Issue - meetings

44.1.      The Committee considered a report providing an update from SECAmb on a number of areas, including performance against national response times and the new NHS 111 service.

44.2.      Ray Savage, Strategy and Partnership Manager at SECAmb, clarified that there was an error in one of the tables in appendix A (p. 53). In the table ‘Sussex CCG performance 2020’, The East Sussex CCG entry for Category 1 said 00:18:18 but it should have read 00:08:18.

44.3.      The Committee asked whether there were sufficient resources to meet the category response targets consistently in the future in East Sussex.

44.4.      Mark Eley, Associate Director of Operations – East at SECAmb, said the Category 1 and 2 targets are challenging to achieve in East Sussex compared to other areas in its patch, such as Brighton & Hove, due to the rurality of the county. The low population density and country roads make it very challenging to reach a patient in the 7 minutes required for a Category 1 response. Staff sickness due COVID-19 and the winter weather has made it harder in the last few months to respond as quickly. He clarified that the 7-minute performance of SECAmb is taken as an average. Therefore, to balance out the slower response in rural areas, ambulance crews in urban areas such as Brighton & Hove are expected to respond in less time. He added that SECAmb aims to arrive as soon as possible, not just at the mandated response time.

44.5.      Mark Eley said the Trust continues to look at all opportunities to  improve its performance, including reviewing local standby points to make sure they are in the best place relative to population centres and that the appropriate number of ambulances are located closest to those areas that require them most often, for example, those with higher health inequalities.

44.6.      The Committee asked how many clinical staff are working for the Clinical Assessment Service (CAS) and whether they were working in a call centre or remotely.

44.7.      Simon Clarke, Head of Operations, Integrated Urgent Care, 999 & 111, said the CAS has approximately 130 whole time equivalent (WTE) clinicians, which is made up of many more individuals due to not all of them doing it full time. This workforce includes General Practitioners (GPs), Advanced Nurse Practitioners, midwives, dental nurses, pharmacists, mental health nurses, and urgent care practitioners. The majority are working remotely, in part due to COVID-19 restrictions, but a certain number are required in the Emergency Operations Centres to be able to give direct advice to call handlers in the call centres when immediate advice is needed for a challenging call.

44.8.      The Committee asked about the performance of Think NHS 111 First.

44.9.      Simon Clarke said that it launched officially in December, although there had been an earlier soft launch. The aim of Think NHS 111 First is to reduce ED attendance by providing anyone who calls 111 with a disposition that may require them to go to an ED with  ...  view the full minutes text for item 44

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28.1.      The Committee considered a report providing an update on the quality and performance of services provided by South East Coast Ambulance NHS Foundation Trust (SECAmb).

28.2.      The Committee received a number of responses to its questions from the witnesses in attendance.

Category 3 wait times

28.3.      James Pavey, Regional Operations Manager, explained that the Ambulance Response Programme (ARP) Categories are nationally set and are designed to ensure that those patients who are the sickest get the quickest response, but also the most appropriate response and are then conveyed to the most appropriate place of care. This means that during periods of high demand on the service there can be a backlog of less urgent calls (category 3 or 4) which is the result of prioritising the more serious calls and, as identified in the Demand and Capacity review, it is at these times there is insufficient resource to send a response to all calls. He agreed that it is not acceptable that patients triaged to category 3 or 4 have to wait too long and he apologised for the excessive waits that some patients experience, however, he said the additional funding from the Demand and Capacity review would help to address response times in the longer term.

28.4.      Mr Pavey explained that there are escalation plans in place for when the backlog of calls reaches a certain level of approximately 70-80 calls across the Kent, Surrey and Sussex region. This occurs when there are more calls than resources, the service is under severe pressure, and there is a high level of patients waiting for an ambulance, including patients who may not need one. It is during these times the trust does quite a bit of ‘no sending’ to deal with those patients who do not need an ambulance by giving them advice over the phone on other alternative sources of care available to them. He explained that staff will try and give the right advice to these patients over the phone where it appears that they do not need an ambulance, however, sometimes it is difficult to tell what is happening over the phone and it is necessary to dispatch a clinician to visit the patient and determine what care they require.

Falls

28.5.      James Pavey explained that falls are initially categorised under Category 3 (response time of 2 hours) provided there are no other serious symptoms such as shortness of breath. The Trust also carries out welfare call backs for patients who are waiting, and their category will be upgraded if they are displaying more serious symptoms.

Hear and treat

28.6.      It was explained that only about 60% of patients seen by ambulance crews need to be conveyed to hospital, so it is possible to diagnose and treat some patients over the phone through a process called Hear and Treat. James Pavey  ...  view the full minutes text for item 28