Agenda item

(To receive a report from the East Midlands Ambulance Service (EMAS) NHS Trust, which provides the Committee with an update on current EMAS performance in the Lincolnshire Division and provides further assurance on progress made since June 2023.  Sue Cousland, EMAS Lincolnshire Divisional Director will be in attendance for this item)    

The Committee considered a report from the East Midlands Ambulance Service (EMAS), which provided an update on current EMAS performance in the Lincolnshire Division, which included information relating to:

·       A vision for the NHS Ambulance Sector, created by the Association of Ambulance Chief Executives;

·       Performance improvement, including activity for Greater Lincolnshire, resourcing and hours lost as a result of delays at hospital emergency departments;

·       Recruitment and retention; and

·       Emergency preparedness, resilience, and response, i.e., for Storm Babet

The Chairman invited the EMAS Lincolnshire Divisional Director, and the EMAS Head of Operations for Lincolnshire Division, to remotely present the item to the Committee.

During consideration of this item, the following comments were noted:

·       The Committee noted that at paragraph 3.3 of the report, second line, there was a typographical error the date should have been ‘Nov 2022’;

·       That a further Appendix would be circulated to members of the Committee following the meeting relating to paragraph 4.3 of the report pack;

·       Confirmation was provided that sickness levels were still high.  The Committee noted that the service was aiming for a 5% sickness figure which was in-line with national expectations.  It was highlighted that the long-term sickness elements were because of an ageing workforce, and that musculoskeletal reasons for absence aligned to the more mature workforce; and that some staff members who were exposed to traumatic incidents had to take time away from work with support from EMAS.  The Committee noted further that short-term sickness elements, were Covid, flu, cough, colds etc., as ambulance staff were constantly coming into contact with poorly patients;

·       The Committee was advised that Category 2 performance was still being maintained and that for the month of January it was at 41 minutes.  It was noted that the trajectory was to be closer to 30 minutes; and it was felt that quarter 4 would see that period of stability;

·       A request was made for future reports to include information relating to Category 1 performance;

·       The Committee was advised that ‘post-handover’ were actions that needed to be taken before the ambulance was available to respond to its next call.  For example, re-stocking, cleaning the vehicle and paperwork;

·       It was reported that there were a multitude of career options open to a paramedic, that could be in higher education, research primary care etc. The Committee was advised that the approach being taken was to make it easier for staff who chose to have multiple opportunities throughout their career, to gain more experience;

·       That figures relating to the rate of participation in the most recent staff survey would be made available to members of the Committee;  

·       It was reported that all elements of healthcare were experiencing high patient numbers.  It was noted that in some cases individuals could access alternatives to GP practices and A & E departments by employing self-care in the first instance.  It was noted further that education regarding access to the most appropriate health service would be continuing across the Lincolnshire system to improve the situation;

·       The Committee was advised that Appendix A to the report was a national vision for ambulance services, and that the report indicated how far advanced Lincolnshire Division was against some of the points within the national vision.  Reassurance was provided that there would be no de-skilling, the workforce plan was encouraging staff to take a pathway to take them through to paramedic, specialist paramedic and even to the role of an advanced paramedic in the future, to help with skill mix and senior clinical decision making;

·       Thanks were extended to EMAS staff for the services they provided;

·       The Committee was advised that in relation to quality assessment on the front line, there were a range of senior clinicians who worked 24 hours a day, four duty commanders a day who were experienced paramedics and there was also the clinical leadership team.  Reassurance was provided that newly qualified individuals who were on scene with a patient were contacted after a certain length of time to check if any additional support was needed or clinical advice was required. It was noted that crews all had radios should they need to make contact;

·       That information relating to the percentage of staff over 50 would be made available to the members of the Committee;

·       The Committee was advised that new eligibility criteria were being applied with regard to patients being conveyed to the Grantham Urgent Treatment Centre rather than going elsewhere such as Peterborough City Hospital or Pilgrim Hospital, Boston.  It was confirmed that there had not been any significant issues with patient care since the new eligibility criteria had been applied;

·       Presenters agreed that for future reports, figures would be included on the number of patients being conveyed to urgent treatment centres, including Grantham;

·       Confirmation was provided that the Lincolnshire Resilience Forum (LRF) would hold information relating to vulnerable people, and that EMAS worked very closely with the LRF.  In a flooding scenario, i.e., a care home under the threat of flooding the Committee noted that there were business continuity plans in place at the care home involving local authorities that ordinarily would be involved in such an event.  It was noted that EMAS would not be involved as a 999 emergency service in events, such as evacuation;

·       The Committee was advised that the recruitment figures quoted in figure 21 (on page 37 of the report pack) for November and December had been achieved;

·       The Committee was advised that EMAS worked very closely with the Highways Departments and when storm conditions caused roads to be closed, workarounds were put into place, i.e., whether that was alternatives routes, or alternative vehicles;

·       Reassurance was provided that the only way to ensure stability was to change the way the service worked and that was being strived for across the Lincolnshire system;

·       It was highlighted that there were delays in EMAS responding, but the care received from EMAS was excellent and that this was reflected in the number of complaints and PALS interactions.  It was noted that most complaints were regarding delays.  It was hoped that in the future this would be reduced;

·       It was reported that all ambulance staff nationally carried iPads, to enable them to access information and gain assistance.  The Committee noted that staff completed the electronic patient form via the iPad, recording all the actions taken during the incident, the document was then transmitted to the hospital to become part of the patients notes. The iPad also enabled staff to see patients electronic NHS records, provided access to available pathways, provided data around medication doses and pieces of equipment etc;

·       The Committee was advised that feedback cards were not used, however, what was provided through various mechanisms and interactions was the ability for people to provide retrospective feedback via the friends and family test, which was a national mechanism for feedback in terms of service users.  It was also highlighted that some calls were provided with a retrospective call to see how the caller would rate the interaction.  It was highlighted further that when EMAS were discharging a patient in their home, a leaflet was provided which provided follow up advice and a description of what had happened;

·       The Committee was advised that when reviews took place such as the Humber Acute Services Review, EMAS were an integral part to the review process, and that risks and mitigations to any remodelling would be planned for;

·       That a written response would be provided regarding ‘Hear and Treat’ and ‘See and Treat’ trajectories; and

·       Confirmation was provided that the Mental Health Urgent Assessment Centre at Lincoln County Hospital was hugely beneficial to the ambulance service, and for the patient experience.

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

RESOLVED

1.      That the higher rates of ‘Hear and Treat’ and ‘See and Treat’ in Lincolnshire be supported.

2.      That the ambulance hours lost as a result of hospital handover remains a concern, but the Committee recognises this is a health system issue, where the East Midlands Ambulance Service’s performance is dependent on the patient flows in the system. That the work done to reduce waiting times be commended.

3.     That a further update be received in twelve months, and that additional information be requested with regard to the participation rates in the most recent staff survey; the age-profile of front-line staff; and the trajectories for ‘Hear and Treat’ and ‘See and Treat’.