Agenda item

(To receive a report from Lincolnshire West Clinical Commissioning Group (CCG) which provides a summary of the actions taken by Lincolnshire West CCG in order to seek to secure improvement by Thames Ambulance Service Ltd (TASL).  Performance data for February 2018 will be circulated to the Committee separately in advance of the meeting.  Sarah-Jane Mills (Chief Operating Officer, Lincolnshire West CCG) and Tim Fowler (Director of Commissioning and Contracting, Lincolnshire West CCG) will be in attendance for this item)

Pursuant to Minute number (62) from the 17 January 2018 meeting, the Committee gave consideration to a report from the Lincolnshire West Clinical Commissioning Group, (LWCCG), which provided a summary of the actions taken by Lincolnshire West CCG to seek to secure improvement by Thames Ambulance Service Ltd (TASL).

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West CCG and Tim Fowler, Director of Commissioning and Contracting, Lincolnshire West CCG.

The Committee was advised that hard copies of the Supplementary Report from Lincolnshire West CCG circulated by email during the previous day relating to the February 2018 performance position had been circulated at the meeting for their consideration.  

In guiding the Committee through the report the Director of Commissioning and Contracting extended his thanks to staff from TASL for ensuring that a service was provided during the snowy conditions.

The report provided a step by step commentary from LWCCG.  Since the December 2017 meeting, at which the Health Scrutiny Committee for Lincolnshire had expressed a vote of no confidence, it was reported that for the months of December 2017 and January 2018, TASL had failed to achieve the level of performance improvement they had put forward in their Remedial Action Plan (RAP).  In accordance with the process set out in the Contract, LWCCG had issued formal contractual Exception Notices for December 2017 and January 2018.  These Notices gave TASL 20 operational days from the date of the Notice to meet the performance standard to which the Notice related; and in the absence of the achievement, a penalty of up to 2.0% of the monthly contract value could be retained by the CCG.  The Committee was advised that this penalty had been applied for the December failure and would be reviewed for the January failure once the February performance data was available.

It was highlighted that the LWCCG had advised TASL that it would consider exiting the Contract if the required improvements in the RAP were not reached by the end of March.  The Committee was advised that this decision would not be taken lightly by LWCCG, due to the disruption caused by a potential change in provider.

The Committee was advised that although TASL still had a long way to go to meet the required standards, they were heading in the right direction with invalidated weekly performance data for February and March showing some improvement. 

The Supplementary Report provided the latest performance information up to February 2018.  Details relating to performance were shown on page 2 of the Supplementary Report.

The LWCCG welcomed the reported achievement of the recovery trajectory for 2 KPIs; and the month on month improvement in all KPIs for February 2018.  The Committee was also advised that LWCCG was pleased to note the significant improvement in reported performance for call answering.

The Committee was advised further of the Care Quality Commission Inspection (CQC) of TASL sites in Grimsby, Scunthorpe and Canvey Island in September /October 2017.  The main areas of concern highlighted related to: lack of systems and processes for reporting; lack of a means for assessing, monitoring and mitigating risk; lack of a clear reporting structure for concerns and actions for improvement in relation to specific aspects of safety and quality.  The Committee was advised that the CQC had undertaken an inspection of TASL's Lincolnshire sites on 9 March 2018, and as yet no details were known.

In conclusion, the LWCCG identified that challenges still remained; and that the improvements reported in February were a step in the right direction.  The Committee was advised that the LWCCG would review the March performance information before considering what further action should be taken.

Attached at Appendix A to the report was a copy of the Operational KPI Summary; and Appendix B provided information concerning TASL's performance against the Remedial Action Plan trajectory.

During discussion, the Committee raised the following issues:-

·         Some members acknowledged the improved performance; and the LWCCG optimism; but some concerns were expressed as to whether enough improvement would be made by the end of March 2018;

·         Some concern was expressed to the difficulty of finding another provider if the need arose; and whether a more realistic date should be set as to when TASL would be able to achieve the required performance.  LWCGG agreed that finding another provider would be a challenge and confirmed that in relation to performance, March was a key date.  It was hoped that the new TASL management structure and the support TASL was receiving from the parent company would be instrumental in helping improve TASLs overall performance;

·         Penalties – The Committee was advised that within the Contract there were a number of elements of service where the KPI had to be achieved, which were expressed as a %; and were measured on a monthly basis.  Where a KPI was not achieved an automatic penalty was applied.  It was noted that the maximum penalty was 2.5%.  Also, if the recovery plan milestone was not met a further fixed penalty of 2% would be applied;

·         One member highlighted that the data did not identify the number of trips completed.  The Committee was advised that since the start of the contract activity had been down by 15 – 20%;

·         A question was asked as to whether hospitals were being reimbursed when alternative transport had been arranged.  It was highlighted that TASL could be charged; however there was still discussion to be had concerning reimbursement;

·         Use of Volunteers – The Committee was advised that it was up to the provider as to whether they used volunteers or not.  The LWCCG could not advise TASL what to do.  It was however noted that TASL was now aware that the use of volunteers was a key part of the service;

·         The need for improved journey planning – The Committee was advised that this was an area LWCCG was working with TASL on;

·         Letting of the Contract – The Committee was advised that the contract had been let based on the information presented, not on what was projected in the media; and

·         One member asked whether liquidated damages were included within the Contract.  The Committee was advised that this was a standard feature in NHS Contracts.

RESOLVED

1.    That ongoing monthly reports be received by the Chairman of the Health Scrutiny Committee for Lincolnshire and the Health Scrutiny Officer; and that monthly updates be received by the Committee as part of the Chairman's Announcements.

2.    That performance reports concerning the Non-Emergency Patient Transport Service – Contract Management from the LWCCG be received by the Committee on a quarterly basis.

The Committee adjourned at 1.05pm and re-convened at 2.00pm.

Additional apologies for absence for the afternoon part of the meeting were received from Councillors Mrs K Cook, M T Fido and Dr B Wookey (Healthwatch).