Agenda item

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 at every incident.

7.11     Richard Harker explained access to information would depend on the condition of the patient and how quickly the crew arrives on scene, as it depended on correctly identifying the patient and required information such as their NHS number and date of birth. It was also dependent on the information having been uploaded to SECAmb’s systems, which was not something all care providers did. Ray Savage, SECAmb Strategic Partnerships Manager (Sussex), added that SECAmb was currently working with NHS Sussex to access the countywide Plexus Care Record platform which brought together primary and community care plans on one system. This would give clinicians in Emergency Operations Centres access to further information on patient incidents, to improve clinical decision making. This would hopefully be in place within the next few months. Ray agreed to confirm how care providers linked into the Plexus system.

7.12     The Committee asked when SECAmb expected handover delays at Eastbourne and Conquest hospitals to reach the target of 65% under 15 minutes.

7.13     Richard Harker explained that the handover delays at Eastbourne and Conquest hospitals were relatively good compared to other areas. SECAmb worked closely with East Sussex Healthcare NHS Trust to reduce handover delays, holding regular meetings to discuss the issue. Ray Savage, added that SECAmb compared well to other ambulance trusts on the level of ambulance delays.

7.14     The Committee asked how SECAmb measured improvements in organisational culture and what the key metrics were.

7.15     Matt Webb explained that getting things right for its staff was a key element of SECAmb’s Improvement Journey. This included a review and overhaul of freedom to speak up (FTSU) processes to ensure people felt comfortable to raise concerns. There had been an increase in the number of FTSU grievances raised following that review, which showed people felt safer to report issues within the workplace. There was also a focus on meeting sexual safety charter commitments, which had involved senior leadership and managers completing sexual safety training to foster a safe working environment across the organisation. SECAmb had also enhanced its Equality, Diversity and Inclusion plan, improving workforce equality data monitoring and presenting equality reporting to the Trust’s Board to ensure compliance. A key metric for measuring improvement was the number of individual and collective grievances being opened and the subsequent closure of those grievances once they had been resolved in an appropriate timeframe, with an aim to reduce average case length. There was now a downward trend in the number of bullying and harassment, disciplinary and sexual safety grievances being opened. Richard Harker also noted that NHS staff survey results showed an increase in satisfaction, which suggested they culture was improving.

7.16     The Committee asked how ambulance response times in Seaford compared to average response times.

7.17     Richard Harker agreed to provide comparative figures outside of the meeting.

7.18     The Committee asked if ambulances were placed outside of ambulance stations during core hours to improve response times along the coast.

7.19     Richard Harker explained that ambulance crews were sent to ambulance community response posts at the start of shift if there were no outstanding emergencies. There was a prioritised list of where crews would be sent if there was capacity, and there was one in Seaford.

7.20     The Committee asked what the outcomes had been of the Flow Improvement Workshop with the Royal Sussex County Hospital (RSCH).

7.21     Ray Savage explained that the multi-partner workshop took place in May 2024 and there were a number of actions and outputs that different organisations had taken away to improve patient flow. The Brighton and Hove health and care system was particularly challenged, and consideration was being given to whether an unscheduled care navigation hub could be placed in Brighton to reduce the number of patients needing to present to the RSCH. Further information could be provided in a future report to the Committee.

7.22     The Committee asked what response category children’s mental health issues and epileptic seizures were placed in.

7.23     Ray Savage explained that the category would be determined through with the support of NHS Pathways to ask the right questions understand how a patient is presenting and what support they need. Category 1 was a life-threatening condition that would receive an immediate ambulance dispatch. Category 2 covered heart attacks and strokes, and could also cover epileptic fits, and in most cases, this was an automatic ambulance dispatch also. Category 3/4 were classed as urgent, which a majority of mental health issues would likely fall into. SECAmb was working with the mental health trust to improve how mental health incidents were responded to. Category 3/4 response times were improving, and through the new SECAmb strategy there would be improvements in the call-back rate to those patients to understand their conditions and unsure the right clinician is available to them when they need one. Richard Harker added that patients were advised to call 999 again if they notice a condition worsening, and these would always be re-triaged and in some cases would result in the response Category changing.

7.24     The Committee asked when the Trust would be in a position to exit the Recovery Support Programme (RSP).

7.25     Matt Webb responded that there were some benefits to the Trust remaining in the RSP, including the support of an Improvement Director from NHS England, as well as other support from NHSE. SECAmb had demonstrated significant progress which had been recognised by commissioners and NHSE, particularly in the areas of clinical and corporate governance, risk management and organisational culture. It was important the Trust was also set up to successfully deliver its new strategy and that it was financially sustainable before it exited the RSP. SECAmb was aiming to exit the RSP between Q3 and Q4 of the current financial year, but no proposed date had been set.

7.26     The Committee asked why ambulances did not carry CPAP for people with breathing difficulties.

7.27     Richard Harker explained that ambulances have never routinely carried CPAP, and ventilators were not required to be carried by ambulances either. There were critical care paramedics at each dispatch desk who do carry CPAP, and they had the right equipment for responding to Category 1 emergencies which could be transported to a scene if needed.

7.28     The Chair noted that the Committee had previously requested a visit to SECAmb’s Medway Emergency Operation Centre, and Ray Savage agreed to work with HOSC officers to arrange that.

7.29     The Committee RESOLVED to:

1)    note the report; and

2)    receive an update report from SECAmb in March 2025.