Agenda item

East Midlands Ambulance Service NHS Trust - Lincolnshire Division Update

(To receive a report from the East Midlands Ambulance Service NHS Trust (EMAS), which updates the Committee on the following areas within the Lincolnshire Division: ambulance response performance information; handover delays at acute hospitals; collaboration with Lincolnshire Integrated Voluntary Emergency Service; the urgent care tier; the ambulance fleet; recruitment; blue light collaboration; and the transformation programme within the Lincolnshire Division.  Mike Naylor, Director of Finance EMAS and Sue Cousland General Manager, Lincolnshire Division EMAS will be in attendance for this item)


The Chairman welcomed to the Committee the following representatives from the East Midlands Ambulance Service NHS Trust:-


·         Mike Naylor, Director of Finance, East Midlands Ambulance Service;

·         Sue Cousland, General Manager, Lincolnshire Division East Midlands Ambulance Service; and

·         Will Legge, Director of Strategy and Transformation, East Midlands Ambulance Service.


The Committee gave consideration to a report from the East Midlands Ambulance Service NHS Trust – Lincolnshire Division, which provided an update on the following areas:-


·         Ambulance response performance information;

·         Handover delays at acute hospitals;

·         Collaboration with Lincolnshire Integrated Voluntary Emergency Service LIVES;

·         The urgent care tier;

·         The Ambulance fleet;

·         Recruitment;

·         Blue light collaboration; and

·         The transformation programme within the Lincolnshire Division.


Detailed at Appendix A to the report was a copy of a report considered by the Accident and Emergency Delivery Board concerning Hospital Handover Delays for January 2019.  Appendix B provided details relating to the Falls Response Programme – Performance Summary; and Appendix C provided the Committee with a copy of the Transformation Brief which had commenced in April 2019.


The Committee received a short presentation, which provided information on the key elements being focussed on by EMAS; an overview of progress that had been made and, what the highlights were for 2018/19; Quarter four performance and the residual challenges for Lincolnshire, details of which were contained within the report presented.


The Committee was advised that the Lincolnshire Division of EMAS currently had a total fleet of 82 ambulances, which were supported by 'in house' mechanics seven days a week 365 days of the year.  The Committee was advised further that from March 2019 Lincolnshire had received the first 39 new vehicles to replace 28 of the oldest vehicles in the fleet; and an additional 11 new vehicles to support the expansion in workforce.  In addition to this the Committee was advised that 15 new Urgent Care Vehicles had also arrived and these were based at Sleaford, Boston, Grimsby and Market Rasen stations.  It was also highlighted that the Lincolnshire Division was also working with fleet colleagues to trial an electric vehicle and that a review was currently being undertaken relating to the current fast response vehicle resource.


It was highlighted to the Committee that one of the largest, but positive challenges had been the large scale recruitment of staff into EMAS.  It was reported that during 2018/19, 484 new staff had been recruited through a mixture of transfers from other services; the up skilling of existing staff or external recruitment.  It was highlighted further that the largest proportion of new staff had been from external recruitment, with 331 trainee technicians being welcomed into EMAS.  The Committee noted that for the Lincolnshire Division this equated to 91 new ambulance technicians, 8 paramedics and a further 14 urgent care assistants.  The Committee noted further that the recruitment process would continue into 2019/20.   


It was reported that handover delays at acute hospitals continued to be a challenging aspect, and the significant pressures it posed in a rural county such as Lincolnshire.  Details of the average pre-handover delays were shown on page 4 of the report.  The Committee was advised that Appendix A to the report detailed a national requirement for Acute Trusts to take responsibility for patients conveyed to their sites within a maximum time frame of 30 minutes in order to release crews to assess patients waiting to receive a resource in the community.  The Committee was advised that EMAS continued to work in close collaboration with Lincolnshire Integrated Voluntary Emergency Service (LIVES), who remained an integral component of urgent and emergency response across the county.  Performance information for each of the four Clinical Commissioning Groups was provided for the Committee to consider as part of the presentation; as were details pertaining to the Ambulance Response Programme, which had come in to effect from 1 April 2019.  The Committee was advised that the geographical area of Lincolnshire and the ageing population remained a challenge; and that processes and procedures were being put in place which would help EMAS achieve the response programme targets.   


The presentation also highlighted to the Committee the achievements made by EMAS.  The Committee was advised that EMAS was very proud of their team in Lincolnshire.  It was noted that there had been a threefold increase in the number of responses received from the division to the national staff survey in 2018, which had totalled 51% compared to 19% in 2017.  Details relating to the initial feedback and areas of positive feedback were shown on page 9 of the report.


It was also highlighted that the organisation had received an unannounced inspection by the Care Quality Commission during early April 2019; and initial informal feedback had indicated that staff morale had improved, and that there had been a positive change in culture, and that all front line staff were caring and compassionate. 


Other areas of achievement mentioned included, the organisation's transformation programme, details of which were shown in Appendix C to the report; the EMAS Strategy and Vision of 'The Big 3' responding, developing and collaborating; releasing time to care, which was a piece of work which primarily focussed on increasing efficiency to make sure more time was spent with the patient; the success of the Blue Light Collaboration during 2018/19, which involved the opening of co-located fire and ambulance stations in Sleaford and Louth.  The Committee noted that the very first 'tri-located' blue light service property in the country was to be located on the South Park, Lincoln, and that a phased move for all the three services was planned to take place during June to September 2019.  Also mentioned, was the Physician Response Unit, and the provision of providing an urgent care tier of staff to support Health Care Professional admission.  It was highlighted that there were 15 urgent care crews in Lincolnshire covering the county, based at Boston, Sleaford, Grimsby and Market Rasen.


The Committee was advised of the divisional work programme for 2019/20; and EMAS appreciated that Lincolnshire was different; and that EMAS was committed with its caring staff and dedicated senior leadership team to provide a responsive, developing and collaborative service to the residents of Lincolnshire.


During discussion, the Committee raised the following points:-


·         Some of the Committee expressed their thanks to the representatives for their open and frank report; and for the way EMAS was taking the lead in dealing with culture and morale.  Reference was also made to the positive effect modernising the fleet would have on the service.  Representatives confirmed that things were beginning to change, but there was still a lot more to do;

·         The effect of the collaborative working with LIVES on the EMAS performance figures.  One member requested figures showing separation of the data;

·         Staff turnover.  The Committee was advised that EMAS had around a 9% staff turnover;

·         Confirmation was given that Peterborough City Hospital was not taking any more patients than they had done previously;

·         Confirmation was given that EMAS had found the national targets challenging; and that it was correct to continue to strive to meet the national targets.  The Committee was advised that Lincolnshire was leading the way nationally, trying to find ways of collaborative working to overcome the rurality of Lincolnshire;

·         Paramedic project at GP surgeries.  The Committee was advised that the 18 month pilot of using Specialist Paramedics in emergency care was working well along the east coast.  The specialist paramedics were able to deal with Category 2 and 3 calls; which enabled them to enhance their primary care skills but also keep the necessary skill set required for A & E.  Some members welcomed the pilot, as it provided more experienced staff the opportunity to be utilised in a different way, but still providing career progression;

·         The need to improve handover times;

·         A question was asked whether all 999 calls were emergency calls.  The Committee was advised that 'Fit to Sit' had been introduced in Lincolnshire; and that if patients were stable then a family member was able to drive them in; in a 'You take Yourself ' policy.  It was highlighted that some of the suggestions were not always taken on board by the patients.  It was noted that EMAS would always support the actions of the ambulance crew;

·         Anaphylactic shock – One member enquired whether first responders were trained to deal with such incidents.  Reassurance was given that first responders would be trained to administer adrenalin; and that call handlers were also trained to be able to advise people what to do in such a situation;

·         Some clarification was sort regarding the availability of 999 for members of the public.  Confirmation was given that the frontline 999 was available 24/7;

·         Manual Handling - The Committee was advised that obesity was a national problem, and that patients over 25 stone would have an assessment, prior to being transported and that this information would be on the EMAS system; and that additional support would be sent.  It was noted that there was a reliance on GPs to provide this information.  The Committee noted that there were two bariatric support vehicles that were based at Boston and Market Rasen, which had a range of lifting equipment.  It was noted further that the new ambulances had a central locking system which enable them to transport patients over 25 stone in the middle of the vehicle, which then ensured stability of the vehicle;

·         The need to ensure that the public were aware of what was being done.  The Committee was advised that internal discussions were on-going regarding a communication campaign and that some promotion was being done as part of the Healthy Conversation;

·         A question was asked what would happen when the Fall Response Programme 'pilot' finished in June 2019; and how the initiative would be evaluated.  The Committee was advised that the results would be evaluated by the Lincolnshire University; and that EMAS would like the service to continue; however, the evaluation results would have to identify that the initiative was good value for money;

·         One member enquired why category 3 was proving so troublesome to achieve, as targets were being missed by about an hour.  A further question asked was whether the national standard would ever get close to being achieved.  The Committee was advised that the reason for the target not being achieved was due to the non-availability of ambulances on the east coast.  It was reported that processes were in place to help reduce the waiting time and that it was hoped that there would be some improvements by September 2019;

·         One member enquired when the trial of the electric vehicle and the fast response vehicles would be taking place.  The Committee was advised that the electric vehicle was a one–off vehicle, which was being trialled in Immingham.  It was hoped that the review of the fast response vehicles would be made available within the next three months; and the Trust was more than happy to share the information with the Committee.


The Chairman extended thanks on behalf of the Committee to the representatives for their honesty and for the positive progress being made.


That the East Midlands Ambulance Service NHS Trust – Lincolnshire Division Update be noted, and that a further update be received in six months, which should include an update on the falls response programme, the outcomes of the fast response vehicle review and the electric vehicle trial.

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