Agenda item

The Committee considered a Report of Director of the Transformation and Partnerships and presentation by representatives of DDES CCG and North East Ambulance Service that gave a post implementation update for the Durham Dales, Easington and Sedgefield CCG Accident and Emergency Ambulance Service Review (for copy see file of Minutes).

The Assistant Director of Communications and Engagement, NEAS gave a detailed presentation that included:-

•           Our service in numbers – figures from April 2015 to March 2016

•           A new journey operating environment – adapting to changing needs – a new Chief Executive and Board were in place

•           Our Strategy 2015-20 – driving our purpose and direction

•           Care Quality Commission – rated GOOD

•           CQC inspection rating

•           Chief Inspector of Hospitals Quote - “The North East Ambulance Service has a lot of to be proud of. We found a general culture of passion and enthusiasm at the trust and it was clear that everyone’s first priority was the patient.”

•           Performance

         Incident and Call Volume

         Top Conditions

         Red Incident Volume – steady increase in the number of red calls.

         Impact of Increased Red Volume – deterioration in performance standards.

         Age Profile of A&E Attendances via ambulance – NEAS conveys more patients to A&E to the NHS than the England average.

         Hear & Treat, See & Treat, See & Convey Rates – number of calls increased.  Investment made to control rooms and more clinicians available to assess.  280 staff had been trained.

         Arrivals and Handover Time

         Time lost to Handovers

         Workforce – currently recruiting and the vacancy gap was closing.  Paramedics had 140 vacancies last year compared to 70 this year.  It was hoped to achieve a full establishment by 2017. Most effective way was to grow our own and NEAS were working closely with the Universities of Sunderland and Teesside.

         Clinical Quality Indicators

•           Durham Dales and Easington progress update

         Staffing levels in Weardale and Teesdale – an increase in staffing levels in the Weardale and Teesdale areas with less overtime claimed.

         Response times in Durham Dales – showed response times by minute from March 2015 to March 2016. 

         Service Improvements – invested heavily.  Challenges included funding for 1st responders.  First responders had been recruited.  Worked with Durham Police and Durham and Darlington Fire & rescue.  2 advanced practitioners attend lower community calls in the Dales. 

The Chairman invited representatives from the Rural Ambulance Monitoring Group to comment on the report.  He referred to the information circulated to members from the group for information (for copy see file of Minutes).

Mrs Joy Urwin, Rural Ambulance Monitoring Group referred to the Independent Clinical Senate Review and said that the group felt no wiser from anything that had been said today.  The group supported the work carried out by the paramedics and had respect for them.  She said that it was accepted that NEAS were not supported by the NHS foundation trust.  The group were no clearer in the data regarding response times and felt that Bishop Auckland was an urban area, not rural, and that Crook was a long way to parts of the Dales.  The group felt strongly that it was recognised that defibrillators were put in place and funded by community fund raising and not NEAS, that they were not maintained by NEAS and that training had not been arranged by NEAS.  The first responders were very welcomed but gave a false sense of security as did not work in all situations and emergencies.  Rural in the title of the report did not reflect that it was about rural areas.

Mrs Urwin said that some issues within the report were worthy of merit but felt that some of the points did not address the core problems.  The group felt that the performance remained poor.  With regards to staff shortages it had been recognised that trainees were being utilised.  On occasions two vehicles were being brought into the Dales to deal with cardiac patients. This was a drain on resources.  The projected number of paramedics from the Dales had been unrealistic and the group felt that the rural areas were receiving a downgraded service.  People were waiting for ambulances longer than ever and the groups believed that the CCG were not holding NEAS to account for failing to deliver the provision.  She asked how a 48% response time across the patch could be justified.

The Chairman said that discussions had taken place about rurality for the whole of Durham at the Joint Health Committee, including the percentage of fair access, the drop in response times and staffing.  He confirmed that these issues had been taken up with NEAS.

Councillor Savory said that we all had a duty of care to residents in County Durham and the wait for an ambulance in Weardale was always a topic of conversation.  She referred to a recent incident whereby an elderly gentleman had to wait over one and a half hours for an ambulance.  She found this totally unacceptable and asked where the ambulances were located at that time.

Councillor Bell echoed those comments and said that he too had heard many stories about response times being poor.  He referred to the additional resources DDES put into NEAS and asked if detailed data could be provided for each area to show service delivery.  He emphasised that the Committee needed sight of local data so that points could be addressed.  The Chairman that this should be looked at for the whole County.

The Assistant Director of Communications and Engagement made an apology about the ambulance incident and would provide a response once investigated.  He said that this was not the type of service NEAS wanted to provide.  He advised that locality data was published on their website each month and would circulate a weblink on performance data.

Councillor Bell said that this information should be included in the report and asked that NEAS come back to a future meeting with that locality data.

Referring to paragraph 4 of the NEAS report ‘The need to manage resources across wider areas has been impacted on by the increased pressure on services, resulting in a higher number of periods of clinical escalation where otherwise ring-fenced resources are allowed to be used across a wider geography to meet the needs of those most acutely unwell’, Councillor Temple asked if this meant that ambulances were pulled out of the Dales to treat emergencies at other parts of the County.  He said that performance for the whole of DDES was poor and asked what would be done to improve the figures.  He was concerned that the statistics that used to be available were no longer and therefore comparisons were not possible.  He also raised concerns about the statement under system pressures within the report ‘This has greater significance for the DDES area due to the lack of acute hospital provision within the locality’.  The threat to Darlington Memorial Hospital through the STP was very important to the residents of the Dales and the whole of DDES.  He was concerned that if that capacity was removed then we would end up with more overcrowding at other hospitals.

Councillor Brookes agreed that the Committee needed more bespoke information and commented that the figures for August and September were unacceptable in terms of performance.

Councillor Shuttleworth felt that the bottom line was that the ambulance was hardly ever present in the Dales as would be somewhere else in the County on a call out.

The Chairman concluded that uniformity was required and would request that both the CCGs and the acute trust would be asked for their views and comment on the information shared by NEAS and the inspection report.

Resolved:

(i)            That the comments made by the Committee were noted.

(ii)          That NEAS be requested to come back to a future meeting of the Committee with a further report showing locality data.

(iii)         That County Durham and Darlington NHS FT and the Durham CCGs be asked to comment on what they were doing to ensure that A& E Ambulance response times for R1 and 2 calls improved across County Durham, especially what steps are being implemented to reduce the unacceptable delays in patient handover from NEAS to CDD NHS FT at hospital A&E departments.