Agenda item - South East Coast Ambulance NHS Foundation Trust (SECAmb): Update on Quality & Performance

Report of the Executive Lead for Strategy, Governance & Law, providing an update on SECAmb activities (copy attached)

27.1    This item was presented by Steve Emerton, SECAmb Director of Strategy and Business Development; Andy Cashman – Regional Operations Manager: WEST; and Helen Wilshaw – Strategy and Partnerships Manager: WEST.

27.2    Mr Emerton told members that SECAmb is on a journey to improvement, but has seen significant improvement in the past 12 months. There has been substantial new funding from CCGs following a capacity review, which has enabled the Trust to invest in workforce and its fleet. Performance in Brighton & Hove is generally good, and has historically been so, although SECAmb has sometimes struggled to meet targets in the more rural parts of its patch.

27.3    Ms Wilshaw told the committee that SECAmb had worked hard with local commissioners and providers via the A&E Board to reduce hospital handover delays. Performance is improving although challenges remain. There has also been local focus on admission avoidance (e.g. investigating why there are many more 999 calls from some care homes than others); on frailty; on homelessness; and on the ‘longest patient waiting’ initiative which aims to reduce very long patient waits.

27.4    In response to a question from Cllr Marsh on category 3 calls, Mr Cashman explained that calls to 999 and referrals from GPs etc. are classified according to their urgency. Responses to category 3 calls will be slower than to categories 1 and 2, and where appropriate may involve sending a less highly-equipped vehicle.

27.5    In response to a question from Cllr Marsh about the new Make Ready Centre, Mr Cashman explained that this represents the implementation of long term aims. The centre will become operational in Quarter 3 of 2020. There will be response posts across Brighton & Hove – not all ambulances will be despatched from the Centre at Falmer. HOSC members are welcome to visit the new centre.

27.6    In answer to a query from Cllr Deane about stroke response times, Mr Cashman told members that effective treatment for stroke was about identifying the most urgent cases and getting them to the most appropriate places for diagnosis and treatment. Ambulance response times are only a part of this picture.

27.7    In response to a question from Cllr Greenbaum about SECAmb involvement in the BHCC Outdoor Events consultation, the SECAmb representatives noted that they were unaware of the consultation. (Following the meeting SECAmb was sent a link to the on-line consultation. BHCC officers responsible for the consultation also explained that their plan has always been to engage fully with key partners, including SECAmb, in the second stage of this consultation.)

27.8    In answer to a question from Ms McCabe on managing falls risks, Mr Emerton told the committee that the Trust works hard to mitigate the risks of patients having to wait for a category 3 ambulance – e.g. by ensuring where possible that the patient is made comfortable and by keeping in touch with patients while they wait so as to be immediately aware of any deterioration. Helen Wilshaw added that it was important to ascertain whether someone was present and able to support the patient; this would be one factor in determining what type of ambulance response was appropriate. There is also work to be done with care homes; in many instances there is no reason why care home residents need to be left where they fell until an ambulance arrives.

27.9    In response to a question from Cllr Janio on the proportion of unnecessary calls, Mr Cashman replied that this was difficult to estimate as callers may not always be in a good position to understand the seriousness of their condition. Placing more clinicians in call centres and building in more time to assess calls before a response is triggered should reduce the number of inappropriate call-outs. SECAmb also focuses on frequent callers to work out what their conditions are and whether they are receiving the support they need.

27.10  In answer to a query from Cllr Greenbaum on the reliability of second-hand ambulances, Mr Emerton explained that the trust does plan for the need to make repairs when buying second-hand fleet. Most repairs are undertaken in-house, unless they are particularly specialist or can be done under warranty.

27.11  In response to a question from Cllr Morris on the categorisation of calls, Mr Cashman explained that this is based on national rules. Categorisation depends on the urgency of the call and also whether the problem is something that can be treated at the scene rather than requiring conveyance to hospital.

27.12  In response to a question from Ms McCabe about handover at the Royal Sussex, Ms Wilshaw told the committee that there has been an improvement and that SECAmb works very closely with BSUH. However, significant challenges remain. Mr Emerton added that this is an issue for the whole health and care system not just for acute trusts.

27.13 RESOLVED – that the report be noted.