cross border response agreements were in place and ambulances from out of the area would be used if it was more appropriate and timely than using one from NWAS.  A crew would take a patient to the most appropriate hospital for treatment (such as a specialised centre) which could be an out of area location, which would impact on the time taken to get the ambulance back into service.   There were also sometimes issues around turnaround times at hospitals.  It was also relevant to note that even though an ambulance was stationed in an area it may not remain there as it would be out responding to calls and may not return to the station for a long time.

It was noted that Cheshire East was an area with an increasing elderly population, with meant increasing healthcare needs, and there were also increases in chronic illness.  There were also areas of deprivation which had their own health and social care needs and demands. 

All paramedics were currently undergoing diploma training which would mean they could treat patients in the more appropriate manner using the most up to date techniques.

A directory was being developed regarding existing services available in the community which would ensure that each patient was handed over to the most suitable service, if they did not require hospital.  If an ambulance crew was called out they would always ensure a safe handover for the patient.  There was a role for the community to manage demand through local services.

In response to a question regarding SatNavs, the Committee was advised that such systems were updated as soon as uploads became available but all systems were there to assist local knowledge.

In the future a new national call system would be introduced where callers would ring 111 for non emergency calls; this had been piloted in the North East and had reduced inappropriate emergency calls.  It was important that strategies to reduce demand could be introduced as calls classed as Category A when received, were often not found to be life threatening when the ambulance crew arrived.

NWAS officers then outlined their proposals around Foundation Trust status.  The Government White Paper “Equality and Excellence”; Liberating the NHS” outlined the commitment for all NHS Trusts to become Foundation Trusts – Foundation Trusts were still part of the NHS and subject to NHS standards, performance ratings and systems of inspection.  However, they were run locally with local people as members having a say in how they wished their services to be developed.  If NWAS were to achieve Foundation Trust status it would have more freedom to design services that met community needs, greater financial freedoms that would allow any surplus funds to be kept to invest in better facilities and services for patients, more involvement for staff and the public including opportunities to stand as a Governor of the Trust and strengthened local partnerships. 

The Vision of NWAS was “We will deliver a high quality service to patients ensuring we deliver the right care, at the right time and in the right place”.  Their plans for the future included modernising the emergency service and the patient transport service, developing its role further as a key partner and service provider in an integrated emergency and urgent care system across the North West and devising stronger plans to meet responsibilities under the Civil Contingencies Act 2004 for when a major emergency occurred.

All members of the public who live in the North West could become a member of the Trust and NWAS was aiming to attract at least 5000 people by September 2011; there would be a separate class within the public constituency for volunteers to reflect the key role they played.  The Board of Directors would be responsible for strategic and day to day management of the Trust and would comprise six non-executive directors (including people from business and education rather than just health) and five executive directors.  A series of consultation events had been organised and views were welcomed.

Finally, NWAS officers reported on Serious and Untoward incidents – there had been 57 of these across the North West over a 3 year period.  Any serious incidents were reported to commissioners, the Strategic Health Authority and to the NWAS Board.  There had been no such incidents in this area.

Any untoward incidents were those reported by staff and they were encouraged to report any matters of concern.  For the year to date there had been 180 untoward incidents including injuries, near misses, clinical issues (loss of drugs, equipment fault), and non clinical (assault on staff, persistent callers). 

During discussion, Members asked about manual handling issues and could these be addressed by training?  In response, Members were advised that there training was provided in both handling patients and equipment and in relation to patients there were issues caused by obesity, which was a significant and increasing issue for all the health services.

The Chairman thanked the representatives of NWAS for their attendance and full explanation of all the issues covered.

RESOLVED:  That

(a) the Committee notes the action taken in relation to performance and response times but remains concerned about the failure to meet targets;

(b) NWAS be requested to report to the next meeting in April on measures introduced to improve performance;

(c ) a report from NWAS and Adult Social Care be made to the meeting in June on how the two organisations can work together to make improvements to response times including sampling of cases where alternative services to an ambulance may have been appropriate but lack of knowledge meant this was not possible;

(d) NWAS return to the meeting in June with updated performance figures for all postcode areas in Cheshire East;

(e) the application for Foundation Trust status be supported; and

(f) the update on Serious and Untoward incidents be received.