Agenda item

(To receive a report from Sue Noyes (Chief Executive of East Midlands Ambulance Service NHS Trust), which outlines the key areas of performance within the East Midlands Ambulance Service (EMAS) and, in particular, the Lincolnshire Division.  The report also includes an update on the work and ongoing projects being carried out to enhance and support performance.  Andy Hill (Lincolnshire Divisional Manager – EMAS) will be in attendance for this item)

A report by Sue Noyes (Chief Executive of East Midlands Ambulance Service NHS Trust) was considered which outlined the key areas of performance within the East Midlands Ambulance Service (EMAS) and, in particular, the Lincolnshire Division.  The report included an update on the work and ongoing projects being carried out to enhance and support performance.

Andy Hill (Lincolnshire Divisional Manager – EMAS) and Steve Kennedy (Divisional Support Manager – EMAS) were in attendance for this item of business.

Members were given an overview of the report which provided Quarter Two Performance Data (July, August and September 2015).  It was also reported that the Care Quality Commission (CQC) had inspected EMAS in November 2015, the outcomes of which were expected in early 2016.

It was reported that the Lincolnshire Division had achieved the Red 1 target for the quarter (76.56%).  This had been challenging with the Division falling short of the required target by 1.44%.  Handover delays at hospitals were detailed in Table 2 of the report but it was stressed that these figures were subject to validation.  Overall activity in comparison to Quarter Two in 2014/15 had increased by 6%

EMAS had noted that inter facility transfers (IFTs) from Grantham and District Hospital had increased by 23% compared to 2014/15.  In order to establish the reason for the increase a review was being undertaken.  The review would also identify what actions would be required to mitigate impact on performance in the South Lincolnshire and South West Lincolnshire CCG areas.  Once the review was complete, the findings would be made available to the Committee.

Close working with United Lincolnshire Hospitals NHS Trust (ULHT) had resulted in proactive management of handover delays although this remained an ongoing issue which was being reviewed as part of the Recovery Plan for ULHT.  December 2015 saw the deployment of a clinical navigator by the Division to Pilgrim Hospital which was to liaise with ULHT staff to efficiently signpost patients thereby freeing up EMAS resources to respond to other calls.  The impact of this initiative would be reported to the Committee once available.  It was confirmed that Hospital Ambulance Liaison Officers (HALOs) would also continue to be deployed to all sites where pressures were identified.

An EMAS Healthwatch Task Group had been formed between the Trust and Healthwatch Lincolnshire to consider and act upon initiatives in response to local need.  Engagement with both System Resilience Groups (SRGs) and Urgent Care Working Groups was well established with representation and participation being regular and inclusive.  Unique initiatives with partner organisations, including CCGs, Integration Executive, Local Resilience Forum (LRF) and others were congoing in support of the improvements necessary for the wider Lincolnshire health economy. 

The following initiatives had been developed to improve service and performance:-

·       Mental Health Car Initiative;

·       Mobile Incident Unit, Butlins – Skegness;

·       Clinical Assessment Car Initiative;

·       South Lincolnshire Investments/Initiatives;

·       Joint Ambulance Conveyance Project (JACP) – Stamford, Woodhall Spa and Long Sutton;

·       Clinical Navigator role at Pilgrim Hospital, Boston; and

·       Addressing patient handover delays within the acute trusts.

In relation to the Joint Ambulance Conveyance Project (JACP) Project Data, Lincolnshire Fire & Rescue (LFR) and EMAS had developed a pilot project aimed at improving the quality of service and outcomes for patients in Lincolnshire.  The project had built on LFR's existing co-responder scheme, run in partnership with EMAS and Lincolnshire Integrated Voluntary Emergency Service (LIVES), in which on-call retained firefighters from 21 stations responded to medical emergencies, delivered first aid, provided oxygen therapy and administered defibrillation and cardiopulmonary resuscitation. 

The Fleet Services Strategy was agreed by the EMAS Board in March 2015 and highlighted the case for investment in the EMAS fleet to respond to a range of challenges.  A commitment had been made to invest between £19m - £24m over the next five years on new vehicles and would ensure that the age profile of the fleet was reduced to seven years by the end of the financial year 2018/19.

The allocation of ambulances to the Lincolnshire Division had been identified from the age profile of all ambulances within the fleet.  Lincolnshire received 46% (37 of 80 acquired) of the new vehicles in 2012 therefore did not have the same aging vehicles as other Divisions. 

Members were given the opportunity to ask questions, during which the following points were noted:-

·       It was noted that the figures reported in South Lincolnshire were of concern to the Committee.  This was acknowledged and explained that there had been 600 hours of resource drift in December 2015 alone for DCA's and solo responders.  Work was ongoing to rectify this situation and to more appropriately utilise the resources available.  Specific information on the resource drift in December would be provided to the Committee;

·       Turnaround times and delays in hospitals all impacted on response time and in the south of the county in particular.  There had been a recruitment drive but the benefit of this would not be felt until mid-March 2016 due to the requirement for newly appointed staff to undergo 750 hours of supernumerary training;

·       There had been an increase in handover delays at each of the sites although had seen success at Pilgrim Hospital following the appointment of the Clinical Navigator.  This role was designed to detect certain clinical conditions of patients conveyed to hospital and make preparations to avoid the A&E department and transfer immediately to an appropriate ward.  It was stressed that this role was navigational but had appeared to have a tremendous amount of success;

·       The Clinical Navigator role was not a duplication of the HALO role which had been an ad hoc position which was put in place to support the hospitals.  The Clinical Navigator was a new role designed to proactively manage delays;

·       Red calls coming through to EMAS from other sources were unable to be downgraded and this had been reflected in a change to the Ambulance Quality Indicators (AQI);

·       Figures were requested regarding the number of 111 calls resulting in unnecessary conveyance to A&E.  EMAS representatives felt that this information should be available and would take this as an action point to provide to the Committee following the meeting;

·       Hear and Treat was a telephony based treatment system that enabled management of lower priority calls, which often resulted in the despatch of a vehicle not being required;

·       It was confirmed that the maximum number of ambulances available during peak times was 48 within Greater Lincolnshire with approximately 10 in the East of the County.  Shifts were 12 hours from 0630 to 1830hrs and 1830 to 0630hrs.  In addition to these ambulances, a further 12 were available to be tied in.  Ringfencing vehicles would be difficult but EMAS also had a Clinical Assessment Car and a Mental Health Car in the County which assisted in the appropriate utilisation of resources;

·       LIVES were acknowledged and applauded for their voluntary support of the scheme which was reported as a model envied across other ambulance services across the country.  It was a model to be nurtured and embellished and rolled out further;

·       In relation to the Toughbooks, it was explained that it was a robust working environment so they do suffer some knocks.  Despite this, it was acknowledged that the tag system wasn't adequate for the needs of the ambulance service.  The new equipment incorporated a different system to the tags, further to hardware development, which was a positive step forward.  The model in the south was to be rolled out to the north west and east of the County;

·       The table shown at 2.2 on page 27 of the report showed the Quarter 2 performance figures for JACP.  The figures were combined data and a full breakdown would be sent to the Committee following the meeting;

·       Clarification of the figures in table 1 was provided.  RED1 and RED2 data was outcome data which was able to be shared.  95% was the conveyance target with 75% as the response time target.  In terms of the survival figures for those calls against national benchmarks, 8 minutes was a target set nationally and there was a lot of ongoing work to ensure allocation of the right response and despatch to that call.  Details of this work would also be shared with the Committee following the meeting;

·       A job advertisement was currently out, from Lincolnshire Community Health Services (LCHS) for two full-time Clinical Navigators in Lincoln and Boston.  The ambulance service was current covering these roles and a meeting was scheduled to discuss the roles in greater detail.  Although there was no tangible data of the impact of these roles at present, anecdotal feedback had been positive;

·       A&E handover times at Grimsby were a concern for residents in the East Lindsey district.  This was acknowledged that a Clinical Navigator would benefit Grimsby but this would be dealt with by the processes North East Lincolnshire;

·       Within planning, winter pressures were considered.  Rotas needed to be flexed to utilise staff over those particular months.  At peak times road accidents become a huge cost to EMAS which was not necessarily as a result of the weather but the increased activity on the roads.  EMAS was working with local road safety partnerships to ascertain why the activity had increased;

·       Concern was raised about the performance figures and asked how Lincolnshire was performing in relation to other areas within the East Midlands.  Other areas in the East Midlands were experiencing the same issues and problems but Lincolnshire appeared to be the highest performing division within EMAS currently, having held its year-to-date RED1 target;

·       Although the figures within the South Lincolnshire CCG area were down to 50%, that was a measurement on two jobs alone, one target was reached, the other was not.  With such low numbers to measure, the percentage will always be fairly low but it was also stressed that although performance and percentage were important, quality of the service provided was key;

·       A suggestion was made to utilise NSL Ambulances (Human Touches) to assist with Inter Facility Transfers (IFT).  This was felt to be a valid suggestion as NSL was currently contracted to do non-emergency work.  Dedicated Transfer Crews were currently being considered but EMAS would like to run that from their own workforce rather than utilise third parties due mainly to the cost involved but this did highlight the need for dedicated IFT crews;

·       The figures throughout the report show the response time of the first person to respond to the call rather than when an ambulance arrived.  A breakdown of the data from the arrival of the first responder to the time of arrival of an ambulance capable of conveying the patient was requested;

·       "Other Conveyances" on page 27 of the report included figures of self-conveyance but also where third parties had conveyed patients to hospital;

·       For future reports, it was requested that Kings Lynn hospital be included within the figures as patients from the South Holland area were often taken to this hospital for treatment;

·       In relation to the Recovery Programme at ULHT, the Chief Executive of EMAS had a seat on the Lincolnshire Recovery Board and was proactively supporting the trust with Pathfinder and Clinical Navigators to reduce the amount of patients being taken in.  The Chairman requested that this information be included within the report from EMAS for the next scheduled update;

·       The work between Healthwatch Lincolnshire and EMAS regarding the potential initiatives of local needs was in the early stages but there was an intention to develop a formal protocol for this.  The Chairman requested the findings from this task group be presented to the Committee;

·       A number of unique initiatives were mentioned in the report and these were further explained as continued work with CCGs and community teams in terms of projects; paramedics on bikes; Clinical Navigators, etc.  Also an Alliance Agreement with CAS was a key piece of work;

·       The Committee acknowledged that there was a lot of positive activity but requested the outcomes of the activity.

RESOLVED

1.    That the report and comments be noted; and

2.    That a further update be scheduled for the meeting of the Health Scrutiny Committee for Lincolnshire on 20 April 2016.