Notification of items which the Chair considers to be urgent and proposes to take at the appropriate part of the agenda. Any members who wish to raise urgent items are asked, wherever possible, to notify the Chair before the start of the meeting. In so doing, they must state the special circumstances which they consider justify the matter being considered urgent.
Minutes:
32.1 The Chair informed members that he had asked Sir Peter Dixon, the newly appointed interim Chair of South East Coast Ambulance Trust (SECAmb); and Geraint Davies, acting SECAmb Chief Executive, to detail recent events affecting the trust.
32.2 Sir Peter Dixon informed the committee that he had been appointed SECAmb Chair by Monitor, the NHS Foundation Trust regulator. His appointment is initially for six months, although this may well be extended for a further six months. Sir Peter has a long track history of assisting NHS organisations that are experiencing problems.
32.3 The recently published Monitor report on the SECAmb 111-999 triage scheme describes an initiative that was hastily introduced, with poor risk and clinical governance mechanisms. Details of the initiative were poorly communicated to SECAmb’s commissioners.
32.4 From investigations to date, it appeared that the scheme caused no actual patient harm, although this will not be confirmed until the publication of a second report in June. The only trust staff criticised in the Monitor report are very senior officers. Disciplinary procedures against some of these officers are ongoing. To date there has not been a significant impact on organisational morale.
32.5 Geraint Davies added that SECAmb has agreed a joint recovery plan with Monitor and with its commissioning CCGs.
32.6 The context in which the triage scheme was undertaken was that of increasing service pressures which meant that SECAmb was struggling to meet its response time targets. However, the trust’s priority should been to provide a safe and effective service, even if this meant missing targets. There will be a full and open examination of what went wrong at the trust.
32.7 The 111-999 triage scheme aside, the ambulance service and indeed the whole health system are currently experiencing severe pressures. James Pavey, SECAmb Paramedic and Senior Operations Manager, told members that ambulance demand is currently 15% higher than predicted volumes (SECAmb had forecast demand to be 5% higher than last year). Similar demand pressures are being faced across the system – and particularly in hospital emergency departments. Dealing with this level of demand calls for a holistic response, with more being done to share the burden across the health and care system. Changing ambulance or A&E ways of working alone will not be sufficient as these services have already made significant changes to cope with increased demand – SECAmb is already dealing with around 50% of ambulance call-outs by means other than taking patients to A&E.
32.8 James Pavey told members that it is uncertain why demand is 20% higher than a year ago. This may in part be because we are currently experiencing a flu outbreak – there has been a significant increase in patients reporting shortness of breath which could be indicative of flu. In part it is also likely to be because patients are presenting with increased acuity, due to complex co-morbidities which may often be age-related. Hospital emergency departments are reporting similar problems.
32.9 Difficulties with hospital handover inevitably impact upon SECAmb performance: ambulances that are waiting at hospital to handover patients are unavailable for other calls. The focus has been on this issue, including very close liaison with hospital colleagues. Indeed, managerial focus on dealing with hospital handover is diverting managers from more general management duties. Members agreed that hospital handover was an important issue, and one that the committee would explore in detail at a later date.
32.10 In response to a question about paramedic recruitment, James Pavey told the committee that there was a national shortage of paramedics, exacerbated by growing demands from non-ambulance trusts sources such as primary care. However, Sussex does reasonably well in recruiting and retaining paramedic staff.
32.11 In reply to a question as to how SECAmb could persuade the public of its future integrity, Sir Peter Dixon told members that it was his responsibility both to find what had gone wrong and fix it and to ensure that the trust never again prioritised hitting targets over providing the best possible service to the public.