Meeting documents

            Meeting: Health Scrutiny Sub-Committee (County Hall, Durham - Committee Room 1b - 11/03/2008 10:00:00 AM)

                  Item: A2 Ambulance Service in Rural Areas a) Report of Head of Overview and Scrutiny b) Reports and Presentation of County Durham Primary Care Trust and North East Ambulance Service c) Report and Presentation of County Durham Primary Care Trust Public and Patient Forum

         

---

To view maps or photographs please refer to PDF attachments.

Report of the Head of Overview and Scrutiny

Purpose of Report

1. To consider an evaluation report on ambulance stations in Weardale and Teesdale in line with a decision taken in October 2006 by the then Durham Dales Primary Care Trust about proposed changes to Ambulance Services affecting residents of Weardale and Teesdale.

Background

2. 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.

3. 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 ended on 18 September 2006) before reaching a view on the issues.

4. 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 and agreed (see appendix 1):

§ That a 24/7 ambulance service was established in the Weardale and Teesdale areas staffed by Community Paramedics and a Technician. § 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.

Information

5. Members of the JHOSC recommended (5 September 2006)regarding changes to the ambulance services in Weardale and Teesdale :
§ 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. § 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.

6. The PCT and NEAS have completed an evaluation of ambulance services in rural areas (Report attached Appendix 2).

7. The County Durham PCT PPIF have also produced a report that reflects their concerns with the CDPCT and NEAS report on evaluation of ambulance services in rural areas (Report attached Appendix 3) Recommendation

The JHOSC are asked to note both reports and suggest that the CDPCT entire into dialogue with key stakeholders to ensure they fully understand the outcome of the evaluation of rural ambulance services.

That following this meeting, having received and digested the information contained in both reports, the JHOSC share its thoughts in writing with interested parties, namely CDPCT,NEAS and CDPCT PPIF, regarding the evaluation of ambulance services in rural areas

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 27th 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 11th 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:

1. Standby must stop
2. Want to retain existing ambulance station at St Johns Chapel.
3. Want a 24/7 ambulance crew
4. Want either two paramedics or one paramedic and a technician.
5. Do not want ECA’s
6. Ambulance crew state 10 out of 11 paramedics already working in the two Dales will not work alone with ECA
7. No formal plans in place where new ambulance would be based in Stanhope.

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 17th July at 2pm

40 people attended this meeting. Issues raised were:

1. Training skills of ECA
2. Concerns about paramedics carrying out GP duties
3. What do current ambulance crews think?
4. Concerns that public views will not be taken into account.

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

Stanhope Community Centre on Monday 24th July at 2pm

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

1. Possible location of the garage for ambulance could be in Stanhope but not yet where has been decided
2. Concerns from Upper Dale residents that they would be worse off with longer response times
3. Approval of 24/7 service
4. Training of Emergency Care Assistant
5. Role of Community Paramedic not yet decided
6. The positive support having injected funding into the service

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 31st 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:

1. Concerns over the proposed closure of Middleton in Teesdale Ambulance Station
2. Training and skill level of ambulance crews
3. Unhappy about predictive positioning of ambulances
4. Unrealistic response times in upper dales would be increased due to further distance to travel.
5. Major concerns about A66 accident blackspot
6. Concerns that ambulance will be used more in Darlington than Teesdale
7. Why proposed staffing levels at Weardale to be same at Teesdale when smaller population?
8. Will community paramedics be at Barnard Castle all the time and not at Middleton?
9. Increased population during holiday periods

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 20th August 2006. The comments were as follows:

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

Comments
· Unacceptable to expect ambulance crew to park by roadside during a winter storm waiting for a call out which may be 25 miles away (comments made by two people)
· Consider keeping current stations as standby point for 2 - 3 years during implementation of changes. Effective monitoring on how reconfiguration is working in practice plus reassurance to local resident.
· It should still be possible for paramedics based at St Johns Chapel to perform a more fulfilling role in the community.

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

Comments
· Use of air ambulance in emergencies, would NEAS be able to contribute financially?

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
· ECA skill level not adequate back up for paramedic
· If managed correctly, the community paramedic will also provide an enhanced health service for the benefit of all.
· Community paramedic an excellent idea but as an additional role

Recruitment
2 want local recruitment

Comments
· Recruitment needs monitoring

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

Comments
· Opportunity to truly bring health care into the heart of the community by developing A&E service, which will provide equity of response times for all residents.

Two petitions have been received by the PCT

1. The following petition was received by the Durham Dales PCT on the 31st July 2006. 3621 signatures were signed up to the following proposal.

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.”

PPI Forum Responses

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

2. North East Ambulance Service Patient and Public Involvement Forum
o Lone working in remote areas
o Transportation of patients to hospital
o Base of community paramedics when not answering 999 calls. o Concerns over use of ECAs instead of technicians to support paramedics
o Accepts the reason for relocating the ambulance stations to the new bases on the grounds of service greater population
o Providing there is a robust triaging system along with a dynamic system of predicting “Hot Spots” this proposal is seen as an improvement to the current service
o They do feel the original idea of having a single community paramedic in the area at all times remains the optimum option with greatest benefit to patients. They note that this system has been successfully implemented in rural areas in Northumberland

3. Durham Dales PCT Patient and Public Involvement Forum

Decision Making Process

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:

· Poor response times
· Detrimental effect on staffs’ working lives
· The limitations it places on modernising the service
· The future problems it would cause in relation to recruitment

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:

· Provide faster response times
· Provide equity of service during both the day and night
· Create the opportunity to develop greater links with primary health care
· Offer a greater variety of roles and enhanced career development to existing paramedic staff
· Remove the outdated and unpopular stand-by working arrangements for existing staff
· The Emergency Care Practitioner could be recruited from the local communities and this would enable the service to have the ‘local knowledge’ that the public have requested be retained during the consultation process.

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

1. Introduction

1.1 In September 2006 the former Durham Dales PCT, following extensive public consultation in 2005, agreed to a year long monitoring of the decision to modernise rural ambulance services in the Teesdale and Weardale areas, provided by the North East Ambulance Service (NEAS).

In summary the modernisation comprised:

· Removal of the standby working practices,
· Recurring investment by the PCT of £254,000 to introduce a community paramedic service working 24/7 dedicated to the Teesdale and Weardale areas,
· The relocation of the ambulance stations. The Middleton in Teesdale crew to relocate to Barnard Castle, and the St Johns Chapel crew to relocate to Stanhope Community Hospital.

1.2 The year long exercise ran from December 2006 to December 2007. The final monitoring report has now been issued. The Chair of the Monitoring Group has been a senior management representative of the County Durham PCT, and represented stakeholders included the County Durham Primary Care PPI Forum, NEAS PPI Forum, local GPs, NEAS and the County Durham PCT.

1.3 As a consequence of the approved modernisation it is recognised there are now more staff on rotation able to work in these rural areas and greater potential for integrated working across other health services in the area including GP practices, community nurses, First Responders, and Stanhope Community Hospital. It is also recognised that some of the anticipated improvements and integration have not been fully analysed or implemented yet and will be a key focus for commissioners in 2008/9.

1.4 The final report from the NEAS is attached for information. This has been shared and discussed with the Monitoring Group and amended to reflect comments made. It is now the responsibility of the County Durham PCT to consider the outcome of the monitoring and whether the requirements for the closure of the two stations have been met.


2. Implications and Risks

2.1 Due to the consequences of reconfiguration, the responsibility for chairing the Monitoring Group changed hands 3 times. There were difficulties as the framework for monitoring had not been established at the outset, and the monitoring analysis grew ‘organically’ as a consequence of discussion and challenge through the year. It was believed that by Q3 (end September 2007) an agreement had been reached on the consolidation of the monitoring framework whereby performance would be objectively analysed and was sufficiently detailed across a number of target areas. This has most recently been refuted by the CD PC PPI Forum members.


2.2 Time series comparisons on performance were rendered incompatible as a consequence of the new clinical decision support system ‘NHS Pathways’ which led to changes in the categorisation of patients, and the introduction of a new computerised control and dispatch system in A&E control. The introduction of both systems significantly damaged performance between October 2006 and February 2007.


2.3 The CD PC PPI Forum continue to maintain that their inability to insist upon having their ‘own’ vehicles and crew for both Weardale and Teesdale has had a detrimental impact upon service response and leaves these rural communities - particularly Weardale at significant risk. The PPI Forum maintains that the averaging of performance at these two rural area levels, with a lack of breakdown to dedicated post codes masks poor performance.

2.4 It will be for the County Durham PCT to establish the extent to which a drilling down to specific post code level may be required to fulfil the objectives set by the former Durham Dales PCT, and provide the protections described above.

2.5 The performance analysis has been undertaken separately across the Teesdale and Weardale areas as follows:

· No of Category A incidents

· Performance for Category A calls. National requirement 8 minutes (75%)

· Category A Night Time and Day Time Response and by Time Band
· Response Performance by ‘In Area’ Vehicles and ‘Out of Area’ Vehicles

- The ‘Weardale’ Vehicle is used approximately 43% of the time ‘in area’
- The ‘Teesdale’ vehicle is used approximately 73% of the time ‘in area’
· Conveyance (Transport of Patients) Rates
2.6 From the above it could not be stated that the modernised arrangements has led to a deterioration in service. Generally there has been improvement overall, although there has been disagreement about the reasonableness of detailing down to specific postcodes and the appropriateness of very small data sets to measure performance.

2.7 It is also clear that no defined parameters were set at the start of the process and as a result a significant part of the year was spent to no-ones advantage in establishing this and emerging positively from a challenge and clarification process.

2.8 There remains a fundamental worry at the heart of the local community that the loss of a visible vehicle, particularly in the upper dales area will leave them at significant risk as overall performance is improved across the wider service pulling response vehicles further and further away from them. There is no evidence of this, although the contention is that performance analysis has been at too high a level ie ‘Teesdale’ and Weardale’ to demonstrate otherwise - and so we are left with the judgement within the PCT of how far we drill down to measure performance with increasing unviable numbers for robust statistical analysis.

2.9 The basic requirement from the former Durham Dales Board was not deliverable in respect of the closure of the Ambulance Stations. It is impossible to prove absolutely the impact of something that was not allowed to happen.

2.10 It is disappointing that the process was unable to provide more quantitative analysis on the direct impact of the Community Paramedic Service, as qualitatively the indications are that this has been, and can continue to be nurtured to provide a high quality, locally owned and integrated service, valued across both primary and secondary care sectors.

2.11 Clinical protocols need to be developed so that clinical handovers for urgent treatment and conveyance to hospital are agreed so that the practice of the service of taking patients to hospital and leaving the local area for the time this takes is discontinued, and the service genuinely remains a 24/7 service in the two localities.

2.12 What can be stated however is that at ‘Teesdale’ and ‘Weardale’ level the changes in service have not detrimentally impacted upon service provision, and as such there appears to be no case to be made in principle for the ambulance stations to be retained.

2.13 However what is key is an overall improvement in the response times are needed for this local community, which are significantly below the wider County Durham performance levels. It would therefore be imprudent to alter the status quo until a more responsive service, meeting the needs of a rural population have been approved by the County Durham PCT.

3. Recommendations


3.1 In recognition of the significantly below average Category A response performance in these local areas it is recommended that a decision to close the stations is deferred until a plan has been agreed, implemented and monitored to improve this to a level to be determined by the County Durham PCT. This decision to be recommended to the County Durham PCT Board. The timescale for this work needs to be agreed with NEAS and the local community.

3.3 It will be the responsibility of the County Durham PCT to work with the NEAS and the local community as part of the decision making process. In recognition of the development of the Community Paramedic Service, the Ambulance Service are to be commended. It is however recommended the County Durham PCT should work very closely with NEAS, and the CD PPI to agree and implement a development plan in 2008/9 for the service to enhance and improve response times and assess the opportunities and alternative means by which integration with other local services can be best achieved, and to reinforce confidence in urgent and emergency health care.

3.3 It is recommended that the means by which the outcome of this process and the arrangements for the ‘next steps’ review of urgent and emergency care is agreed between the County Durham PCT, the Overview and Scrutiny Committee and the CD PC PPI Forum and NEAS.



Author: Sharon Smith
Title : Assistant Director of Acute Care Pathways Date: 21st February 2008

DiagnosisTotal

Fall/Accident	34
Lower Limb Injury	16
Upper Limb Injury	14
Abdominal, Lower Back or Flank Pain	4
Breathing Problems, Breathlessness	4
Abdominal, Lower Back or Flank Injury	3
Hand or Wrist Injury, blunt	3
Headache	3
Vomiting Blood	3
Abdominal Pain	3

The approach to Forest in Teesdale School
The Patient and Public Involvement Forum would like to pay tribute to the dedicated service which the Paramedics and Technicians provide in our area. Comments and recommendations contained in this report relate to shortcomings within the system, not to the work undertaken by this vital part of our National Health Service.

Report by members of the County Durham Primary Care Trust PPI Forum
Jean Heatherington, Margaret Dent and
Joy Urwin, Weardale Ambulance Group
February 2008

Weardale and Teesdale in relation to A&E hospitals and ambulance stations

Summary

1. Monitoring was set up to address concerns expressed by residents in postcodes DL13 1 (upper Weardale) and DL12 0 (upper Teesdale).

2. The PCT failed to provide leadership in the monitoring process.

3. NEAS presented no data which monitored the effect of the service on the above postcodes but has instead, in their draft final Q4 report, based its conclusions and recommendations on data averaged across the whole area masking wide variations in response times. Response time improvements were to be expected, in any case, with the change from stand by to fully manned 24/7 service.

4. Raw data collected by the ambulance crews and collated by the CDPCT-PPI highlights key concerns in both upper Teesdale and Weardale related to ‘out of area’ activities, both when the local ambulance is drawn out of area and when ‘out of area’ ambulances are called in when the local ambulance is not there (or on a meal break). Raw data demonstrate that from the base at Stanhope the ambulance is 3 times more likely to be drawn out of the area than from St John’s Chapel. In Teesdale an out of area ambulance is attending to calls in upper Teesdale for up to 45 % of the time.

5. The target driven proposals take little account of the distribution of population or the topography of these huge catchment areas.

6. The PPI welcome the developing Community based Paramedic Service in Weardale but are disappointed that team working across health care professionals has not been achieved in Teesdale

7. As there has been no attempt to differentiate data for the upper Dales and no evidence has been presented to justify the relocation of the ambulance bases, any decision to close the stations would not only be most inappropriate, but totally unacceptable to the residents of the upper Dales, therefore the PPI does not accept, as it stands, the NEAS report, its conclusions or recommendations to close St John’s Chapel or Middleton in Teesdale stations.
8. At the last monitoring meeting the PCT backed down from its promise to hold public meetings saying that there was no statutory requirement to do so. The PPI have therefore taken the initiative to organise public meetings because they feel that there is both a duty and moral requirement to answer their original concerns by feeding back to the public the findings from the monitoring process.
9. The Bellingham Incident in Northumberland (Appendix VIIa,b,c,) highlighted a failure by the Health Services to get a very sick patient to hospital in less than 8 hours, despite all parties claiming that they had met their target. What good are targets? Where is rural equity? We take this incident as a terrible warning of how things might be if the ambulance service implements its proposal of closing stations at St John’s Chapel and Middleton inTeesdale. Where was the Bellingham Community Paramedic in this scenario and how did it help the patient that every health professional hit their target? This incident also highlights concerns about the effectiveness of the Out of Hours Service and Emergency Care Assistants. (Appendix VII)


Recommendations

1. The St John’s Chapel and Middleton in Teesdale ambulance stations remain open and in use. The PCT must demonstrate that it is taking rural equity seriously and make a commitment to residents of the upper dales that as part of its “Big Conversation” not only is it listening but also implementing services which residents consider to be essential.

2. When the Weardale or Teesdale ambulance leaves its area a rapid response vehicle or another A&E vehicle should provide cover by moving into the area. This vehicle would need to be positioned to ensure a reasonable response time to the furthest extent of the Upper Dales.

1. Introduction and Background

Following concerns raised during public consultation events to discuss the document “Modernising rural ambulance services” in the summer of 2006, Durham Dales Primary Care Trust (PCT) (as it was then) agreed to delay a decision on the relocation of Middleton-in-Teesdale and St John’s Chapel ambulance stations until a twelve month monitoring process had been undertaken.

To address public concerns that any relocation would result in a “significant change in service that may have a detrimental effect on the most rural and isolated areas” (Durham Dales PCT Board Report, September, 2006), it was agreed that current ambulance stations would remain in place until changes had been “evaluated and proved to be more effective” (ibid).

Over the past twelve months, the North East Ambulance Service (NEAS) has produced and presented quarterly monitoring reports of emergency vehicle activity levels, including, at the request of the Public and Patient Involvement Forum (PPI), raw data compiled by the paramedics that shows both the vehicle starting point and the incident location.(Appendix I) In addition, the PPI members of the group receiving the monitoring reports have visited NEAS headquarters to view the new NHS Pathways System and have continued to seek stakeholder views via their local networks and contacts.

2. Role of the PCT in the monitoring process

The CDPCT, as the commissioning body, has failed to

1. manage the monitoring process
2. set clear, agreed monitoring criteria
3. provide continuity and consistency of personnel attending monitoring meetings (four quarterly monitoring meetings have had three different chairmen).
4. ensure that the data provided to the monitoring team differentiated A&E activity in postcodes DL12 0 and DL13 1 in order that the effect of station closure on Upper Teesdale and Upper Weardale could be properly evaluated.
5. challenge or evaluate any part of the NEAS report
6. address several areas of concern highlighted by Overview and Scrutiny Health Sub Committee report of 5th September 2006
7. engage all relevant parties in the monitoring process - GPs, paramedics, First Responders, Richardson Hospital etc.
8. require NEAS to provide relevant raw data repeatedly requested by CDPCT PPI Forum members of the group
9. engage paramedics in the importance of the data they were asked to collect
10. be informed by, or responsive to, the opinions of local people re Government Health White Paper Chapter 7 'Our Health, Our Care, Our Say'

3. The NEAS Report

NEAS presented no data which monitored the effect of the service on the above post codes but instead based its conclusions and recommendations on data averaged across the whole area masking wide variations in response times.

4. Concerns raised by Raw Data

Information presented during the monitoring process has done nothing to alleviate or answer key concerns which relate specifically to the more remote areas of Weardale and Teesdale.

4.1 Weardale
The key concern is that if the station at St John's Chapel is closed and the base moved to Stanhope the Weardale ambulance will be drawn more often to support the service in mid and east Durham, as the raw monitoring data demonstrates. This is to the detriment of the population in the whole of the dale.
4.2 Teesdale
the key concern is that this has already happened in practice because the station at Middleton has not been used since December 2006. Insufficient evidence has been presented to show where an ambulance is travelling from, or the time taken, to answer calls in the upper dale as the statistics are not differentiated. Evidence of an overall improvement masks a worsening picture in some areas. Teesdale covers an area of 836 sq km and has a population of 24,000 ranging from widely dispersed settlements to market towns.

Weardale

Raw data showed that the further east the starting location of the ambulance at call-out the more often it was called out of the area.(Appendix IIa)

· 57% of job locations starting from Wolsingham were east of Harperley Banks on the A68
· 30% of job locations starting from Stanhope were east of Harperley Banks on the A68
· 11% of job locations starting from St. John’s Chapel were east of Harperley Banks on the A68

It also showed that in total 38% of jobs carried out by the Weardale ambulance were to the east of Harperley Banks. (Appendix IIb)

This raises the concern that an ambulance based permanently in Stanhope would be used out of area more often as has happened in Teesdale where the base has been relocated to Barnard Castle.(Appendix III and IVa)

There is also evidence that when the ambulance is out of the area Weardale can be left with very poor cover. The following incident serves to illustrate how the local ambulance can be redeployed once out of the area.

On 18th December an elderly lady became ill at a concert in Ireshopeburn and was unconscious when the ambulance was called. The Weardale ambulance had already been called out of the area and was then called to attend an incident at Seaham! The nearest available ambulance was just to the west of Darlington and took 45 minutes to arrive.

Data shows that 25% of call outs for the Weardale ambulance are made when the ambulance is already out of the area.

It is recognised that the service will operate widely in the community but there are pragmatic reasons why the base at St John’s Chapel should be retained.

· it provides existing designated facilities for ambulance crews
· appropriate garaging and parking facilities with sufficient protection for bad weather such as frost and snow
· cleaning and maintenance facilities including available and easily accessible equipment charging points
· a suitable entrance with good lines of sight
· no further capital investment is required as would be the case if it moved to Stanhope

Regular attendance at the St John’s Chapel base also ensures a visible and reassuring daily presence of the ambulance in the upper Dale.

It is questionable whether all of the facilities, presently at St John’s Chapel, can be provided at Stanhope. This was acknowledged by the Director of Ambulance Operations, Mr Paul Liversidge, in a letter to Helen Suddes of the Durham County Primary Care Trust, dated 19.06.07 “Stanhope Community Hospital is a temporary base and does not have sufficient facilities for the crews to operate there full time, logistically we have agreed for them to pick up their vehicle at the start of their shift at St John’s Chapel, move down to Stanhope and return for their meal breaks and to finish their shift. This arrangement exists due to the reduced facilities at Stanhope Hospital.”

If the Station at St John’s Chapel closed there is a concern that not all of the functions presently conducted by the ambulance crews could be carried out at Stanhope, causing the ambulance to travel further a field for facilities.

Teesdale

The situation in Teesdale is of even greater concern because the Teesdale ambulance spends much less time in the Middleton area than the Weardale ambulance spends at St John’s Chapel. Raw data for Teesdale, spanning the second and third monitoring quarters, was unavailable to the group. NEAS and the PCT failed to ensure this data was provided. However, the data presented in the first quarter recorded no calls west of Barnard Castle attended by the Teesdale ambulance and only ten in the rest of the area. All other calls recorded in the three month period were to patients out of Teesdale (Appendix III). Ten incidents west of Barnard Castle were recorded as attended by the Teesdale crew. Does this mean, therefore, that all other calls in Teesdale were attended by ambulances from out of the area such as Darlington, Newton Aycliffe etc.? The monitoring process has failed to allay public concern about A&E ambulance cover in Upper Weardale and Upper Teesdale.

Historically Teesdale has had two stations, Middleton and Barnard Castle but a combined rota was worked and the crew was based at Middleton for one third of the time. The ambulance is now based full-time in Barnard Castle and the Middleton station has been ‘mothballed’ throughout the monitoring period, this has led to a public belief that the decision to close the station had already been taken and implemented in December 2006, notwithstanding that the station has been repainted inside and out in January 2008.

The monitoring process was charged with proving that the “significant change in service would not have a detrimental effect on the most rural and isolated areas” however, the ambulance spends far less time west of Barnard Castle than it used to and NEAS figures (not derived from raw data) demonstrates that ambulances from other stations such as Newton Aycliffe, Bishop Auckland and Weardale are attending upper Teesdale residents up to 45% of the time, rather than the Teesdale ambulance (Appendix IVa). This inevitably means considerably longer waiting periods, well outside the target times, and happens when the Teesdale crew is called out of the area to attend incidents in Darlington and Bishop Auckland or when transporting a patient to hospital etc. In these circumstances the local vehicle may be out of the Dale for up to four hours. Weardale and Teesdale ambulances are sometimes used to transfer patients between hospitals e.g. from Darlington Memorial Hospital to the R.V.I., Newcastle.

The statistics produced for the monitoring group do not differentiate between the upper and lower Dales and raw data from the Teesdale paramedic team shows virtually no presence west of Barnard Castle.

Equally, the monitoring information does not answer crucial “what if” questions in relation to emergencies that occur in very remote areas west of Stanhope and Middleton such Killhope, Cauldron Snout, High Force etc. The Teesdale ambulance also has to cover a long stretch of the A66, with notorious accident black spots including the exposed Pennine section beyond Bowes to Stainmore and the Cumbria border. While recognising the need to comply with national performance targets, Taking Health Care to the Patient: Improving NHS ambulance Services (2004) clearly states that “It is a performance requirement that patients receive the same level of service wherever they live”. Equally, an insistence on rural equity has been a central theme of much government policy over the past several years. Payment by targets however, is at odds with delivering rural equity.

In Teesdale the concerns about the closure of the Middleton base revolve around the long distances and travel time from the facilities in Barnard Castle, Darlington and Bishop Auckland for residents and visitors to the Upper Dale. (Appendix Va). The ‘golden hour’ (the critical time span for treatment to be administered to give the best possible outcomes for patients with life threatening conditions) seems a hollow sham if it takes almost that long for an ambulance to arrive, let alone transport the patient to hospital. A & E crews are trained to stabilise patients but cannot be expected to do the same job as a full A&E team of doctors and nurses using more sophisticated equipment in controlled hospital conditions. It is the luck of the draw if an ambulance is available and waiting at Barnard Castle, the chances are high that it will arrive from further away. This concern is mirrored by residents of upper Weardale. (Appendix V)

5. The Rural Situation

Upper Teesdale and Weardale have sizeable though scattered populations and this runs contrary to the perception that they are sparsely populated.
Statistics presented in the consultation are misleading - a press release in February 2006 reported that Stanhope had a population of 2000 and St John’s Chapel 300 whereas figures from the electoral roll show that the population of Stanhope is 1,526 while there are 9 villages and 15 hamlets to the west of Stanhope whose population totals 1,848 (electoral role figures). These need to be taken into account along with two substantial new developments at St John’s Chapel and Eastgate.

Similarly, Middleton was represented as having 1500 residents; however a population of more than 4,100 live in 17 villages and hamlets as well as several hundred dispersed farmsteads and dwellings to the north-west of Barnard Castle. Excluding the A66 / Bowes corridor, this figure accounts for more than 17% of Teesdale’s population, almost as many as in Barnard Castle itself, yet occupying approximately 50% of the total area of Teesdale. (DCC website based on updated census figures).

Additionally both upper Dales are part of an Area of Outstanding Natural Beauty (AONB) covering 1983 sq km, with a dispersed population of 12,000 (source AONB) attracting thousands of extra visitors every year increasing the incidence of road traffic accidents, outdoor injuries and general health emergencies. If both St John’s Chapel and Middleton ambulance stations close there will be no ambulance based in the whole of this AONB.

The proposals presented by NEAS appear to be totally target driven and take little account of rural equity. A performance driven service based on target setting and dynamic deployment will always provide a second-class service to isolated areas because it does not take account of the extended journey time when factors such as rural topography and isolated hamlets are included. The Emergency Medical Journal’s observation that the “percentage chances of seriously ill patients surviving ambulance journeys decreases according to distance travelled” is particularly crucial when the time spent waiting for an ambulance to arrive is added. Emergency vehicles in this part of the county often have to negotiate a narrow, winding spine road, farm tracks with gates, outlying dwellings, lack of street lighting and remote dwellings that are often not known by anything other than local names and this needs to be factored in. A further drawback of ‘out of area’ vehicles attending is the risk of time delay due to lack of local area knowledge. Concerns about this were expressed at public consultation meetings and NEAS promised that it would be addressed. No evidence has been presented. This is the justification for an ambulance base in both St John’s Chapel and Middleton in Teesdale.

6. The Community based Paramedic Service

We fully support the work of the paramedics working in the community and hope that this will continue to be developed to enhance the health care within the upper Dales.

1. Expectations of better team working across health care professionals do not seem to have been achieved. For example, GPs appear to lack information relating to systems and processes. In a recent letter from a GP Practice in Middleton-in-Teesdale, the following issues were raised:

a. The ambulance is not always available when needed and we seem to get more “out of area” ambulances attending
b. What provision is there for cover when the Middleton-in-Teesdale ambulance is dealing with a call from another area
c. The Blackberry is not robust when out of signal range, what back-up is there
d. The ambulance has disappeared from the Middleton-in-Teesdale station altogether
e. The new telephone number for telephone ambulance requests had not been disseminated to GP Practices
f. The Practice could not book a Saturday morning ambulance for a patient needing to go to James Cook University Hospital as a stretcher case. The Practice was advised that the patient could ring on the Saturday morning to see if an ambulance was available but the telephone was not answered. The patient had to use a private ambulance
2. There is the potential for confusion and/or conflict in relation to roles and demands, for example in relation to the work of paramedics, GPs, community nurses and first responders.
3. Is the promised training of paramedics and technicians in their Community role continuing?
4. How are GPs, hospitals, Out of Hours Services, Community nurses, etc. communicating with each other and working as a team and is communication between NEAS and the PCT adequate? For example, is NEAS providing sufficient information on systems and processes? Stanhope Community hospital is liaising with the Weardale ambulance crew but there has been no feedback on the situation at the Richardson Hospital, Barnard Castle.

7. Other Concerns
Quality of A & E Service to rural communities in Upper Weardale and Upper Teesdale
1. There is a systemic bias towards more densely populated areas and a lack of coverage in remote areas that have a similar number of residents but more dispersed communities resulting in a focus on demand rather than need.
2. The first responder system, although a valuable service, relies entirely on volunteer support and as such lacks absolute stability and sustainability. There is only one First Responder in Upper Teesdale. There are also questions surrounding the level of equipment they carry and their inability to administer drugs; this is particularly important given that the clock for a targeted response time stops when the first responder arrives, (if this is earlier), rather than when the A&E paramedic, technician and ambulance arrive. Though this is correct procedure it is misleading and influences target times.
3. How secure is funding for paramedic and technician crews, is there a possibility that we may lose technician level support and revert to the Emergency Care Assistant option favoured by NEAS in the consultation?
4. There is no information relating to the use of the air ambulance, a resource funded solely by charitable donation. Has this usage increased because of the closure of the Middleton station?
5. The impact of meal break cover has not been taken into account. Crews on meal break are not called out even if they are the closest to the incident. The impact of this policy is likely to be far greater in the upper Dales as there are no other ambulances nearby to call on. (Appendix VI) 8. Public Voice

A Public meeting was held at St John’s Chapel on 19th Feb and one is planned for Middleton inTeesdale on 3rd March. Councillor Shuttleworth chaired the Weardale meeting and Councillor Bell will chair the Teesdale one. The CDPCT PPI members gave a power point presentation to report back on the monitoring process.

Outcomes from SJC Meeting
· Over 200 attended the meeting.
· People were shocked and upset at the implications of ambulance relocation.
· 56 statement and comment sheets were filled out at the meeting.
· many other attendees expressed an intention to write to the CDPCT and MP to express their concern.

Conclusion

The NEAS case for relocation is based on improved response times across the region. These response times would have improved in any case because of the ending of standby, the introduction of 24/7 working and fully manned stations. The improvements shown over all hide concerns about levels of service in Upper Weardale and Upper Teesdale. These concerns have always been about response times to outlying areas and the monitoring process has failed to address this because all the information is averaged across all the post codes in each area.

When the ambulances are used out of area the Dales are left vulnerable. While the Community Paramedics in the Dales are part of an overall service across the NE of England their situation is isolated and catchments are huge. It has been shown that external vehicles responding to incidents within the Dales can take up to an hour to arrive on scene. There should be a predisposition against using the Dales ambulances out of area and towards returning them to base as soon as possible.

Insofar as the monitoring was set up to examine the effect of the service on the concerned residents of the upper dales the only relevant evidence, so far presented, to the monitoring group has been by CDPCT PPI Forum who have extracted and analysed information from raw data collected by the paramedics. This raw data does not include response times, as none were provided, although they were part of the information included in the pro forma designed by the PPI (Appendix I). However, it has illuminated the activity of ambulance movements, in particular it has shown that the Teesdale ambulance operates for much of its time around Bishop Auckland and Darlington and that the Weardale ambulance, when based in Stanhope, is much more likely to be drawn into east Durham. This worrying trend to use the ambulances out of area is supported by NEAS figures (Appendix IV)about ‘out of area’ activity and relates directly to the concerns of residents and GPs in the upper Dales that they are often waiting 40 minutes to an hour and a half for an ambulance to arrive.

The incident at Bellingham on Feb 2nd 2008 provides a sober reminder of the vulnerability of ‘real’ patients in outlying rural areas.

The CDPCT seems prepared to accept NEAS’s subjective self asssessment and has placed little or no value on the relevant and substantiated evidence presented by the CDPCT PPI Forum.

As there has been no attempt by NEAS, during a whole year of monitoring, to differentiate data for the upper Dales there is no justification for the relocation of the ambulance bases and any decision to close the stations would not only be most inappropriate, but totally unacceptable to the residents of the upper Dales.

Recommendations

1. The St John’s Chapel and Middleton in Teesdale ambulance stations remain open and in use. The PCT must demonstrate that it is taking rural equity seriously and make a commitment to residents of the upper dales that as part of its “Big Conversation” not only is it listening but also implementing services which residents consider to be essential.

2. When the Weardale or Teesdale ambulance leaves its area a rapid response vehicle or another A&E vehicle should provide cover by moving into the area. This vehicle would need to be positioned to ensure a reasonable response time to the furthest extent of the Upper Dales.

Appendix I Pro forma suggested by CDPCT PPI Forum to collect raw data

Date and time of call out 23/11/06	Starting location	Call ID Inci-dent No	Cat/ S/by	Time taken to arrive	Incident Location	Distance driven	Outcome - transport, hospital, treat and leave, other	Comment
08.00	Middleton		A	7 mins.	Thringarth	3.2 m	A&E DMH

Appendix V
Distances to emergency facilities from Locations in Weardale

Location	Post code in Weardale	Distance/ Time from Stanhope Community Hospital DL13 2JR	Distance from A&E and Out of Hours Centre, Bishop Auckland DL14 6AD	Distance from University Hospital of North Durham DH1 4SQ
Wearhead School	DL13 1BN	9.0 miles/ 17 min.	29.8 miles/ 53 min.	30.7 miles/ 1 hr 1 min.
Lanehead	DL13 1AJ	10.7 miles/ 21 min.	31.5 miles/ 57 min.	32.5 miles/ 1 hr 4 min.
Killhope Wheel	DL13 1AR	11.9 miles/ 23 min.	32.7 miles/ 59 min.	33.7 miles/ 1 hr 6 min.

Appendix Va
Distances to emergency facilities from Locations in Teesdale

Location	Post code in Teesdale	Distance/ Time from Barnard Castle Ambulance station DL12 8ET	Distance from A&E and Out of Hours Centre, Bishop Auckland DL14 6AD	Distance from Memorial Hospital, Darlington DL3 6HX
Forest School	DL12 0HA	16 miles/ 42 mins	33 miles / 1 hr 2 min.	36.5 miles/ 1 hr 12 min.
Birkdale	DL12 0JA	22 miles/ 1 hr 6 min.	37 miles/ 1 hr 26min.	41 miles/ 1 hr 36 min.
Herdship Farm	DL12 0YB	20 miles/ 53 min.	34 miles/ 1 hr 13 min.	40 miles/ 1hr 24 min.
Lune Head	DL12 0PB	16 miles/ 40 min.	31 miles/ 1 hour	36.5 miles/ 1 hr 9 min.

Information from the AA

Appendix VI- Effect of Meal Breaks on Rural Services

Whilst visiting Ambulance Headquarter members of the CDPCT PPI Forum took part in a real time simulation exercise as used by call centre trainees. The example given was for a Category A call from Westgate, Weardale. The simulation showed that at that particular time there was no ambulance available. The nearest ambulance was on station two miles away but the crew were on a meal break and all other ambulances were in use.

Because this was a simulation it was not possible to demonstrate which of these ambulances would be stood down from a lesser emergency to be diverted to Westgate, however, the crew on meal break two miles away would not have been alerted. The category A target time could not have been achieved.


This is the response of the CDPCT-PPI Forum to the NEAS report which was amended following the final monitoring meeting 4th Feb 2008. This amended report was not made available to the PPI Forum until 21st February, which was too late to be reviewed in time for the printing deadline for the full Forum meeting on 26th February 2008 at which our report will be presented for approval.

Our report, summary, recommendations and conclusions remain unaltered but we wish to make the following responses.

The following comments should be read and noted in conjunction with the NEAS Report dated 16th February 2008.

Page numbers refer to pages in the NEAS Report.


The PPI Forum on the monitoring panel wish to register the strongest complaint that differentiated postcode information now included in the NEAS final report, which should have formed the basis of the monitoring evaluation from the outset, was only provided to the PPI on 21st February 2008 following the final monitoring meeting. This information had been requested by the PPI Forum from the outset on 4th December 2006. Why could this not have been provided for evaluation at every monitoring panel meeting as this was the purpose of the monitoring process?

Page 1 Summary

“The review has been undertaken in collaboration with representatives from the PPI Forum who have formed part of the monitoring group” [NEAS REPORT]

This however is the NEAS Report and not a joint report.

Page 3 Background

“ The original location of the stations reflected population flows and employment in the areas; local industries included mining and cement works which were based in the dales.” [NEAS REPORT]

This statement is assumed, guessed and inaccurate. The ambulance station situated at St John’s Chapel is there not because of any corporate decision based on previous population size or industry. Indeed there was no national ambulance service or National Health Service, no lead mines and no cement works when the station was set up. Before 1930 private cars were used to take patients to the nearest hospital, Newcastle Infirmary , but it was common for local surgeons to conduct operations on the kitchen table. In 1930 Upper Weardale residents responded to the need and purchased their own ambulance through public subscription. In 1948 it was handed over to the safe keeping of the NHS. It was a similar situation in Middleton ( This is why the residents at St John’s Chapel, Middleton and the upper dales have fought so hard over the years to protect the services in Weardale and Teesdale - there is a real sense of ownership of the service which goes far beyond selfishness.) With constant speculation about Bishop Auckland Hospital, regular use of out of area ambulances and an Out of Hours services 30 miles away today’s residents feel just as vulnerable.

NEAS has continually underestimated population size of both upper dales.

“Although the report focuses on the activity of the Community Paramedics in
this area, it must be acknowledged that they do not operate in isolation from
the overall service provision in the North East. As such, they will where
necessary, be supported by vehicles and crews from outside of the locations
identified as Tees and Wear Dales, and will be required to support their
colleagues out with their normal working area. This is essential to ensure the
most responsive service to both the Tees and Wear dales and the rest of the
North East.” [NEAS REPORT]

While the Community Paramedics in the area operate as part of an overall service provision for the whole of the North East , the logistics dictate that, the calls from people in remote areas cannot be answered with an adequate response time if the local ambulance is out of the area and replaced by crews from outside the area. The residents in Upper Weardale and Upper Teesdale do not get a responsive service in these circumstances.

Page 5

“The manually collated information requested by and shared with members of
the review group has not formed part of the following analysis as it does not
reflect all resources utilised within the defined areas and as such does not
reflect overall responses, only those of the identified vehicles.” [NEAS REPORT]

There was a failure by NEAS and the PCT to provide all of the evidence to reflect overall responses by all vehicles. Information regarding response times to DL13 1 and DL12 0 was never shared at any of the monitoring meetings, neither was information about response times by out of area crews. Concerns about these could not be evaluated.

Pages 5 - 7 Community Activity

“A key element of the new role of community paramedic is integration into the
local community and a more pro-active role in supporting local primary and
secondary health care services in the area.” [NEAS REPORT]

PPI have always supported community activity and are not suggesting that the ambulance crews would be sitting in their building at St John’s Chapel and Middleton. They do believe that it is possible to work throughout the community, at GP surgeries , the Community Hospital and in peoples homes while retaining the overall bases at St John’s Chapel and Middleton in Teesdale. The PPI firmly believe that removal of the base to Stanhope will result in Community Work being carried out exclusively at the Health Centre and Community Hospital in Stanhope and that the ambulance will not be seen in the upper dale as has already happened in Teesdale.

“The general view of the Weardale paramedics is that the location within Stanhope is the preferred option” [NEAS REPORT]

Paramedics prefer the Stanhope and Barnard Castle locations mainly because of the greater volume of incidents and the greater number that can be served within the recommended orcon time. While recognising the role which the paramedics will play in the larger centres, from the patient’s perspective we must remember that there are as many people in the villages and hamlets of the upper dales, scattered over a much wider area, who fall well outside the orcon times.

Page 11

“The table below gives this performance split by postcode area.” [NEAS REPORT]

Information regarding postcode should have been shared and evaluated at monitoring meetings.

Response time improvements in DL13 1 from 41.7% to 60% are very welcome. Much of the increase will be due to the change from standy to 24/7 working. However they also show that an ambulance working out of St John’s Chapel (130 starts) and Stanhope (155) starts can accomplish the improvements that NEAS want without a relocation of the ambulance station.
Compare this to Teesdale where the ambulance was relocated to Barnard Castle and the performance in DL12 0 plummeted from 40.9% to 5.7%.

Page 14

Without explanation this table using postcode information is difficult to comprehend. The “Total” row at the bottom while appearing to be an average requires further explanation as it does not calculate as a ‘mean’ and fails to provide a comparison from one year to the next.

Page 16

Figure 10 and the table on page 18 shows the Weardale Vehicle answering about 50% of its Category A responses outside the area.

Analysing 2006-7 data
The Weardale Ambulance answered 81 CAT A calls in Weardale (including Wolsingham).
The Weardale Ambulance answered 80 CAT A calls out of area.

The Forum’s 50% sample of Raw Data showed the Weardale Ambulance answered 163 out of area calls. We can estimate from this that there would have been approx 300 ‘out of area’ callouts over the 12 months. Only 80 of these were CAT A (26%)

Therefore 74 % of out of area calls are for non life threatening conditions. Is it reasonable to leave the whole of Weardale without emergency cover in these circumstances.

Page 17-18

“The table on the following page (18) gives all activity by the Weardale Vehicle…”. [NEAS REPORT]

This is incorrect it shows only CAT A activity.

Page 19

Of the CAT A incidents in Weardale 17 were answered by an out of area ambulance. See Figure 11. This is an improvement on the situation during standby but still 21% of CAT A calls each of which will take from 30 - 45 minutes to reach DL13 2 and DL13 1.

Page 22-23

“Both charts demonstrate that performance in relation to Category A incidents has improved, particular emphasis must be given to figure 14 which relates to the postcode area…” [NEAS REPORT]

NEAS draws our attention on page 23 to an average 15.1% improvement for Teesdale.
The table on page 22 giving performance split by postcode area highlights exactly the concerns which the PPI Forum have raised throughout the monitoring period ie. that averaging masks huge variations in performance. Most worrying of all the effect of closing the ambulance station at Middleton in Teesdale has reduced performance for CAT A (immediately life threatening) conditions from 40.9 % to only 5.7%. Only 2 of 35 incidents in 2006-7 were responded to within the 8 minute target. NEAS do not record whether the two successes were achieved by a first responder or an A&E ambulance crew.

Page 27-28

“The table on the following page (28) gives all activity by the Teesdale Vehicle…”.[NEAS REPORT]

This is incorrect it shows only CAT A activity. 26.3% of CAT A activity is out of the area but the paramedic Raw Data analysed by the PPI Forum shows far higher levels of out of area activity when all categories are included. Is this reasonable when they are failing to meet their CAT A targets in Upper Teesdale and DL13 5.

Page 31

“it is acknowledged that the whole raw dataset requested by the
representatives was not collated due to it adding increased bureaucratic
workload onto the frontline staff outside of their duties” . [NEAS REPORT]

The raw dataset was seen as an essential part of the monitoring by the PPI . The PCT and NEAS had a duty to ensure that the whole raw dataset was provided. By failing to do so the professional bodies have demonstrated a lack of commitment to the monitoring process and a casual disregard of the lay members on the monitoring panel.

The raw data which was collected has illuminated many concerns which NEAS have chosen to ignore in their report.

Appendixes

Page 37 Weardale Paramedics comments

This letter from the Middleton in Teesdale GPs presented to the NEAS on 30th October 2007 at the third monitoring meeting was not answered until 14th February 2008, following a reminder at the last monitoring meeting on 4th February 2008. The PPI Forum feels that the response failed to answer the concerns raised in this letter.

Page 46-7

Paramedics prefer the Stanhope and Barnard Castle locations mainly because of the greater volume of incidents and the greater number that can be served within the recommended orcon time. Performance in Upper Teesdale has shown that hitting easy targets in bigger centres has a profoundly detrimental effect on the large but scattered population of the upper dales.

Page 48

The student while not in any way supporting our cause helps to make the PPI case

· by noticing and complaining about commuting times (28 miles) to St John’s Chapel station. Patients have more reason to complain about waiting this length of time for an out of area ambulance followed by equally long conveyance times to hospital.

· by innocently confirming how ‘remote’ is St John’s Chapel while not appreciating the vulnerability of patients in upper dales villages.

· by observing that she herself lives within 8 miles of four stations. How very fortunate.

· by revealing 100s of miles of travelling being sent to Crook, Bishop and Darlington on standby, without realising that this has left Weardale without cover.


NEAS have obviously not impressed upon trainees that they will, within this new service, be working alongside GPs and other healthcare professionals giving a very valuable lifeline to patients in the upper dales not only when performing these duties but also while on A&E duty.

Page 49 Teesdale Paramedics Comments

Both paramedics in Teesdale seem totally disillusioned by the new paramedic role. One complains of false promises and failure to deliver promised training by the ambulance service and the PCT to deliver new courses and skills. The other says his role is no different than before the change.

The Teesdale paramedic admits to basing his view about the closure of Middleton-in-Teesdale station without any supporting orcon evidence.

Attachments

 Item 2C_i_.pdf;
 Item 2C.pdf;
 Item 2B_i_.pdf;
 Item 2B.pdf;
 Ambulance Services in Rural Areas - JHOSC 11 march COVER Item 2A.pdf