Agenda item

(To receive a report from the East Midlands Ambulance Service, which provides the Committee with an update on the various issues relating to the emergency ambulance service in Lincolnshire. Ben Holdaway, Director of Operations and Sue Cousland, Divisional Director for Lincolnshire will be in attendance for this item)

The Chairman advised the Committee that this item had been circulated as part of the supplement issued on the 10 February 2022.

The Chairman invited the following presenters from East Midlands Ambulance Service (EMAS): Sue Cousland, Lincolnshire Divisional Director and Ben Holdaway, Director of Operations, to remotely present the report.

Note: Councillor S R Parkin joined the meeting at 10.20.am.

The presentation provided the Committee with an update on the EMAS, which made reference to:

·       The strategic vision, the strategy and supporting strategies; and the objectives of EMAS respond, develop and collaborate;

·       EMAS Performance 2021/22 – Quarter 1 to Quarter 3. 

·       Lincolnshire Performance 2021/22 – Quarter 1 to Quarter 3.  It was noted that the number of Lincolnshire incidents had continued to increase, and details of activity rates, conveyances, operational resources and pre-handovers were shared with the Committee.  It was noted that there had been a downward trend in conveyances;

·       Details relating to the reshaping of operations, service improvements were shared;

·       The importance of system relationships and that the positive benefits from the pandemic had been enhanced system working with all stakeholders;

·       In relation to system relationships strategically and with providers, particular reference was made to the relationship with United Lincolnshire Hospitals NHS Trust and Lincolnshire Community Health Services NHS Trust;

·       Lincolnshire Initiatives; and

·       Priorities for 2022/23.  It was highlighted that the top priority for EMAS was to provide safe and effective care delivery.  There was recognition that some responses to patients were delayed, but when crews arrived the service delivered was a quality service.  Reference was also made to empowering staff to reach their full potential; and improving efficiency and effectiveness of all resources.

During discussion, the Committee raised the following comments:-

·       Whether the times for Lincolnshire pre-handovers were averages.  Confirmation was given that the figures provided were mean averages and that the service recorded data on 90^th percentile and 95^th percentiles.  There was recognition that some people were waiting longer and, similarly some people were waiting less time.  Confirmation was also given that in circumstances where patients required care immediately, these were prioritised.  Reassurance was also given that processes were in place to ensure patients received the care they required as soon as possible;

·       Some concern was expressed, from personal experience to the questions asked by 999-call handlers regarding the condition of patients.  The Committee noted that the 999-call handlers used a script based on a series of algorithms to assess the information provided and initiate the most appropriate response.  There was recognition that it was sometimes difficult for a caller to communicate the exact nature of the problem, but call handlers were trained to get the best information they could to help identify the problem.  The Committee noted that all calls were prioritised and allocated to one of five categories, with category one being the top priority, and that EMAS aimed to get to these patients within seven minutes; with 99% of them being within 15 minutes.  Confirmation was also given that Covid-19 tests were not performed on ambulances.  It was also highlighted that any patient waiting in an ambulance would be assessed in greater detail so that more informed advice could be provided to clinicians, to ensure that the patient went to the right place; and that anyone waiting in an ambulance would be regularly checked by ambulance staff and emergency department staff;

·       Hear and Treat for Lincolnshire.  One member enquired whether there was any clinical breakdown in the categories for those treated; and how ongoing clinical care was provided or communicated in these instances.  The Committee noted that 10% of the transport provided was for cardiac related incidents, and around 10% to 15% was for patients with breathing difficulties, and then between 5% and 10% was for patients who had fallen, and that stroke patients represented under 5% of the total responses.  It was highlighted that a better breakdown of clinical cases could be provided for in the next update to the Committee.  In relation to see and treat incidents, the Committee was advised that normally EMAS staff would see, treat and refer the patient to primary care, or back to their GP, or to out of hours care.  In relation to stroke and heart attack patients, it was highlighted that staff had a direct line in to the hospital and that nearly always, stroke patients were taken directly for a CT scan, which was the initial part of the diagnosis;

·       Timing of calls – The Committee was advised that prior to Covid-19, early hours of the morning demand would decline and then increase at lunchtime; then fall and increase again in the evening.  However, since Covid-19, there had been a change in the pattern of demand, there was now more demand in the early hours of the morning and between nine and ten in the morning, with people accessing their healthcare through 999.  As a result of this change, resources had been changed to meet the demand;

·       Whether handovers were still being made at Grantham hospital, as there had been no mentioned of this in the presentation.  The Committee noted that only a small number of patients were taken to Grantham & District Hospital;

·       Whether there were ambulances dedicated to Lincolnshire.  Confirmation was given that Lincolnshire ambulances were predominantly available to respond to emergencies in Lincolnshire.  If, however, there was a serious emergency in a neighbouring county, Lincolnshire would send whatever was available to help, as there were clear protocols in place to deal with serious emergency situations.  Likewise, if a serious emergency were to happen in Lincolnshire, mutual aid would be received from other counties.  Further reassurance was given that Lincolnshire received a large proportion of aid, whether that was additional ambulances or additional clinicians working with colleagues on the front-line to support see and treat elements.  The Committee noted that a system approach was taken, based on demand and the right amount of resource.  It was highlighted what would help the resource and demand situation, would be better flow through a hospital, enabling the service to hand over patients quicker, freeing up ambulance staff to be able to attend the next incident to treat further patients.  It was highlighted that two summits had been held by the County Council working with partners to try and address the issues, and that a system was already in place to start to move things forward in the right direction.  The Committee was also advised that if a major incident occurred in Lincolnshire local crews would deal with the incident and support would be provided from neighbouring counties to keep the day-to-day services running and that processes were in place to deal with differing scenarios;

·       Outcomes of patients, via hear and treat and see and treat. The Committee noted that re-contact rates were monitored, and that re-contact rates were below 5%.  It was also highlighted that call incident response forms were looked at and issues were logged if it was felt that the response made was incorrect.  The Committee was advised that different mechanisms were in place to ensure that the service was making the right decision for the patient;

·       Military support provided to EMAS.  It was reported that the trust had received assistance from sixty general duty staff who had gone out with clinical staff.  Twelve of those staff had been in Lincolnshire.  The Committee was advised that that the military personnel had provided great support and had been fantastic to work with;

·       Relationships with providers, Particular reference was made to Lincolnshire Integrated Volunteer Emergency Services (LIVES), neighborhood teams and Community Emergency Medicine Services (CEMs).  The Committee noted that the CEMs, which was provided by LIVES had three vehicles which were active most days; and that advice could be sought from them regarding clinical input, pre-hospital, and that their focus was mainly on the more complex cases.  It was highlighted that they had a range of diagnostic equipment on board to help them determine the best route for a patient to take.  Ambulance staff liaised with them, and they were linked to the day-to-day service.  With regard to primary care networks, it was reported that a pilot had been working in the south of the county, which was focused on the role of an advanced paramedic or a first contact paramedic working side by side in primary care.  It was noted that work continued with the more engaged networks to demonstrate the value of the role, both for primary care and for EMAS.  With regard to the role of CEMs staff, it was noted that staff were available to attend emergencies, working with ambulance crews as they arrived, ascertaining the acuity of patients.  It was noted further that CEM staff aimed to keep the flow through any hospital; and

·       The effect the acute services review could have on existing services pressures.  Confirmation was given that EMAS had put together a business case based on the impact of the review on services.  EMAS had also been involved in the consultation and had attended public meeting to address any concerns.  Overall, it was felt that there would be minimal impact on the proposed changes from both EMAS and the patient perspective.

The Chairman on behalf of the Committee extended thanks to the presenters.

RESOLVED

1.      That the Committee’s thanks be recorded to all staff of the East Midlands Ambulance Service NHS Trust for their efforts since the beginning of the pandemic.

2.      That a further presentation be requested in six months’ time, to include the additional statistical information requested by the Committee.