Issue - meetings

1.1.        The Committee considered a report by the Assistant Chief Executive on the extent of delays in handover of patients from ambulances to hospital emergency departments, how handover is managed, and actions in place to address this issue.

1.2.        East Sussex Healthcare NHS Trust (ESHT), Brighton & Sussex University Hospital NHS Trust (BSUH) and South East Coast Ambulance Service NHS Foundation Trust (SECAmb) provided presentations on their role in the hospital handover process.

1.3.        HOSC asked the witnesses from the three Trusts a number of questions.

Impact on ambulance services

1.4.        HOSC asked when SECAmb would reach a critical point in terms of handover delays.

1.5.        Geraint Davies said that SECAmb was already at a tipping point and there were regularly days where there were ‘planned wipeouts’ ( i.e. no ambulances available to respond to new calls). These occurrences did not necessarily fit a pattern.

1.6.        Tim Fellows, Operational Manager, SECAmb, said that the delays in hospital handover meant that most ambulances were having to travel from one of the three hospitals in Brighton, Eastbourne and Hastings to respond to emergency calls, making response times more lengthy. If hospital handover times could be improved then ambulances could be redistributed strategically across a wider geographic area so that there would always be an ambulance close to most residents. He clarified that patients, in the main, had not been suffering any harm as the response times were still good and the quality of care remained high.

Causes of handover delays

1.7.        Dr Adrian Bull, Chief Executive, ESHT, said that hospital handover was not an issue just for the A&E department, or even the hospital, but the health system as a whole. The delays in hospital handover were a symptom of a wider problem that was also affecting ESHT’s 4 hour and 12 hour A&E waiting time targets.

1.8.        Dr Bull accepted that hospital handover times were unacceptable but made the point that it was dangerous when considering a system–wide issue to focus on just one parameter and try to fix it at all costs. He said that handovers were taking so long because busy staff were attending to patients who need care elsewhere; a patient waiting in an ambulance with paramedics may be safe whilst another patient may arrive at A&E in urgent need of care. Focusing exclusively on handover would have knock-on effects elsewhere. It was a complex interdependent problem with a lot of competing issues that need resolving,

Actions to reduce handover times

1.9.        HOSC asked what actions are being taken to reduce handover times, in particular the recruitment of staff, and what the timescales for these actions having an effect would be.

1.10.      Geraint Davies said that the main issue for SECAmb was for acute trusts to get the appropriate capacity at A&E departments to enable ambulance crews to handover patients in a timely way. He recognised the pressure this put on acute trusts, which was why the ambulance and acute trusts needed to work  ...  view the full minutes text for item 6