Agenda item

(To receive a report from Nikki Silver (Chief Executive Officer, LIVES) which provides the Committee with a status report and update on services provided by Lincolnshire Integrated Volunteer Emergency Services.  Nikki Silver (Chief Executive Officer, LIVES) and Dr Simon Topham (Clinical Director, LIVES) will be in attendance for this item)

Consideration was given to a report from Nikki Silver (Chief Executive Officer, Lincolnshire Integrated Volunteer Emergency Services (LIVES)) which provided a status report and update on services provided by LIVES.

 

Nikki Silver (Chief Executive Officer, LIVES) and Dr Simon Topham (Clinical Director, LIVES) were in attendance for this item.

 

Dr Simon Topham (Clinical Director, LIVES) introduced the report which explained that LIVES was a charity in its 48^th year of operation and which held the charitable objectives noted below:-

 

          To provide Immediate Medical Care to any person injured in an accident involved in any medical emergency in the area of Lincolnshire, North East Lincolnshire, or any area reasonable close to.  To advance the principle of Pre-Hospital Emergency Care on a national basis; providing advice and guidance in all aspects of such care, including the delivery of training and provision of approved emergency equipment.

 

Responders were organised into operational groups based on a response time of approximately six minutes under normal driving conditions.  There were over 160 responder groups across Lincolnshire with around 700 active LIVES Community First Responders and LIVES Medics.  The service had responded to almost 21,000 emergency calls in 2016 which was an increase of approximately 15% on the previous year.  It was expected that this would continue to increase.

 

LIVES appointed its first Chief Executive Officer in recognition that the organisation had reached a level where strategic development was required to respond to the ever-growing demand for health and care within a resource-limited NHS.

 

On receipt of a 999 call within a responder's area, East Midlands Ambulance Service NHS Trust (EMAS) would despatch an emergency ambulance with a response category determined by the AMPDS computer-based triage system.  At the same time, the EMAS Community First Responder (CFR) desk would activate the LIVES responder 'on-duty'.  The responders were dispatched using a response 'isochrones map' determined by an ability to get to the patient within six minutes.  The schema leads to the responder:-

·       Clearing and controlling the airway of an unconscious patient;

·       Providing resuscitation and defibrillation;

·       Giving oxygen therapy;

·       Controlling any bleeding;

·       Taking observations; blood pressure, blood glucose, temperature, respirations and pulse;

·       Being the 'eyes and ears' of the ambulance service and feeding back information to control if the situation is not as initially expected;

·       Making the patient feel more comfortable and at ease; reassuring worried relatives and taking charge of the situation; and

·       Using local knowledge to ensure that the ambulance can find the location quickly.

 

Responders made the biggest impact on calls coded by the AMPDS system as RED1 or RED2 calls which had been deemed "serious and/or life threatening".  Examples of RED calls were:-

·       Signs of cardiac arrest;

·       Unconsciousness and collapse;

·       Chest pains (for example, heart attack and acute angina);

·       Breathing difficulties (for example, asthma);

·       Diabetic emergencies (for example, hypoglycaemia);

·       Fitting or convulsions (for example epilepsy);

·       Stroke;

·       Anaphylaxis (severe allergic reaction); and

·       Choking.

 

More experienced volunteers also respond to traumas and some to road traffic collisions and made the early assessment if additional resources were required.

 

LIVES medics had been voluntarily providing advanced pre-hospital emergency care since the inception of the charity in the early 1970s.  These members were qualified healthcare professionals; doctors, nurses, paramedics and technicians who freely offered their spare time to respond to 999 calls when available.  Medics may attend the following types of incidents:-

·       Life-threatening medical emergencies;

·       Cardiac arrest;

·       Paediatric emergencies;

·       Road traffic collisions;

·       Major trauma;

·       Major incidents; and

·       Respond to requests for on-scene advanced clinical support.

 

It was reported that 18.8% of EMAS RED calls were attended by a LIVES CFR.  Although the contribution to EMAS performance had reduced over the last year, the actual number of calls attended had increased by 3,628.  Work was ongoing with NHS commissioners to understand the reason for this.

 

In 2016, LIVES responders achieved a ROSC (return of spontaneous circulation) rate of 31.8% in patients attended.  This was a significant improvement on the national average of 10-13% and could be attributed to a number of factors including geographic reach, responder availability and a focus on training to ensure volunteers were well equipped.

 

LIVES was dependent on generating income to enable volunteers to deliver this level of response.  Delivery of LIVES services cost in excess of £1m.  Lincolnshire CCGs provided £307k of funding under a contract to deliver the CFR service although no funding was received for medic response or the new CAS response.  This income was generated through fundraising and commercial activities.

 

Two grants had been awarded, totalling £29k, to fund the development of a Cycle Response Unit (CRU) in the Lincoln shopping centre and also to facilitate the delivery of CPR training to secondary schools in the area.

 

Disappointingly, LIVES was unsuccessful in securing a grant from the LIBOR funds distributed by the Chancellor of the Exchequer in the Autumn Statement.  These grants were available to military and emergency services charities and, despite the submission of a bid for £850k to fund monitoring equipment for volunteer medics, this had been rejected due to concerns around additionality due to the close working with the NHS and the size of the grant in proportion to the turnover of the organisation.  The Chief Executive was currently meeting with MPs in Lincolnshire to secure support for a future funding bid.

 

As a progressive organisation, ongoing development projects included:-

·       Clinical Assessment Service;

·       Lincoln Cycle Response Unit;

·       Ongoing development of volunteers;

·       Pilot of LIVES volunteers on the CFR dispatch desk at EMAS;

·       A pilot of a smartphone APP for dispatch of responders;

·       Introduction of telemedicine and advanced monitoring capability for medics; and

·       LIVES 2017/18 CQUIN proposal to train and equip responders to undertake near patient urine testing.

 

An additional element of the work of LIVES was the commitment to education and sharing skills both with healthcare colleagues and the wider community.  Two key developments included providing CPR training to schools, youth and community organisations and to provide full training to those volunteers content with providing a Level 1 response only.

 

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

·       The Committee was disappointed that the bid for a LIBOR Grant had been unsuccessful and it was explained that this may be due to profile.  LIVES was the only organisation of its kind in the country and it was suggested that more detail was required within future bids to ensure decision-makers understood what exactly the service provided;

·       Although there were other community co-responder schemes throughout the country, the level of service provided in Lincolnshire was very different;

·       Following a meeting with EMAS, LIVES had requested data to enable a comparison of the calls responded to by LIVES rather than EMAS;

·       It was confirmed that any funding received was not used to pay responders, these were very much volunteers.  The funding was for equipment and training to ensure the best and safest level of service was given;

·       The motivation for LIVES was to provide support to communities and not to alleviate pressure from EMAS although any pressure taken from EMAS in this current climate was acknowledged as a bonus;

·       Responders were trained to different levels depending on their own personal drive.  Some responders had become 'train the trainers' which would help people to retain skills and remain competent;

·       The impact of the service needed to be better promoted and it was intended that LIVES would contact every parish; district, town; and county councillor in addition to all county MPs to provide detailed information on what they do;

·       An application was also being prepared to bid for the Coastal Community Fund as the coastal area was an area which needed further recruitment and coverage;

 

At 2.57pm, Mr P Keeling left the meeting and did not return.

 

·       The Road Traffic Act allowed medics who were required to travel some distance to be 'blue light' trained but there was no provision for responders to do the same.  This type of training and equipment could cost in the region of £3500 for each responder which was prohibitive although it was being considered for some areas which were regularly gridlocked;

·       A suggestion was made to make arrangements to celebrate the 50^th Anniversary of LIVES in 2019 and to continue to raise the profile across the county.  This could include contacting past fundraisers to take part.  Responders and volunteers were intent on helping their communities, however it was agreed that more needed to be done to celebrate the achievements and to promote the continued endeavours of LIVES.

 

The Chairman encouraged discussions with the seven Lincolnshire MPs and also suggested requesting an opportunity to give a presentation in London, to the Chancellor of the Exchequer, prior to the next round of LIBOR bids.  The Chairman also suggested to the Committee that a letter be written to the Chancellor of the Exchequer to express the Committee's disappointment that the bid submitted by LIVES for LIBOR funding had been rejected.

 

RESOLVED

1.    That the report and comments be noted; and

2.    That the Chairman, on behalf of the Committee, write to the Chancellor of the Exchequer to express disappointment at the rejection of the bid for LIBOR funding.