Agenda item

6.1       The Committee considered a report providing an update on the work being undertaken to reduce Hospital Handover times between South East Coast Ambulance NHS Foundation Trust’s (SECAmb) ambulances and the EDs of the three hospital trusts that provide services to East Sussex residents.

6.2       The Committee asked how communication could be improved between EDs and the 111 service to prevent reserved time slots being given out at times of higher demand in the ED.

6.3       Ray Savage, SECAmb Head of Strategic Partnerships and System Engagement answered that it was possible to indicate times of pressure for specific service pathways to 111 call handlers, as well as remove the option to book appointment slots at peak times, on the Directory of Services. Ray agreed to check whether this was the same process for booking appointment slots at EDs.

6.4       The Committee asked why the report showed average response times increasing as of May 2023 and how those increases were being mitigated.

6.5       Ray Savage noted that hotter weather led to an increase in demand for health services generally, so the sustained period of hotter weather during May and June had caused the increase. Matt Webb, SECAmb Associate Director Strategic Partnerships and System Engagement also noted there had been an increase in the daily average number of calls since January, but that despite the increase, average ambulance response times remained within defined tolerances of targets.

6.6       The Committee asked why the Pembury hospital had a fewer number of delays and what learning could be applied from this to other hospital sites.

6.7       Ray Savage commented that handover delays where often a consequence of other challenges at a hospital site, and that Maidstone and Tunbridge Wells NHS Trust (MTW) had done a significant amount of work to improve patient flow through the hospital. Laura O’Mahony, MTW Deputy General Manager Emergency Medicine added that having a dedicated member of staff on duty to assist ambulance crews with administration had helped in reducing delays. Hospital avoidance work was also important, such as by using virtual wards and 111 integration to direct patients to Urgent Treatment Centres rather than EDs.

6.8       The Committee asked what was causing the high level of sickness among staff and what was being done to address it.

6.9       Laura O’Mahony explained that a lot of the problems with sickness was due to staff burnout and low moral across the workforce after a difficult few years in the health service. At MTW sickness levels were decreasing and the Trust continued to monitor the situation and was putting a lot of work into supporting staff wellbeing.

6.10     The Committee asked if there was detailed information of any differences in average ambulance response times in different areas of the county.

6.11     Ray Savage confirmed that SECAmb had to report its data across its whole operational footprint, so this was not broken down by specific areas. SECAmb did monitor its own local performance to understand how responses differed between urban and rural areas. Julie-Marie Allsopp-West, SECAmb Operating Unit Manager for Polegate and Hastings added that ambulances were placed strategically in anticipation of where calls were most likely to come in. Matt Webb added that there was very little variation between the Trust average response time and the average East Sussex response time.

6.12     The Committee asked whether the arrival of clinicians who weren’t paramedics were included in the average ambulance response times.

6.13     Matt Webb confirmed that while not everyone who arrived at a scene in an ambulance was a paramedic, they all had the right skills and training to provide appropriate interventions, and SECAmb had systems in place to ensure the right personnel responded to a call out.

6.14     The Committee asked what the impact there was on average response times of service reconfigurations that had consolidated specialisms to single hospital sites.

6.15     Matt Webb answered that regional services had specific capabilities that were designed to ensure the best patient outcomes, but there was a balance between this and ambulance travel times within the confines of NHS resources. Ensuring patients went via the most appropriate pathway first was not only better for outcomes but made better use of resources.

6.16     The Committee asked how patients were assessed to ensure they received the most appropriate care.

6.17     Matt Webb confirmed that all SECAmb clinicians had the necessary training to direct patients to the most appropriate care pathway. This would not always be the nearest, but if patients needed intervention sooner, then ambulances would be diverted to the closest appropriate centre if their condition needed to be stabilised, although this would not necessarily guarantee a better patient experience or outcome.

6.18     The Committee asked how SECAmb was working to improve data sharing across the system and whether it made use of data on the NHS app.

6.19     Matt Webb affirmed the importance of the data sharing work outlined in the previous item for ensuring better patient experience and outcomes. The work on integrating and sharing patient care records was ongoing and it was a priority for the system as well as nationally. The NHS app did not necessarily offer the solution as it was seen as more important for providers and trusts to be using the same systems for storing records to achieve better integration.

6.20     The Committee asked for more detail on the challenges SECAmb had in responding to Category 3 and 4 calls, and when they expected to see and improvement.

6.21     Ray Savage answered that a higher proportion of calls fell into Category 1 and 2 which were prioritised because they were time-critical life-threatening calls, but SECAmb was still within the national average Category 3 and 4 response times. For a lot of Category 3 and 4 calls ambulance crews would identify best care pathways for patients which often did not involve taking them to hospital. Category 3 and 4 patients who did not receive an immediate physical response were monitored and called back when necessary to ensure their condition had not deteriorated. Work with partners was being done to ensure patients always received the most appropriate care first and is ongoing, but it was not possible to say when improvements would be seen.

6.22     The Committee asked what feedback had been received from ambulance crews via the QR code available to them at the Royal Sussex County Hospital (RSCH).

6.23     Ali Robinson, General Manage Acute Floor RSCH, explained that most of the feedback had been positive, including that the Rapid Assessment and Treatment (RAT) model worked well. Other feedback had resulted in moving IT terminals and improved communication between hospital staff and ambulance crews.

6.24     The Committee asked whether the Blue Light Triage model had been a success and if it would be applied elsewhere.

6.25     Ray Savage explained that SECAmb were working very closely with Sussex Partnership NHS Foundation Trust (SPFT) mental health practitioners to reduce the need for an ambulance to be sent to those in mental health crisis when not appropriate, and avoid conveyance where possible. Early evidence had demonstrated that it was an effective model and there was work to bring mental health practitioners to the scene more often where someone was presenting in crisis, as well as improve telephone triage. Ray agreed to share more details after the meeting.

6.26     The Committee RESOLVED to:

1) Note the report; and

2) Request a progress report on Hospital Handovers at the RSCH for the December HOSC meeting and combine this with the update on the CQC inspection report of University Hospitals Sussex.