Agenda item

(To receive a report from the Lincolnshire West Clinical Commissioning Group, Lead Commissioner of Emergency Ambulance Services in Lincolnshire, which provides the Committee with an overview on how emergency ambulances are commissioned from the East Midlands Ambulance Service.  Martin Kay (Head of Commissioning, Lincolnshire West Clinical Commissioning Group) will be in attendance for this item)

The Committee gave consideration to a report on behalf of Lincolnshire West Clinical Commissioning Group (CCG), Lead Commissioner of Emergency Ambulance Services in Lincolnshire, which provided an overview on how emergency ambulances were commissioned from the East Midlands Ambulance Service (EMAS) NHS Trust.

The Chairman welcomed to the meeting Martin Kay, Head of Commissioning, Lincolnshire West CCG who provided the Committee with some background information to commissioning arrangements.

The Committee noted that the four CCGs commissioned emergency ambulances as part of a collaborative commissioning arrangement across East Midlands, along with further 18 CCGs, to make 22 CCGs in total.  The emergency ambulances commissioned from East Midlands Ambulance Service covered five counties comprising of Derbyshire, Leicestershire, Lincolnshire, Northamptonshire and Nottinghamshire.  It was noted that the commissioning meetings were held at EMAS Trust level and at divisional level.  For Lincolnshire this involved the four County CCGs; and North and North East Lincolnshire CCG (Six CCGs in total who constituted the EMAS Lincolnshire Division).  Full details as to the meeting arrangements were shown on page 54 of the report presented.

It was reported that there was a single contract across the 22 CCGs and EMAS, which was managed by Hardwick CCG.  It was highlighted that additional local requirements could be added to the contract. 

The Committee was advised that the contract currency with EMAS was activity-based using four counts: calls; hear and treat; see and treat; and see and convey; and that contracted activity was based on a three-year rolling analysis, which was then adjusted for system changes that would have an impact on any of the four counts.  The Committee was advised further that the contract value across the four Lincolnshire County CCGs was £25.5m.

It was brought to the Committees attention that the majority of commissioning decisions were managed at Trust level, as these were largely determined by national requirements, which both local commissioners and the provider were obliged to follow.  Regional application of the contract was determined through meetings between the commissioners (Hardwick CCG and County Leads) and EMAS through negotiation.  In Lincolnshire County decisions involved all CCGs, but at times could be CCG specific.  It was noted that there was clear communication between Lincolnshire West CCG, as the lead commissioner and the other three Lincolnshire County CCGs.  It was noted further that having a local approach was important to identify and meet the needs of local people; and that local working had delivered changes which had benefitted the local population.  An example of this was EMAS being a partner in the Lincolnshire Clinical Assessment Service (CAS).  The CAS provided additional clinical support to paramedic's on-scene, which had reduced the number of people taken to hospital, as these people had been better cared for within other community-based services.

A discussion ensued, from which the Committee raised the following issues:-

·         In response to a question on emergency ambulance cost adjustments, it was confirmed that any adjustment in national funding would be passed to the CCGs in the first instance;

·         The situation regarding EMAS Ambulances being delayed at hospitals outside the EMAS region.  The Committee was advised that in the past Lincolnshire had lost significant ambulance resources to other counties in the region; but the numbers of ambulances from Lincolnshire leaving the county had now reduced.  This had been helped by improved hand overs at A & E; and by reducing the number of patients being taken to A & E;

·         The Joint Ambulance Conveyance Project - It was confirmed that the joint arrangement between EMAS and Lincolnshire Fire and Rescue had been a success; and that there had been a lot of interest from other councils;

·         Confirmation was given that at commissioning level, the support from LIVES co-responders was valued by EMAS;

·         The Committee was advised that the contract was a three year contract based on activity, which was negotiated every year; an explanation was also provided relating to the discrepancies.  It was noted that the contract was front loaded and that all the CCGs paid the same rate for activity; and that the County did get penalised due to the rurality of Lincolnshire.  It was highlighted that discussions were underway to recognise the need for an adjustment and that a case could be made for Lincolnshire on the grounds of sparsity;

·         A request was made for information relating to the activity agreed between Hardwick CCG; and the 21 other CCGs; and that any discrepancies were managed locally through Hardwick CCG and EMAS.  The Committee was advised that this information was evidence based;

·         How risk was managed year on year – The Committee was advised that each CCG paid one twelfth of their overall annual commitment to EMAs directly each month; and that the financial risk sat with each individual CCGs; and

·         A tribute was paid to EMAS and their responses to 999 calls as a job well done within limited resources.

RESOLVED

That the information presented on the commissioning arrangements for the East Midlands Ambulance Service be noted.