Agenda item

To receive an update on the work of South Central Ambulance Service (30 mins)

Kirsten Willis, Head of Operations (Berkshire West), South Central Ambulance Service and Mark Ainsworth, Director of Operations, South Central Ambulance Service presented an update on the work of South Central Ambulance Service (SCAS).

During the discussion of this item the following points were made:

·         Kirsten Willis outlined the principles of the Ambulance Response Programme (ARP).  What the patient needed had to be considered and what was the right vehicle to be deployed and the right skill set.  Members were informed that this helped to reduce multi vehicle deployments and diverts and meant less time on scene for rapid response vehicles.

·         The way in which call response times was measured had changed nationally.  Kirsten Willis explained the different standards; Category 1 to Category 4.  Category 1 calls were those patients in a time critical life-threatening event who needed immediate intervention and/or resuscitation e.g. cardiac or respiratory arrest.  Nationally the mean response time was 7 minutes with 15 minutes 90^th centile response time.  The national standard for Category 4 calls – non urgent situations, was 180 minutes 90^th centile response time. 

·         Ambulances were primarily sent to Category 1 and 2 calls, with cars being sent to calls categorised as 3 or 4.

·         In response to a question from Councillor Loyes, Mark Ainsworth explained how calls were triaged.

·         Councillor Soane asked what difference Community First Responders made to Category 1 and 2 response times.   Mark Ainsworth stated that Fire Officers and First Responders contributed to responding to Category 1 calls.  If they arrived first on the scene, the response clock was stopped.  There was a focus on recruiting more Community First Responders.  Fire Officers could not respond to heart attacks.

·         Councillor Richards asked how the call response time standards were set.  Mark Ainsworth indicated that they were set by the Department of Health. 

·         Councillor Richards went on to ask whether the call response time standards were becoming more difficult to achieve.  Mark Ainsworth indicated that because the most appropriate vehicle rather than necessarily the closest was dispatched this made the achievement of the Category 1 and 2 standards, tighter.

·         Kirsten Willis highlighted some of the key benefits of the ARP including the most appropriate clinical resource to meet the needs of patients based on presenting conditions being provided and not simply the nearest; and improved patient experience.

·         The Committee considered information regarding the ARP performance for the Wokingham CCG area between April 2018, when the ARP had been introduced, and October 2018.  Members also received a comparison to the pre ARP year (April to October 2017) which suggested that performance had improved. 

·         Members received information regarding the ARP Category 1 response times for the Wokingham area and the SCAS area as a whole April to October 2018.  The very long response time identified for the week commencing 3 September had been driven by a single incident which had been process related and had been due to the arrive time of the crew not being processed.  Members were advised that the number of Category 1 incidents for the Wokingham area varied monthly, but were relatively small.  The peak had been 80 in October 2018.

·         Kirsten Willis outlined the demand for service in the Borough and patient outcomes, indicating the percentage of those treated under hear and treat, see and treat and see, treat and convey. 

·         SCAS was midway through a transformation programme to align staff to patients.  The number of frontline teams would increase by three over the next two years.  There were 20 members of staff per team.

·         Rapid Response Vehicles had been redeployed to Bracknell and Winnersh in order to cover East and West Wokingham.  An ambulance remodelling was in progress.  As part of this, consideration would be given to the suitable use of resources and the most appropriate place for vehicles to be deployed.

·         The Committee was informed of the Lord Carter of Coles national review of the Ambulance Service.  This had been carried out to assess where efficiencies could be gained across the ambulance sector.  Significant unwarranted variations across the English ambulance services had been identified.

·         Lord Carter had identified three structural issues in the provision of health services which need to be strengthened nationally; Ability to access general practice and Community Services to avoid unnecessary conveyance; Urgent Treatment Centres to avoid conveyance to the acute trust; and Hospital Handover Delays impact heavily on ambulance services’ ability to respond to patients in a timely manner and cost the ambulance service nearly £50million last winter.

·         Members were pleased to note that SCAS was performing well with regards to Category 1 and 2 mean response times.  Work was being undertaken to reduce, where possible, the number of patients being conveyed to hospital.

·         Members noted information regarding the impact of delays at Royal Berkshire Hospital and Frimley Park Hospital.

·         Nationally demand for ambulance services was increasing on average by 6% annually.  9 out of 10 of these calls were not life threatening.  In response to a Member question regarding the reason for this increase, Mark Ainsworth indicated that the number of frail, elderly was increasing.  The number of falls and people in mental health crisis had also increased.  In addition there continued to be a number of high intensity users.

·         With regards to the Lord Carter of Coles review SCAS had been considered to be in the top quartile for 43% of areas, such as cost per head of population, staff engagement and Category 1 and 2 response time standards.  SCAS was in the mid quartile for 43% of areas such as average vehicle age and percentage of bunkered fuel.  SCAS had been considered to be in the bottom quartile for 13% of areas such as staff turnover, sickness days lost, estates: suitable space and calls per call handler per day.  The Committee noted the recommendations which had come out of the Lord Carter of Coles review.

·         Councillor Croy asked about staff sickness levels.  Mark Ainsworth advised that SCAS had the highest levels of staff sickness for Ambulance Trusts in the country.  Kirsten Willis indicated that frontline staff were exposed to patients and that this could result in the member of staff becoming sick.  Stress and muscular skeletal issues were more common causes of sickness absence but it did vary by individual.  There was a Trauma Risk Management Programme in place and staff could also meet with a Trauma Psychologist following a traumatic event if they wished.

·         In response to a question from Councillor Croy regarding staff turnover, Kirsten Willis commented that many front line staff moved elsewhere in the Ambulance Trust.

·         Councillor Croy asked why staff left the Ambulance Trust.  Kirsten Willis stated that a number of paramedics left the Ambulance Trust to work in Primary Care. 

·         Mark Ainsworth emphasised that there was a national shortage of paramedics.  Currently there were 300 staff vacancies within SCAS of which just under 200 were Paramedic vacancies.  The high cost of living in the area made it more difficult to retain paramedic students once they had completed their studies.  Paramedic training lasted 3 years.

·         Members were informed that some paramedics worked at Western Elms surgery in Reading 50% of their time and undertook front line duties the other 50%.

·         Councillor Richards asked what the average life span of an ambulance was.  Kirsten Willis indicated that different types of vehicles were used but that the Ambulance Trust had a good replacement strategy.  SCAS tended to keep vehicles between 7-10 years.  Nevertheless, the Lord Carter of Coles report recommended that vehicles be replaced after 5 years.  Councillor Richards went on to ask whether SCAS used electric ambulances and was informed that currently they did not.

·         The Care Quality Commission (CQC) had inspected the SCAS 999 service and 111 service in 2018.  An overall rating of ‘Good’ had been received.  Ratings had improved on those issued following the 2016 CQC inspection.

·         The Committee was informed that the Patient Transport Service had not been included in the 2018 CQC inspection.  Councillor Haines asked if the eligibility criteria for patients using the patient transport service had changed.  Mark Ainsworth stated that the eligibility criteria was tight and that the transport was booked by the patient’s clinician.

·         Nicola Strudley praised the First Responder car service and asked whether there were plans to commission more.  Kirsten Willis stated that SCAS was working with the commissioners to look at extending the availability of the current service.

·         Nicola Strudley also asked what impact SCAS’ working with the London Ambulance Trust would have on patients in the Thames Valley.  Mark Ainsworth emphasised that SCAS would be working with the London Ambulance Trust regarding procurement (such as the purchasing of ambulances), training and standardising policy and procedures.

·         Kirsten Willis clarified how patient data was received in response to a question from Councillor Miall.

·         Councillor Jones asked whether an Urgent Treatment Centre would be built in the Borough in light of the increased house building in the area, and whether SCAS had any involvement in the planning process.  Mark Ainsworth indicated that there was a strict definition as to what an Urgent Treatment Centre was.  There was an Urgent Treatment Centre at Brants Bridge, Bracknell.  Kirsten Willis added that SCAS was asked for their views and had discussions with the Planning Authority and the providers regarding developments. 

·         Mark Ainsworth invited the Committee to visit an ambulance station should they wish.

RESOLVED:  That

1)         the update from South Central Ambulance Service be noted;

2)         Kirsten Willis and Mark Ainsworth be thanked for their presentation.