Agenda item

25.1     The Committee considered a report by the Assistant Chief Executive providing information on South East Coast Ambulance NHS Foundation Trust’s (SECAmb) planning for 2015/16 winter pressures and other issues.

25.2     Paul Sutton, Chief Executive, and Geraint Davies, Director of Commissioning, provided HOSC with a PowerPoint presentation and, in response to questions from the Committee, provided the following additional information:

Winter period

·         SECAmb considers that the key focus period during winter takes place between 1 December and 12 January – even though the worst winter weather may come after that period – because it is during that time when the availability of NHS staff is at its lowest. After 12 January, the system begins to get back to its normal availability.

Handover times

·         There is a national standard for handover time of 15 minutes after arrival at hospital. However, because three-hour delays are a routine occurrence in some hospitals in the South East, this target is nowhere near to being met.

·         SECAmb considers it to be inappropriate from both a clinical and patient experience perspective that patients often have to wait for hours at a time on an ambulance trolley. As a result, the Trust continues to point out to Monitor, NHS England, and the NHS Trust Development Authority (TDA), that the 15 minute handover time is being ignored. 

·         It is the policy of SECAmb to tolerate a certain amount of delay in the handover time between ambulance crew and the hospital staff and the Trust tries to support the situation by both keeping its ambulance crews on site for as long as it can, and employing a Hospital Ambulance Liaison Officer (HALO) to try to help coordinate and speed up the process of handover.

·         SECAmb now has in place an Immediate Handover Policy that is used when there is a very serious incident that necessitates the immediate withdrawal of ambulance crews who are waiting to handover patients at a hospital, for example, when there is a cardiac arrest in the community that requires an immediate response and there are no free ambulance crews to attend to it. The ambulance crew inform the HALO and hand over their patient to the care of hospital medical staff. 

·         If the national standard for handover times was enforced, it is arguable that acute trusts would recognise that responsibility for the cohort of patients in the hospital rested firmly with them and would do more to achieve the handover time, for example, by employing handover nurses who fulfil the role currently performed by ambulance staff. ESHT and BSUH have carried out initiatives that have improved handover times at the Royal Sussex County Hospital in Brighton, EDGH, and Conquest Hospital. The Sussex-wide Urgent Care Network is meeting on 16 December to discuss handover times.

111 patient triage

·         During the winter period 2014/15, 111 activity was at its peak and there was low confidence within the organisation of the accuracy of the categorisation of those 111 calls. In response, the Trust Board developed a pilot programme that involved paramedic practitioners reviewing the calls transferred across from 111 to 999 in order to determine whether they should join the 999 ‘call stack’; where in the stack they should join, for example, mis-diagnosed cardiac arrest patients would join at the top; and whether they could be dealt with in another way that did not require an ambulance despatch – one third of assessed calls did not require an ambulance dispatch. The purpose of the pilot was to ensure the accuracy of the call categorisation by 111 call handlers in order to prioritise which patients got an urgent ambulance despatch.

Recruitment and retention

·         SECAmb plans for and understands seasonal variations in demand based on the accurate demand analysis it carries out. However, matching capacity to demand is more difficult; SECAmb is 20% more busy in December than in April but sufficient additional staff are not available to meet this demand – although some of the capacity is made up for by bank staff, the private sector, and third sector.

·         There are recruitment, capacity, and retention challenges with paramedics across all ambulance trusts due to the high demand for their skill set from ambulance trusts and GP surgeries. Furthermore, proposed regulations that will allow them to prescribe medicine are likely to make them considerably more desirable, making them harder still to retain. Often, paramedics will join GP surgeries as paramedic practitioners to carry out home visits but will re-join SECAmb as bank staff to retain their 999 response skills and their registration as a paramedic.

·         Paramedic degrees are highly sought after – and more subscribed than medical degrees at the University of Brighton – so SECAmb is keen to retain its paramedics and believes it has an attractive clinical model that results in it being a net importer of paramedics.

·         The retention of paramedics was one of the main reasons for SECAmb’s decision to develop the role of ‘community paramedic’. The purpose of community paramedics will be to provide home visits to patients who are triaged as lower grade 999 calls, who have called 111, or who have called GP out of hours. The only difference between these three categories of calls is the patient’s access point. This will benefit SECAmb as it can retain paramedics, and it will benefit GP surgeries as they will not have to go through the process of recruiting paramedic practitioners to deal with out of hour calls. The CCGs have also expressed support for the community paramedic programme.

25.3     The Committee RESOLVED:

1) that it had considered and commented on the report, its appendices, and the presentation; and

2) that it wished to commend SECAmb for its work in attending to the airshow disaster at Shoreham.