Agenda item

35.1     The Committee considered a report providing an overview of progress made by SECAmb to improve operational performance and meet the requirements of the NHS England Recovery Support Programme (RSP).

35.2     The Committee asked whether the increase in ambulance handover delays were driven more by pressures caused by winter demands or by patients with No Criteria to Reside.

35.3     Ray Savage, SECAmb Strategic Partnerships Manager (Sussex), explained that handover delay issues were multifactorial. Winter also saw an increase in patients with respiratory issues that caused a spike in demand for ambulances, as well as impacting the flow through hospitals that meant there were fewer bed spaces available. SECAmb worked collaboratively with all system partners to identify ways to manage pressures, including greater preventative care in the community and avoid hospital conveyances when a patient would be better treated in a different setting. Of the calls SECAmb received, roughly 15% could be dealt with over the telephone, and a further 30% of calls which received an ambulance response did not require hospital conveyance. Unscheduled Care Navigation Hubs (UCNHs) had been introduced that allowed a multi-disciplinary clinical team to review category 3 & 4 999 calls and determine the right clinical response for the patient, which was not necessarily an ambulance dispatch. UCNHs were helping to identify commissioning opportunities to develop pathways for patients within the community which would not only improve patient outcomes but reduce pressures on acute hospital trusts by reducing pressure on emergency departments (EDs).

35.4     The Committee asked whether all ambulances had the necessary equipment to treat patients with low oxygen levels.

35.5     Richard Harker, SECAmb Operating Unit Manager East Sussex, confirmed that all ambulances were stocked with advanced airway equipment and full advanced airway life support could be administered by all emergency ambulance crews.

35.6     The Committee asked what was being done to increase awareness of patients’ ReSPECT forms.

35.7     Richard Harker explained that ReSPECT forms were regularly utilised by SECAmb crews, as were Do Not Attempt Cardiopulmonary Resuscitate (DNACPR) order. If they had been uploaded to SECAmb’s systems they could be accessed prior to arrival at a scene. People with the forms are recommended to have a hard copy on scene so that ambulance crews can respect the patient’s wishes upon arrival.

35.8     Ray Savage added that SECAmb was working with NHS Sussex to improve digital patient record sharing which would increase the amount of information that a crew would have when they arrived on a scene.

35.9     The Committee welcomed that SECAmb may be leaving the Recovery Support Programme (RSP) and asked how workplace cultural improvements were being managed and monitored.

35.10   Matt Webb, SECAmb Associate Director of Strategy and Partnerships, explained that SECAmb had made significant improvements in the key areas that it had originally been placed into the RSP for. As part of the improvement journey SECAmb had developed a new organisational strategy which sought to sustain the improvements that had been made, including a strategic aim to ensure people enjoyed working at SECAmb. While it was anticipated that SECAmb would soon leave the RSP, it would still receive support from its host Integrated Care Boards and other associate ICBs. There had been significant cultural improvements at the trust, including on Freedom to Speak Up and grievance handling.

35.11   The Committee asked what the results of the NHS staff survey were for SECAmb.

35.12   Matt Webb explained that they were not able to comment on NHS staff survey results as they had not yet been released externally.

35.13   The Committee asked whether there was an acceptable level of staff churn and whether exit interviews were carried out and acted on.

35.14   Ray Savage, noted the report showed that recruitment and retention had improved, and that the staffing improvements in the emergency operations centre in Gillingham had a positive on retention of staff at Crawley, by reducing the workload pressure on staff based there. SECAmb were not running with the vacancy levels that they had been in some recent years. Improved results in recent staff surveys had shown that more staff would now recommend SECAmb as a workplace.

35.15   Matt Webb added that SECAmb currently had a 0.1% vacancy rate, down from 8% in 2023. The staff turnover rate was just below 15%, down from 19% in 2023.

35.16   The Committee asked where SECAmb was able to directly book patients into appointments.

35.17   Ray Savage explained that SECAmb could directly book patients who dialled 111 or 999 into appointments at GP practices, urgent treatment centres and slots at ED, depending on the symptoms and conditions the patient has described. The nature of ED meant that even if a patient was booked into a slot, that could change as clinical staff in the ED had to triage and constantly prioritise patients based on urgency of need.

35.18   The Committee asked whether the UCNHs would be based in the emergency operations centres in future.

35.19   Matt Webb explained that the UCNHs were based across SECAmb’s operational footprint deliberately, to ensure that they could be tailored to population need. The multi-disciplinary teams were therefore designed to best align to the local needs of the population in different areas. The patient would not notice any difference in response based on whether the UCNHs were based in the emergency operations centres.

35.20   The Committee asked that the figure for East Sussex was for the number of hours lost at hospital handover be provided, including those at the Royal Sussex County Hospital.

35.21   Richard Harker agreed to provide the data outside the meeting. Q3 and Q4 were the busiest times for ambulance services and SECAmb worked closely with ESHT to reduce handover delays.

35.22   The Committee RESOLVED to:

1) note the report; and

2) receive an update at a future meeting.