Agenda item

(To receive a report from Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service NHS Trust (EMAS) which provides the Committee with a copy of the Quality Improvement Plan produced in response to the inspection findings of the Care Quality Commission (CQC).  Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service NHS Trust and Blanche Lentz (Lincolnshire Divisional Manager – East Midlands Ambulance Service NHS Trust) will be in attendance for this item)

Consideration was given to a report from Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service NHS Trust (EMAS)) which provided a copy of the Quality Improvement Plan produced in response to the inspection findings of the Care Quality Commission (CQC).

Richard Henderson (Acting Chief Executive – East Midlands Ambulance Service (EMAS)) and Blanche Lentz (Lincolnshire Divisional Manager – East Midlands Ambulance Service NHS Trust (EMAS)) were in attendance for this item.

The Committee received a presentation which highlighted relevant areas for consideration from the report of the CQC.  These included:-

1.    CQC rating following November 2015 inspection;

2.    Key themes from the inspection report – frontline staffing support, leadership and training; vehicles and equipment; medicines management and record keeping; serious incident reporting and learning; complaints reporting and learning; and hospital handover delays;

3.    Progress and action going forward – 2016/17 contract settlement;

4.    Progress and action going forward – frontline staff, support, leadership and training;

5.    Progress and action going forward – vehicles and equipment;

6.    Progress and action going forward – learning from serious incidents and complaints;

7.    Turnaround – Total Lost Hours;

8.    Working together to improve patient safety – Health Education England (HEE), workforce development; Hospital handover delays; and improved system-wide demand management;

9.    Summary – action taken and improvements made were being delivered with support from commissioners and regulators.

Three core services had been inspected by the CQC which included the Emergency Operations Centre; Urgent and Emergency Care including the Hazardous Area Response Team (HART) and the air ambulance; and Patient Transport Services.

Overall the Trust had been rated as 'requires improvement'.

The EMAS Board considered its response to the CQC Inspection on 5 July 2016 and developed an action plan to respond to the issues identified in the CQCs report.  This action plan formed part of the Trust's overall Quality Improvement Plan.  A key element in the action plan was the commissioning of a Strategic Demand, Capacity and Price Review, which was also supported by the commissioners.

A Regional Scrutiny Briefing had been held on 5 July 2016 which representatives from all eleven health overview and scrutiny committees in the EMAS region had been invited.  A number of points were raised during that meeting but, due to the absence of a requirement for EMAS to deliver national response time standards as part of its contract for 2016/17 (including the absence of any requirement for EMAS to deliver these standards at Clinical Commissioning Group level) the Committee was requested to consider how best to scrutinise the response time performance of EMAS at future meetings.  For example, the provision of response time information at Divisional for CCG level would be indicative.

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

·       It was noted that community defibrillators were fit for purpose and suitable for communities but defibrillators used on ambulance vehicles were more advanced and gave the paramedic more relevant information to enable suitable treatment of the patient;

·       Although disappointing to receive an 'inadequate' rating for safety, it had proved helpful as the service were able to revisit the issue of ambulance 'drift'.  It had reaffirmed the need to ensure that other health systems could be adapted to ensure the release of ambulances on arrival at hospital;

·       The contract for the exiting Toughbooks had ended but negotiations for an extension to that contract were ongoing.  Consideration was being given to a replacement for the Toughbook to ensure that the latest product was available to staff and the Trust was confident that this would be rolled out during 2017;

·       Although it was helpful to have an EMAS Clinician in hospitals to receive patients in order to release crews, the challenge was that these members of staff were trained paramedics and should be out in the community;

·       As part of the enforcement action, there was a requirement to ensure that systems were implemented to address issues of significant concern.  As a result an independent body had evaluated all the activity and demand levels to ensure the contract was fit for purpose to deliver services for those demands.  That charge was to be apportioned to commissioners to ensure that the contract met those needs;

At 2.57pm Councillor R C Kirk joined the meeting.

·       Although it was a requirement to ensure that all staff received statutory and mandatory training, the Trust also needed to ensure that there were enough emergency vehicles to meeting demand.  There was not currently sufficient resource to meet demand and therefore the Trust were unable to remove staff from frontline service for training such as Information Governance;

·       An independent review of the Strategic Demand, Capacity and Price Review was ongoing to ensure that there were sufficient levels of units in the community.  Staffing levels remained low and it was difficult to recruit;

·       The line management model for undertaking appraisals had been changed to ensure there was more access to frontline managers.  Staff had regular contact with managers and team leaders which was giving more opportunities for managers to support staff;

·       Over 300 staff had been recruited, the Trust estates programme had been reorganised and £5m savings as a result of that had been invested in frontline vehicles;

·       Staff retention had been an issue and third party providers had been used to support some of the low level support.  Despite continued recruitment, the numbers needed were still too low;

·       The cost of the independent review was insignificant and had been jointly funded by EMAS and lead commissioners (Hardwick CCG representing 22 CCGs across the region). The lead local commissioner for Lincolnshire was Lincolnshire West CCG;

·       It was confirmed that EMAS continued to contract third party companies for patient transport but it was suggested that a certain company utilised unequipped vehicles and/or untrained staff to transport patients.  This was strongly refuted and the Committee assured that EMAS do not use unqualified staff.  All third party staff were also trained to the level expected of EMAS contracted staff.  The Chairman requested a briefing paper to explain the detail of the contract and also the training and equipment required to fulfil that contract;

·       It was further clarified that all companies who provide ambulances had to be CQC inspected and registered;

·       In relation to the NHS 111 service, it was confirmed that once a call was passed to EMAS it then became a 999 emergency.  Work was ongoing with the NHS 111 provider to ensure that inappropriate calls were not received and there has been a high volume of these calls recently;

·       Although there was a clause in staff contracts that training costs would have to be paid back should they leave service within a specified timeframe but this had proved difficult to enforce;

At 3.30pm, Councillor Mrs S Ransome left and did not return.

·       In relation to Slide 4 of the presentation, the Committee requested a full breakdown of the total lost hours for Lincolnshire by hospital as a result of turnaround delays;

·       Full detail on third party contracts and the training those staff receive and the equipment used be provided to the Committee.

·       The Chairman took the opportunity to congratulate EMAS on the success of the Joint Conveyancing Project and also the first responder service and the work undertaken by LIVES in relation to response times.

RESOLVED

1.    That assurance on the response of the East Midlands Ambulance Service NHS Trust (EMAS) to the Care Quality Commission's Inspection Report including consideration of the Trust's Quality Improvement Plan be agreed;

2.    That the additional information, as noted above, be formally requested by the Health Scrutiny Officer.