Agenda item

To receive an update on South Central Ambulance Service.

The Committee received an update on South Central Ambulance Service from Kirsten Willis-Drewett, Head of Operations (Berkshire West) & Interim Head of Operations (Oxfordshire), South Central Ambulance Service, and Mark Ainsworth, Director of Operations.

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

·       Mark Ainsworth referred to graphs which highlighted the demand for 999 calls and 999 responses.  With regards to 999 calls, the blue line was where the Trust anticipated demand would be using historical data from the last 12 months to set the budget.  This was recalculated every 5 weeks to see how demand was progressing. This was represented by the red line.  The green line represented the volume of calls actually received.  In the middle two weeks of February 15,000 calls per week had been expected but approximately 17,500 had been received.  Mark Ainsworth explained that this would not all relate to separate incidents and that people often phoned back to check on the progress of the ambulance.   The second graph highlighted the 999 responses.  The number of actual responses was below predictions and approximately 10,500 were responded to a week by sending an ambulance or car.  Some of the other calls would be dealt with by Emergency Clinicians in the Emergency Operations Centre or who would advise of different routes to access their medical care.

·       With regards to performance, there were nationally set standards for all ambulances.  For Category 1 calls there was a mean target of a 7 minutes, and the Trust was performing at around 9 minutes.  There was also a target of 15 minutes for being on scene for the 90^th percentile.  Through December to early January this was being met but this was starting to slip.  For Category 2 calls the National Target was an 18 minute mean.  This was not being met with an upward trajectory of decline, at around 33 minutes.  The target for being on scene was 40 minutes for 90^th percentile.  Performance against this target had also started to deteriorate.  For Category 3 calls the National Target was 2 hours for the 90^th percentile.  This was being exceeded by just over an hour currently

·       Performance on all measures was challenged.

·       In response to a question from Members Mark Ainsworth explained that:

Ø  Category 1 calls were patients in cardiac arrest, or who were unconscious, or who were not breathing, or who were fitting uncontrollably or had noisy breathing (e.g., were unconscious and were swallowing their tongue)

Ø  Category 2 calls were patients who had chest pains, breathing difficulties, or strokes.  This represented the biggest category of call.

Ø  Category 3 calls were patients who had a lower grade medical emergency such as an isolated fracture.

Ø  Category 4 calls were patients who required a face-to-face assessment and were non emergencies.

·       SCAS also transported GP admissions as requested and there were time targets related to this that the Trust was required to meet.

·       There were challenges in meeting operational hours required to meet the demand and the Trust was approximately 5,000 hours short per week.  The picture was fairly consistent across the South (Hampshire) and North Thames Valley and Milton Keynes).  This was as the result of higher than predicted staff sickness levels, and lower recruitment levels during the pandemic.

·       With regards to handover of patients to the Acute Trusts there was a target of 15 minutes.  Royal Berkshire Hospital was most challenged regarding ambulance handover delays in October, November, and December, with a steady improvement being seen into January and February.  In November, 511 operational hours had been lost, which had reduced to 287 hours in February.  Frimley were more challenged earlier in the year, with a steady improvement from October onwards.

·       Nationally the number of ambulance handover delays over 1 hour was monitored.  There had been an improvement in Quarter 4 on Quarter 3.

·       Members received information on how the Trust performed against other England Ambulance Trusts in various areas.  Whilst it was first in some areas, it was 8^th out of 10 for Calls Answered 90^th percentile, due to a shortage of Emergency Call Takers,

·       Mark Ainsworth provided more information regarding recruitment:

Ø  There were challenges with recruiting Emergency Call Takers in the Bicester Emergency Operations Centre.  Bicester was an area of high employment and reasonably high wages.  The Emergency Call Taker role had a relatively low salary.  In NHS terms it was a Grade 3.  A recruitment and retention premium was being trialled in the Winchester and Bicester Emergency Operations Centres.  15 call handlers had also been appointed who were based with the Isle of Wight Ambulance Trust but who answered emergency calls on behalf of SCAS.  There was currently 100 FTE’s and the Trust was working towards the full 150 FTE’s by June.

Ø  The Trust was part of a Health Education England pilot to appoint Australian paramedics.  48 has been planned for and 42 had been appointed so far and would be starting in the summer.

Ø  The Trust was reviewing options for Eastern EuropeanRecruitment with London Ambulance Service, particularly from Finland and Poland.

Ø  The loss of paramedics to Primary Care Networks as funded through NHS to recruit paramedics, was a big challenge to the Trust.  Hours and salaries were often more favourable. 

Ø  The SCAS region had a high cost of living against the national pay banding.  Sometimes paramedics trained with the Trust before going to cheaper areas in the country.

Ø  Shortages were backfilled with Private Providers, registered with the CQC.  This was more expensive as the equipment and ambulance also had to be paid for.  Private providers were currently covering approximately 9,000 hours a week and this was to rise to 15,000 in April.

·       Mark Ainsworth outlined the vacancies in the different areas covered by the Trust.  High Wycombe, Slough and Windsor and Maidenhead were areas of particular concern with 120.47.

·       It was more difficult to recruit clinical staff as they were required to undertake a 3 year degree programme.

·       Kirsten Willis-Drewett outlined how patients could be dealt with:

Ø  Hear and Treat by a clinician in our Emergency Operations Centre

Ø  See and Treat by a clinician face to face with the patient

Ø  See treat and convey to Emergency department.  This represented the largest percentage of patients.

Ø  See treat and convey to non-Emergency Department location

·       The rates for the different options were noted. 

·       Members were informed of the impact of Covid:

Ø  Absence levels had been well above that expected and budgeted for.

Ø  There had been impacts on estate and capacity at operational bases due to social distancing requirements. 

Ø  Delayed ambulance handovers due to ‘green’ vs ‘red’ patients. (Red being those with either a positive test or symptomatic)

Ø  There had been a detrimental impact on the health and wellbeing of staff who had worked in high stress situations for an extended period, and a significant toll had been taken on individuals' mental health and wellness.

·       The Trust continued to work closely with colleagues from its community partners, utilising pathways which avoid conveyance to the acute trust emergency departments.

·       Members asked what mitigation steps were taken when the service was overloaded.  Mark Ainsworth commented that there was a National Resource Escalation Action Plan designed by the National Ambulance Resilience Unit and which provided direction on increasing resources on the road.  For example, the Education Team may be deployed to crewing ambulances.  30 military personnel had acted as co-responders during the pandemic and 11 would remain in place until the end of March.  The Fire Service, particularly Hampshire Fire Service had provided support in the form of blue light driving.  Consideration was also given as to how the Patient Transport Service could be deployed.  Staff and front-line managers could also be asked to work overtime during peak periods. 

·       A Member questioned how many staff crewed an ambulance and was informed that it was usually two, but a student could also accompany for training purposes. 

·       A Member asked about the Trust’s experience of using private ambulances and the impact on the budget.  Mark Ainsworth commented that budget was a significant impact and the level of staff vacancies.  He reemphasised that private ambulance crews were more expensive.  There were ambulances not currently being used to full capacity due to staff shortages.  The Trust was assured on the quality of staff provided by the private ambulance providers.

·       In response to a Member question as to whether recruitment was becoming more difficult, Mark Ainsworth confirmed that it was.  There had been a change in academic requirements for paramedics.  The number of staff coming in was consistent but the numbers leaving were increasing.

·       A Member questioned whether the Ambulance Trusts could pressure the NHS for the national pay scales to be revisited.  They went on to question whether Thames Valley waiting was possible.  Mark Ainsworth commented that a national review on ambulance service roles was being undertaken.  The paramedic pay scale had increased 3 years ago.  With regards to London waiting, Bracknell and Wexham ambulance centres received a high living cost allowance, but this did not have a great impact on recruitment.  A retention and recruitment premium had been applied to High Wycombe and 40 additional staff had joined in that area in the last 12 months.  it was hoped that the national review would provide an increase for ambulance technicians and emergency call handlers.

·       In response to a question as to how the Council could assist, Mark Ainsworth asked that they promote referring people to the correct services.

·       Members questioned whether the Trust worked with volunteer transport services, and was informed that they worked the Local Authority and health providers.

RESOLVED:  That

1)    The presentation on South Central Ambulance Service be noted.

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