Agenda item

(To receive a report from the East Midlands Ambulance Service NHS Trust Lincolnshire Division, which update the Committee on progress made within the Lincolnshire Division of the East Midlands Ambulance Service.  Mike Naylor, Director of Finance, East Midlands Ambulance Service NHS Trust and Sue Cousland, General Manager – Lincolnshire Division – East Midlands Ambulance Service NHS Trust will be in attendance for this item)

Consideration was given to a report from the East Midlands Ambulance Service (EMAS) NHS Trust Lincolnshire Division, which provided the Committee with an update on the progress made within the Lincolnshire Division of the East Midlands Ambulance Service.

The Chairman welcomed to the meeting Sue Cousland, Lincolnshire Division Manager, EMAS NHS Trust.

The presentation to the Committee made reference to key improvement elements that were being focussed on, which included culture change, leadership, workforce and recruitment, performance, collaborative working and the Divisional Work Plan.  It was highlighted that the Care Quality Commission Inspection - Final Report had indicated a rating for the whole service of 'Good' and a rating of 'Outstanding' for caring.  It was highlighted further that a new Executive Lead Officer had been appointed for Lincolnshire.  The Committee was advised that the Clinical Senior Leadership Team were all working within the area; and that all Senior Leaders had been encouraged to attend a Leadership Programme.  It was highlighted that the area operation management role was being undertaken in the locality, with conversations with staff, for example, taking place in hospital café's.  The Committee noted further that the appraisal process had been reviewed; and that staff were being promoted based on a full assessment of their abilities.

The Committee was advised that the Strategy and Clinical Model had been approved and it was highlighted that a system approach to pre-hospital care was being developed to ensure that alternative pathways were available. 

The presentation indicated that for 2018/19, 116 staff had been recruited.  It was noted that staff turnover rate was between 8% and 10%.  The Committee was advised that for 2019/20 the forecast was for 124 staff being recruited; and that more emphasis was being made on the east of the county.  It was highlighted that there was funding for 2 additional Resource Managers.  The Committee noted that there was also 6 Military Paramedics operating on an honorary contract basis providing more flexibility along the east of the county.

Some reference was made to the Ambulance Response Programme; and the Lincolnshire Trajectories for 2019/20.  It was highlighted that there had been a 12% increase in activity so far during the year.  The presentation also made reference to conveyance information to Emergency Departments by CCG.  The Committee noted that the Lincolnshire West CCG had a number of robust pathways in place, and that work was on-going with the other CCG areas to increase the number of pathways available.  Details of the hospital handover impact on performance were shared with the Committee; and it was highlighted that there had been a loss of 700 hours per week during the July peak, details of which were shown on the slide presented.

The Committee was advised that collaborative working with the Acute Hospitals was on-going; and it was highlighted that a Rapid Handover Protocol had been agreed, which was due to start from 4 November 2019.  Reference was also made to a further co-responder team operating from Wainfleet; and that joint working arrangements with Lincolnshire Integrated Voluntary Emergency Service (LIVES) were going from strength to strength.  The Committee was advised that various practices had been put in place to help maintain productivity; reference was made to PIN reporting, that better management and leadership focus was being put into the Call Centre; and more emphasis was being placed on ensuring the right response happened first time, which would help improve hospital turnaround.

In conclusion, the Committee was advised that transformation of the service was continuing, and that the Divisional Work Programme for 2019/20 would help the service move forward.

During discussion, the Committee raised the following issues:-

·         The need for a written report, rather than a presentation, showing the progress made by EMAS for future meetings;

·         The optimistic picture of the service;

·         Information relating to the effect LIVES had on the EMAS targets.  It was agreed this information would be forwarded to members of the Committee;

·         One member enquired whether there was a central list of where Automated External Defibrillators (AED's) were located for the public to use.  The Committee was advised that a list was held centrally at the Emergency Centre.  It was noted that the service was automated; on request a member of the public would be provided with directions to find the AED, along with a code and instructions to unlock the AED;

·         The education of other road users to assist response vehicle drivers.  Reassurance was given that ambulance drivers were trained to deal with unpredicted situations.  It was agreed that media awareness would be considered;

·         The effects of trauma on staff.  The Committee was advised that it was difficult to spot someone who was in need of help.  Reassurance was given that any member of staff who had faced a traumatic experience would be stood down; and would receive either a telephone or face to face de-brief.  The individual would then be referred for appropriate professional support;

·         The effect problems with handovers at hospitals were having, and the potential risk as winter approached.  Reassurance was given that a Seasonal and Divisional Escalation Plans were in place;

·         Some concern was expressed regarding the number of patients under the 'See and Treat' heading for Quarter 1 and 2, on page 32 of the report.  The Committee was advised that a lot of these patients were elderly, with no transport; some of whom did not require further treatment; and others needing further clinical assessment;

·         The number of ambulance crews units available – The Committee was advised that during the summer there were extra crews.  Confirmation was given that there was out of county drift, but where drift occurred, Lincolnshire usually received backfill.  Clarification was given that patients had to be transported to where the need was required;

·         Video recording – The Committee was advised that a third of the ambulances had 24/7 CCTV coverage inside and outside of the vehicle.  Confirmation was also given that each ambulance was fitted with a Global Positioning System (GPS); and that staff were also tracked by their radios;

·         Ambulance standing time.  Confirmation was given that ambulances did not take 10 minutes to warm up.  It was however highlighted that ambulances could be on 'run lock', but this was something that was avoided if possible.  It was highlighted that when an ambulance was connected to an electrical socket, the connection point's design allowed for a quick release; and

·         Sharing of good practice – The Committee was advised that good practices were shared.  It was noted that the service had excellent Area Managers who looked to see what worked elsewhere and whether the same service could be replicated in Lincolnshire.

The Chairman on behalf of the Committee extended thanks to the Lincolnshire Division Manager for an excellent update and for her open and frank presentation.  

RESOLVED

1.    That a further update report be received from the East Midlands Ambulance Service NHS Trust – Lincolnshire Division in six months' time.

2.    That information be provided regarding concerning the role of LIVES.