Issue - meetings

7.1 The Committee considered a report providing an overview of SECAmb’s progress in its Improvement Journey following the findings of its 2022 CQC report, and updating on the latest performance figures of the Trust.

7.2 The Committee asked how SECAmb was working with other NHS bodies to prevent a loss of staff to other services, including GP practices.

7.3 Richard Harker, SECAmb Operating Unit Manager East Sussex, answered that staffing levels in East Sussex and across SECAmb were improving, following a fall in staff a few years ago. In the East Sussex area there was a fully established paramedic workforce. This was attributed to the improving culture within the service, and rising staff satisfaction. Matt Webb, SECAmb Associate Director of Strategy and Partnerships, added that the professional development offer at SECAmb, from working in a variety of healthcare settings, was one of its strengths and something that would improve staff retention levels.

7.4 The Committee asked how patients who had difficulty articulating their issues were triaged to ensure that the right support was sent to them.

7.5 Richard Harker noted that there was always a slight risk of mis-categorisation of priority, but call handlers were supported by the NHS Pathways system to ensure they were asking the right questions and people were correctly triaged. If there was any level of uncertainty that a patient could be in a higher category or a risk that they could deteriorate then an ambulance would always be dispatched. Matt Webb added that NHS Pathways was a tried and tested triaging system that was used nationally with a number of safety nets and a high risk threshold built. SECAmb’s service model of triaging quickly and accurately was to ensure patients were supported by the most appropriate clinician, as this was shown to be key to improved patient outcomes. An immediate physical response would not guarantee the right clinician was sent to a patient and therefore would not necessarily lead to the best patient outcome.

7.6 The Committee asked if there was always a paramedic present on every ambulance.

7.7 Richard Harker explained that there would not always be a registered paramedic onboard a dispatched ambulance. There were a number of grades below registered paramedic, such as associate ambulance practitioners and ambulance technicians who were qualified clinicians who could work on ambulances.

7.8 The Committee asked how ambulance crews had enough information to provide the correct support to patients.

7.9 Richard Harker explained that an ambulance crew would look for a number of different forms when it arrived at a scene, including ReSPECT (Recommended Summary Plan for Emergency Care and Treatment), do not resuscitate, and treatment escalation plans. The condition of the patient would determine the urgency of asking for or finding these forms. SECAmb also had a service where these forms could be uploaded to its computer systems, giving ambulance crews advance sight of them prior to arrival on scene.

7.10     The Committee asked why the information referenced in the previous answer was not available  ...  view the full minutes text for item 7

7.1       The Committee considered a report providing an overview of SECAmb’s progress in its Improvement Journey following the findings of its 2022 CQC report, which led to a rating of inadequate in the well-led domain.

7.2       The Committee asked what the current rates of staff turnover and sickness were.

7.3       Matt Webb responded that SECAmb’s annual rolling turnover rate was 18.2% against a target of 10%. Although retention issues were sector-wide, SECAmb was investing heavily in improving leadership visibility and exit interviews to understand what could be done to improve staff retention. Since the pandemic there had been a significant increase in staff citing burnout and exhaustion as reasons for leaving. As part of its improvement journey SECAmb had appointed a Programme Director for People and Culture whose role was to implement the People and Culture Strategy that included aiming to improve staff wellbeing and Freedom to Speak Up processes. Other work had been done to improve rotas and reduce the burden on staff.

7.4       The Committee asked how staff were being engaged in SECAmb’s Improvement Journey, what feedback had they received from staff since it began and how the bullying culture identified in the CQC report was being addressed.

7.5       Matt Webb explained that SECAmb is actively communicating with staff on how concerns that they had raised were being addressed. A challenge for SECAmb as part of its improvement journey was that the nature of the CQC report required the organisation to make a number of regulatory improvements. However, having improved in those regulatory areas SECAmb was now better placed to address cultural issues. Staff and unions were engaged to help feed staff views into a five-year strategy which will make any improvements sustainable in the long term. SECAmb has also been working with Healthwatch to make sure patient views are also taken into account.

7.6       The Committee asked if there would be value in SECAmb running its own staff survey in order to track improvements.

7.7       Matt Webb explained that the work on leadership visibility was a more effective way of gaining staff feedback, as the visits were targeted and scheduled and allowed for a dialogue between frontline staff and the organisation leadership. Staff feedback from these visits had been positive as staff felt they were being heard and ensured there was more direct feedback than would otherwise be received through an online survey. SECAmb was also trialling engagement software that focused on smaller teams to provide more granular detail on staff views.

7.8       The Committee asked how many SECAmb managers were yet to complete a sexual safety workshop.

7.9       Matt Webb answered that the training was mandatory for all managers and leaders in SECAmb, and the uptake had been very high with more than half (70% of managers) already having attended one. Ray Savage added that the fact the course was externally led had been beneficial for ensuring there was no unconscious bias involved.

7.10     The Committee asked whether SECAmb had schemes that allowed staff to  ...  view the full minutes text for item 7

14.1.    The Committee considered a report providing an overview of SECAmb’s Care Quality Commission (CQC) report findings, following a rating of inadequate in the well-led domain, and the Trust’s Improvement Plan.

14.2.    The Committee asked how staff are involved in the improvement plan.

14.3.    Matthew Webb, Associate Director of Strategic Partnerships and System Engagement, confirmed SECAmb is absolutely listening to staff and not just transmitting to them. The Trust has now spent the last 6 months listening to staff, as it began its improvement journey last year through the ‘Better By Design’ programme prior to the release of the CQC report in June. Matthew Webb said that Better By Design did not address all the concerns identified by the CQC Report but demonstrated there was a recognition of the fundamental concerns and issues that needed to be addressed as an organisation. He confirmed the Trust recognises staff can contribute to each of the four improvement pillars and are helping to co-design them. There are also leadership visits being undertaken by middle managers and Board members to meet staff and listen to their challenges and concerns, as well as opportunities for staff to communicate via email with executives and receive a response to their concerns. Cultural change will take time, so in the short term ahead of winter, the Trust is aiming to ensure staff have the right toolset, resources and support to enable them to respond to patients effectively.

14.4.    The Committee asked when SECAmb is aiming to exit the Recovery Support Programme (RSP).

14.5.    Matthew Webb explained the Trust has worked through a number of criteria with NHS England covering how it will exit the Recovery Support Programme (RSP). It is working towards a period of 9-12 months before it will leave the RSP, at the earliest. However, a target end date is currently being agreed with NHS England and commissioners. The CQC has also issued warning notices that must be achieved by November 2022. Issues around culture, however, will likely take 24 months or more to fix.

14.6.    The Committee asked why the Trust’s CQC rating slid backwards to inadequate following achieving good in 2019, and asked what reassurance could be given it will not happen again.

14.7.    Matthew Webb agreed that the Trust made a number of improvements between 2016 to 2019, however, it did not as an organisation maintain or sustain them. This is because at the time SECAmb developed a CQC Action Plan to rectify the issues raised by the CQC, which it treated it as a transactional plan to satisfy the CQC’s warning notices. This time, however, SECAmb has developed an Improvement Plan, which is a long term plan recognising the significant journey the Trust is on not just to address the cultural issues raised by the CQC, but also to improve the quality of care it provides and develop the best support it can to staff. The Improvement Plan aims to ensure these changes are embedded and sustained over the long term.

14.8.  ...  view the full minutes text for item 14