Meeting documents

            Meeting: Health Scrutiny Sub-Committee (County Hall, Durham - Council Chamber - 05/09/2006 10:00:00 AM)

                  Item: A2 Response to the Consultation to Modernise Rural Ambulance Services

         

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Health Scrutiny Sub-Committee

5th September 2006 Ambulance Services in Rural Areas: Response to the Public Consultation

Report of the Head of Overview and Scrutiny

Purpose of Report

1. To inform members of the responses received on the consultation document from the Durham Dales Primary Care Trust about proposed changes to Ambulance Services affecting residents of Weardale and Teesdale.

2. To agree a Health Scrutiny response to the issues raised in the consultation document and consultation responses received.

3. To note the decision making process by the Durham Dales Primary Care Trust in relation to the consultation.

Background

4. Durham Dales Primary Care Trust and the North East Ambulance Service Trust gave a presentation to the Health Scrutiny Sub-Committee (3 July 2006) about proposed changes affecting Ambulance Services in Weardale and Teesdale.

5. The Sub-Committee agreed that it would convene a special meeting (5 September) where it would receive responses to the consultation to date (the consultation ends on 18 September 2006) before reaching a view on the issues.

6. The Durham Dales PCT meet on the 20 September 2006 to make a decision, informed by the consultation, regarding changes to the ambulance services in Weardale and Teesdale.

Information

7. i. Response to the Consultation:-

A report produced by Durham Dales PCT on the consultation process and analysis of consultation responses is attached at Appendix 1.

The report includes information on:-

ii. Recommendations to the PCT Board:-

There will be two separate decisions for the PCT Board to make, firstly, in relation to the provision of the service itself and, secondly, with regard to the location of the ambulance stations .

Information on these options is attached at Appendix 2.

The Durham Dales PCT Board will meet on Wednesday 20 September at 10 a.m. in Glaxo Sports and Social Club, Barnard Castle. This will be a public meeting with details to be circulated widely.

iii. Health Overview and Scrutiny Sub -Committee

Members of the Sub-Committee are asked to note the public outcry regarding this issue reflected in the consultation responses, petitions and written responses.

These can be summarised as:-

However, the proposals to relocate services across Weardale and Teesdale have some merit and should be considered, namely:-
(That said, this remains an issue from a training, skill level, role, responsibility and recruitment issues.);

Recommendation

8. The Health Scrutiny Sub-Committee notes the response to the consultation and the concerns raised by communities in Weardale and Teesdale in relation to changes to modernise rural ambulance services.

9. The Health Scrutiny Sub-Committee remains concerned about the depth of public feeling over this issue and urges the Durham Dales PCT in their deliberations to take the views of local people and communities into account.

10. The Health Scrutiny Sub-Committee welcomes the approach to integrated working between the primary health care teams and ambulance staff to meet the needs of the communities its serves; and the recurring investment to fund a modern, responsive ambulance service.

11. The Health Scrutiny Sub-Committee awaits the outcome of the decision by Durham Dales PCT on the proposed changes affecting Ambulance Services in Weardale and Teesdale .The committee will want to revisit this issue at some point seeking clarification on how proposals to modernise ambulance services will be implemented looking for a detailed business case to support this process.

Background Papers:-

Modernising Ambulance Services in Rural Areas consultation document.

Contact: Feisal Jassat Tel: 0191 383 3506 Feisal.Jassat @durham.gov.uk

Overview of Current Position with the Consultation Process into
Modernising Rural Ambulance Stations

The public consultation process runs from the 27^th June until the 18th September 2006. 1000 consultation documents and 2000 summary leaflets were circulated in the local areas and on the PCT and NEAS websites. There has been a high level of media coverage in the Northern Echo, Teesdale Mercury, Weardale Gazette, Darlington and Stockton Times and the Blue Gentian. Radio Cleveland, Radio Newcastle has featured news stories and both Tyne Tees Television and BBC Television News programmes have featured the issues.

Public Meetings

As part of the 12-week consultation, there were four public meetings arranged to hear the views of local residents. These took place at:

St John’s Chapel Town Hall on Tuesday 11 ^th July at 6.30pm

140 people attended the meeting held in the Town Hall. A 1500 named petition had previously been submitted to NEAS to keep the local ambulance station at St John’s Chapel open. There was a high level of debate many questions were raised from the audience. There were very clear messages from the public:

A member of the public asked for a vote whether or not to close the ambulance station in St John’s Chapel. This was done while other people were talking and not with the use of the microphone. There appeared to be some hands erected, but not everyone was involved and the people in the balcony could not hear. This was not considered part of the meeting.

This was a very heated meeting but the public were able to ask questions and the panel were given the opportunity to answer. The meeting finished when there were no further questions from the public.

Glaxo Sports and Social Club, Barnard Castle on Monday 17^th July at 2pm

40 people attended this meeting. Issues raised were:

The meeting finished when there were no further questions from the public.

Stanhope Community Centre on Monday 24^th July at 2pm

30 people attended the meeting held in Stanhope. There was open discussion and the following areas were highlighted:

This was a positive meeting and there was a feeling of support to the proposals if the response times to upper dales and the training issues could be addressed.

Middleton in Teesdale Community Hall on Monday 31^st July at 6.30pm

120 people attended the meeting held in Middleton in Teesdale. A 3621 named petition was handed in to the PCT at this meeting. There was open discussion and the following areas were highlighted:

Councillor Bell called for a show of hands of people who want to keep the retention of the ambulance station one week in three. There was a majority vote in favour with two abstentions.
This was a very heated meeting but the public were able to ask questions and the panel were given the opportunity to answer. The meeting finished when there were no further questions from the public.

Written Responses

27 written responses (10 Weardale, 9 Teesdale, 8 stakeholders) had been received by the PCT as at 20 ^th August 2006. The comments were as follows:

Base
11 to retain base
5 to change base as per proposal

Comments
Service
7 want to abolish standby
8 want 24/7 cover

Comments
Skill mix
7 do not use ECA
0 specifically for ECA
2 introduce community paramedics
1 does not want community paramedic
1 wants community paramedic as extra
2 want paramedic and technician
0 want double paramedic

Comments
Recruitment
2 want local recruitment

Comments
Accept Proposals
4 accept proposals
1 to retain service as it is

Comments
Two petitions have been received by the PCT

1. The following petition was received by the Durham Dales PCT on the 31^st July 2006. 3621 signatures were signed up to the following proposal.
“We would like to make our feelings known about the proposed changes to the Ambulance cover in Teesdale. We do not agree with the reduction in cover from what we have now to a single response Community Paramedic. We think that the people of Teesdale deserve a double crewed paramedic ambulance, 24 hours a day, seven days a week .”

This petition was collected as a response to the pre-consultation meetings held by NEAS in 2005. The initial proposal suggested that there was a single paramedic in a fast response vehicle who would be present in Teesdale 24 hours a day, 7 days a week. The PCT and NEAS listened to what the public were telling them and the proposal for a single paramedic was dropped and is not part of the current consultation. The new proposal does include a double-crewed ambulance, 24 hours a day, seven days a week.

It is important to recognise that the proposal behind this petition has now been agreed and there will be a 24/7 cover by a double crewed, A&E emergency ambulance in place, subject to the results of the consultation. This should not deter from the massive strength of feeling, passion and high regard that the people of Teesdale feel towards their ambulance service.

2. NEAS has kindly forwarded a petition received by them from the people in Weardale and this is considered to be part of this consultation process. 1500 people signed up to the following proposal:

“We the undersigned, hereby support the retention of the Ambulance Station/Ambulance at St John’s Chapel, for the benefit of Weardale Residents.”

This petition was a response to the pre-consultation meetings held by NEAS in 2005 but again indicates the strength of feeling that is felt by Weardale residents for their local ambulance Station in St John’s Chapel.

PPI Forum Responses

1. County Durham and Darlington Acute Hospitals NHS Trust Patient and Public Involvement Forum

Attendance at the County Durham and Darlington Acute Hospitals NHS Trust Patient and Public Involvement Forum meeting was arran ^{ged for 2nd} August. Each member had previously received a copy of the consultation document. Anne Yuill gave an outline of the current situation, the proposed changes and the feedback from the four public meetings. She emphasised the strong feeling in Upper Weardale and Middleton in Teesdale with the closure of their ambulance bases.

One member had attended the public meeting in Barnard Castle and had been disappointed that people were concentrating on single issues and not looking at the wider picture. The PPI Forum was invited to respond to the consultation by the 18 ^th September and this formal response was received by the PCT in favour of the proposed changes.

2. North East Ambulance Service Patient and Public Involvement Forum

Members of the North East Ambulance Service Patient and Public Involvement Forum attended each of the four public meetings and NEAS had been in regular discussion with their Forum. A formal response has been received by the PCT. The Forum remains in favour in principle, of the introduction of Community Paramedics to replace standby working practice. They have some reservations around:

They also make comments on the following areas:

3. Durham Dales PCT Patient and Public Involvement Forum

The Durham Dales PCT Patient and Public Involvement Forum have been very closely involved with the consultation process. On the 19 ^th June, 3 members of the Forum, their Forum Support Officer, the Chair of the NEAS PPIF and their Forum Support Officer met with NEAS and PCT representatives to discuss the formal consultation including a dry run through of the presentation. They have also attended many meetings with NEAS and the PCT to address their areas of concern. The Durham Dales PCT sincerely thanks them for their involvement and commitment to this service.

Members of the DDPPIF have also attended every public meeting and have engaged the local residents with their concerns.

A formal response in being prepared and will be sent to the PCT prior to 18 ^th September.

Decision Making Process

On Wednesday 20^th September, the Durham Dales PCT Board will consider the response to the consultation and make its final decision regarding commissioning the rural ambulance service taking into account all comments made at the public meetings, and in writing to the PCT. This discussion will be the first agenda item on the PCT Board meeting to be held at 10 am in Glaxo Sports and Social Club, Barnard Castle. This is a public meeting and the details will be circulated widely.

In arranging the meeting to be held in Barnard Castle, the PCT were taking into account the comments made at the public meetings that this should be at a venue that could hold a high number of members of the public. It has been acknowledged that Weardale residents would want this decision to be made in Weardale, and Teesdale residents would wish it made in Teesdale. The chosen venue was selected because of its size, availability, parking and disabled accessibility.

The suggestion was made that this decision should be made at a meeting of the Board to be held in the evening, but this has proved difficult for Board members to rearrange and the meeting has been arranged for the normal Board meeting time. This will be the last Board meeting of Durham Dales PCT.
REVIEW OF AMBULANCE SERVICE PROVISION IN WEARDALE AND TEESDALE


Brief Summary of Paper

Ambulance Services in Rural Areas

Until recently all of the ambulance services provided by North East Ambulance Service NHS Trust (NEAS) in Northumberland, Tyne and Wear, and County Durham and Darlington operated a two-crewed A&E ambulance during the day. At night the seven smallest rural stations in Northumberland and County Durham and Darlington operated a step down service known as stand-by.

Standby working is not future proof and requires staff who have been working during the day to continue working during the night. It is an unpopular way of working and makes it difficult to recruit new staff. North East Ambulance Service has recommended to Durham Dales PCT that this working practice in no longer sustainable and needs to be changed and updated. A public consultation exercise has been undertaken to explain why the service needs to change and gain the public’s views in relation to the preferred option that has been suggested.

The Durham Dales services affected cover Teesdale and Weardale, the preferred option put forward during the consultation also recommended closing the ambulance stations in St John's Chapel and Middleton in Teesdale and relocating these at Stanhope and Barnard Castle respectively.

Recent Developments in Ambulance Services

There has been rapid development and improvement in the skills of Paramedics over recent years and Paramedics are better equipped than ever to save lives. These innovations in ambulance service provision over the last few years have produced significant improvements in patient care. Paramedics now spend considerably longer with a patient in their home or at the scene of an accident delivering vital medical care, this sometimes means that a journey to hospital may not be necessary at all.
Technology will also play an important part in delivering better patient care. The implementation of the electronic patient record will help provide targeted, high quality clinical care at any location and enable North East Ambulance Service to access information quickly and exchange data with other healthcare providers. Information support systems are also available to enable North East Ambulance Service to use track and trend data to forecast the most effective location for the ambulance to be and this can be supplemented by local information.

Performance

From April 2006, all Ambulance Trusts have been required to answer 75% of Category A life-threatening calls within eight minutes and have appropriate back-up transport on scene within 19 minutes. North East Ambulance Service cannot meet these new performance targets, which benefit patients, by operating an outdated system of stand-by. Modernising ambulance services in rural areas with the introduction of Community Paramedics will not only improve response times to patients' needs, but will also allow the Trust to provide a better quality of care to its patients.

Financial Implications

To implement these changes additional investment in excess of £200,000 will be required. Consideration will be given by the PCT Board for this investment and how it relates to the health needs of the whole Durham Dales patch and practice based commissioning, when the final decision is made.

Recommendations to the PCT Board

There will be two separate decisions for the PCT Board to make, firstly in relation to the provision of the service itself and secondly with regard to the location of the ambulance stations.

In relation to the provision of the service the following options will be put forward:

Option 1

Standby working continues, this will be an option that will be put to the PCT Board to consider, but it will not be recommended due to the continued problems this option would cause in relation to:

Option 2

That a 24/7 ambulance service is established in the Teesdale and Weardale areas, staffed by a Community Paramedic and Emergency Care Practitioner. This provision would include an A&E vehicle. The Emergency Care Practitioner would be a trained first aider and an advanced driver. They would also receive supplementary training in relation to the equipment available on the ambulance and would always be supervised by the Community Paramedic.

This will be an option that will be put to the PCT Board to consider because it will:

Option 3

This is the same as option 2, but instead of an Emergency Care Practitioner the Paramedic would be supported by a Technician.

This would require additional investment, over and above the £200,000 already identified and the PCT Board would need to consider carefully how the potential benefits of this investment compared with the other competing priorities faced by the PCT, particularly as Teesdale and Weardale have a disproportionately high level of investment compared to the more deprived area of Wear Valley. Many residents of Wear Valley are amongst the most deprived in the country and have significantly poorer health than the residents of Teesdale and Weardale.

The enhancement of the Emergency Care Practitioner role to that of a Technician may however improve the management of incidents where there are multiple casualties. All of the Technicians could not be recruited from the rural areas where they live, due to the level of training required, so the ‘local knowledge’ would be lost.

This option will also be put to the PCT Board to consider.

Relocation of Ambulance Stations

It has been recommended by NEAS that the ambulance bases be relocated to Stanhope and Barnard Castle. The two options that will be put to the Board in relation to this issue are:

Option 1

It is proposed that the ambulance station at St John’s Chapel and Middleton in Teesdale close and that the relocation of the stations is supported. The rationale is that this will base the ambulances in the largest centres of population where the greatest number of calls are received, thereby ensuring that more people receive a faster response.

Option 2

That the current ambulance stations remain in place until the changes have been evaluated and proved to be more effective. This option is being put forward to address the public’s concern that this is a significant change in service that may have a detrimental effect on the most rural and isolated areas.

It should be noted however that the technology which enables NEAS to dynamically base the ambulance using technology and local information, means that the ambulance station is a storage and servicing base, and that the vehicle will not be in it at all times.


Name: Helen Suddes
Title: Director of Primary Care and Performance


Attachments

 Ambulance Services in Rural Areas - 5 Sept.doc