Agenda item

Presentation by Paul Liversidge, Deputy Director of North East Ambulance Service and Mark Cotton, Assistant Director Communications and Marketing, North East Ambulance Service.

The Chair introduced the Assistant Director of Communications and the Deputy Chief Executive from the North East Ambulance Service (NEAS) who were in attendance to provide a presentation to members regarding the post implementation of the audit of national ambulance response standards in County Durham.

The Associate Director for Marketing and Communications

 informed the committee that there had been an audit of the ambulance services response standards over the last 12-18 months to see if the service was achieving its response targets.  He noted that within the audit, the new targets differed from old one with the new aiming to better prioritise the patient who needed an ambulance response.  A new model of working had been introduced to help reach targets that included a new 12 house shift pattern, the reduction of rapid response vehicles, the recruitment of more staff, the reduction of night shift crew and the increase in double crewed ambulances. 

The Associate Director for Marketing and Communications notified the committee that on some elements the response targets were not being met but certain factors influenced response times like the increase in patients requiring ambulance services during the winter, the hand over with hospitals accepting patients and whether the call was for a category one that was life threatening or a category two that was serious.  The ambulance service had relied on the St Johns Ambulance service to help deliver patients to hospital in times of need. 

The Associate Director for Marketing and Communications referred members to several charts within the presentation that showed response times compared to the targets set and the forecasted demand.  In most cases the demand was even greater than the forecasted demand.  He noted that even after the investment and recruitment of staff there were still issues with long waits.  On a positive note, the Associate Director for Marketing and Communications told the committee that when bench marked against other ambulance services it was the most successful, cheapest and fastest ambulance service in category one response times.

Councillor Bell was concerned that the statistics only showed a regional and North East picture of the response times and that they did not reflect rural area response times. He welcomed the increase in resources for the additional ambulances to increase links from urban areas to Durham but was worried on the handover times. 

The Deputy Chief Executive, NEAS stated that the statistics were for CCG level of communication.  He advised that the rural provision for ambulances was different to that of urban provisions.  He added that systems in rural Durham took a Community Paramedic approach that worked well.  He noted that over the last two years the NHS had placed health care around the patient to help treat patients in rural communities rather than having them endure long journey times to get to hospitals. 

The Deputy Chief Executive, NEAS stressed that the increased resources in Durham had gone into Durham as they were the worst hospital for delays.  The integrated care systems (ICS) had raised issues but they had influence and greater traction to ensure that hospital delays and the impact they had were alleviated.  The ICS were requesting the Winter Plan for this year by Easter which would be a huge undertaking.

Councillor Robinson noted that following the winter of 2018/19 the Chief Executive, County Durham and Darlington NHS Foundation Trust had attended the committee to provide an update on the pressures winter had brought to the service and the resources that would be deployed to improve things.

The Head of Communications and Charity, CDDFT advised that measures had been set in motion in Durham and though it did remain a challenge comparatively broken down the situation was not as bad as people thought regarding delays.

The Head of Integrated Commissioning supported the comments made by the Head of Communications and Charity, CDDFT as the service was not looked upon as an individual problem but as Durham as a whole.  She stressed that working collectively was a good opportunity to present that.

Councillor Batey was concerned with the system that monitored the use of the defibrillators.  She gave her division as an example of a defibrillator that had been deployed at a weekend which was not asked to be signed for and the community centre did not realise it had been taken. She wanted to know who checked the host organisation to ensure equipment was returned and pads replaced after use. She thought that additional resources should be put in place so the central system was manned over the weekends.

The Deputy Chief Executive, NEAS stated that staff should be available 24/7 as part of the first responder team.  There was an expectation that once a defibrillator was deployed that the machine would be returned in a state that it was ready to be used again if required. He agreed to investigate this further.

Cllr Batey informed the Deputy Chief Executive, NEAS that the incident happened at Ousten Community Centre.

Councillor Temple mentioned that he had been present on the Committee for the past 12 years and was disappointed that hand over delays in hospitals had doubled with knock on effects for the ambulance service. He questioned what the function of the Committee was and what difference the Committee made.  He wanted to know what the committee could do considering capital investment, who they could lobby and who within the press could take these items up.

Councillor Robinson requested a definitive answer on whether University Hospital North Durham (UHND) had been given approval to extend their A&E service.  The Chief Executive, County Durham and Darlington NHS Foundation Trust had given an update at a previous meeting but no further information had been forthcoming.

The Head of Communications and Charity, CDDFT could not give a definitive answer regarding UHND’s plans for an extended A&E.  She noted that there was a commitment to the A&E being at Dryburn Hospital and that it required a business case in order to take it forward.  She added that there was a lack of resources at present for the project and was waiting for a national response to funding.

Councillor Temple wanted to know if he or the committee as a whole could write to the MP for support to pressure the government to respond regarding 100% investment.

The Head of Integrated Commissioning reassured the committee that the hand over delays had improved in Durham. 

Councillor Robinson felt that a case study could be carried out to show how ambulances came into hospitals and how they went back out.  He supported the suggestion to write to MPs to ask for support for investment. 

Councillor Jopling agreed with Councillor Temple’s comments and noted that people did not just go to hospital for emergencies.  She thought that the triage service should be stepped up to wheedle out the non-emergency cases so those who really needed help received it.

Councillor Robinson notified the committee that everyone who self-presented to casualty had to be seen irrespective of whether they were non-emergency.

The Head of Integrated Commissioning emphasized that the NHS 111 service acted as the first point of triage treatment and if appointments were required could be booked through the service to reduce the impact on people self-presenting in casualty.  She informed the committee that she had been part of an audit on the A&E service that had taken place between the hours of 8am and 10pm that involved talking to patients asking them why they had come in. She added that this was to identify streaming at the front desk to see if patients could be seen in primary care rather than A&E.  It was hoped that the culture could be changed to lessen the burden on the A&E services.

Councillor Quinn explained that she had recently had a bad experience at A&E where she had to wait 8 hours with an elderly client from her care home because of the hand over from ambulances as it was grid locked.

Councillor Robinson noted that it was not just in Durham but other hospitals like the University Hospital of North Tees were just the same.

Councillor Crathorne felt that the walk-in service at Bishop Auckland should just be for people to walk in to relieve the impact on A&E.  The services at Bishop Auckland should also be pushed more.

The Head of Integrated Commissioning advised that there were services not just in Bishop Auckland but also in Peterlee. The NHS were trying to advertise the message that it was better to talk than walk so they should talk to the 111 service before walking to the A&E department or minor injuries units.  She felt that members could help promote this message to residents.

Councillor Crute responded to Councillor Temple’s points regarding the purpose of the committee as it was set up to amplify the voice of the public in matters that were important and to drive improvement forward in public services.  He agreed that MP’s should be contacted and lobbied but it was important that an outcome could be seen.  He believed that there was no quick solution for the ambulance service but felt that MP’s should be lobbied for improvement but lobbying needed to be followed through on behalf of the public.

Councillor Robinson agreed with Councillor Crute.

Councillor Bell felt that things had got carried away with the Purdah period and was worried that business would not be progressed because of it.

The Principal Overview and Scrutiny Officer notified the committee that guidance had been issued by the Monitoring Officer with regards to Purdah that would commence on 23 March 2020 but that did not mean that it was not business as usual.

Councillor Jopling believed there was a good service provided at Bishop Auckland but people were required to ring 111 to book an appointment.  However, she felt that some of the public would not do this as they did not have any confidence in the 111 service.  She understood that people had to work more effectively as walk in services would be busier at some points and that an equilibrium had to be found to ease the pressure on Durham. 

Mrs Hasoon emphasised the message that if anyone was unwell not to contact doctor surgeries but the 111 service for advice.

The Head of Integrated Commissioning explained that the service at Bishop Auckland had not been a walk in for three years as people would rather have an appointment than wait at a walk-in service. She added that this had been a clinical risk but there was a requirement to get people to the right place which the 111 service could channel people as they provided a triage service to get people the right help.

Resolved

             i.        That the report be noted;

            ii.        A further more detailed report analysing ambulance response performance across County Durham and A&E handover/triage performance at UHND and Darlington Memorial Hospital be brought to a future meeting of the Committee;

           iii.        That County Durham MPs be lobbied to secure the required funding to enable plans for the extension of the A&E Department at UHND to be progressed.