Agenda item

1.1.        The Committee considered a report by the Assistant Chief Executive providing an update on a number of developments in relation to SECAmb’s services. 

1.2.        HOSC asked a number of questions in relation to these developments.

Patient triage and patient safety

1.3.        HOSC raised concerns about the safety of SECAmb’s ‘hear and treat’ and ‘see and treat' policies; the effect on patient safety of the use of non-paramedic staff on ambulances; and the reasons for a disparity between the number of incidents recorded by SECAmb and NHS England.

1.4.        Geraint Davies said that neither SECAmb nor any other ambulance trust in the country has an all paramedic workforce. There is a skill mix in the organisation comprising paramedics, technicians, and emergency care support workers.

1.5.        Geraint Davies said it was a challenge for SECAmb to ensure that when a call comes into the organisation it is triaged properly. The hear and treat policy involves putting clinicians into control rooms so that calls can be reviewed by clinical staff. This ensures that calls are triaged correctly and responded to in the most appropriate way. The see and treat policy involves ensuring that the right crew with the right skill mix is present for the clinical need of the patients, maximising the opportunity to provide the necessary care in situ and reducing the need to convey to other services. The triage system used by SECAmb is a national system that is quite risk averse. As part of the ambulance triage programme, SECAmb is working with partner organisations to understand how to adapt the triage system to effectively manage patients in a manner that is as safe as possible.

1.6.        Mr Davies added that nationally the Ambulance Response Programme had been set up to look at how best to ensure ambulance trusts hear and treat and see and treat effectively – there are five ambulance trusts involved in the pilot and if successful it will be rolled out across England in the autumn. The programme should allow ambulance trusts more time to triage patients up front and then re-categorise calls.

1.7.        Geraint Davies said that when a ‘Serious Incident’ (including a death related to an incident) occurs, SECAmb investigates it, learns lessons, and changes its pathways accordingly.

SECAmb culture

1.8.        HOSC asked about the bullying culture and staff morale issues identified by the Care Quality Commission (CQC) in a letter to SECAmb following its recent inspection and what the senior management team would be doing to address these concerns.

1.9.        Geraint Davies said that he would remain as Acting Chief Executive until a new Chief Executive was recruited, which was estimated to be in 4-6 months – he said he would not apply for that role himself. He said that his remit as Acting Chief Executive would be to: stabilise the organisation; ensure that there are plans in place to address the recommendations of the external review into the red 3 triage pilot; and plans to deliver performance improvements over the next few months. Geraint Davies said that he would achieve this using his own experience of building cultural change alongside that of external NHS consultants who would be brought into SECAmb. The challenge over the next two years would be to move away from being a hierarchical organisation to one where staff were engaged and empowered, and senior leadership was open and transparent. He said the organisation had become more open, staff were consulted on proposed changes, and their views were sought on how improvements could be made.

1.10.      Tim Fellows said that culture varied between organisations and also within large organisations such as SECAmb; he said that there were cultural issues in the wider SECAmb that he did not recognise in East Sussex. He said that organisations can always do more to improve.

1.11.      Geraint Davies assured HOSC that SECAmb’s senior management had been aware that bullying and harassment culture was a major issue in the organisation prior to the CQC inspection, and this had been included in a presentation of all of SECAmb’s challenges made to the CQC. He said that senior managers had been made aware of this issue as a result of the outcomes of staff surveys.

1.12.      Geraint Davies said that, in regards to poor staff morale leading to poor patient care, patient satisfaction surveys had indicated that patients considered that they were receiving good care, but he recognised the limitations of such surveys and the importance of staff morale.

1.13.      The Committee RESOLVED to:

1)    request a further update from SECAmb in September 2016 to include findings of the triage scheme patient impact report and the full CQC report (if available).

2)    request further details of the Trust’s workforce skills mix.

3)    arrange a visit to the Lewes Emergency Operations Centre for HOSC Members.