Agenda item

11:50

Steve West, Operations Director; Sue Byrne, Chief Operating Officer; and Linda Scott, Interim Area Manager, Oxfordshire from the South Central Ambulance Service (SCAS) , together with Diane Hedges, OCCG: will report on the service performance and commissioning of the service (JHO8).

The Committee welcomed the following representatives from the South Central Ambulance Service (SCAS) and from the OCCG who had been asked to attend to report on service performance and commissioning of the service, respectively. A report was attached at JHO8.

·         Linda Scot, Steve West and Sue Byre – SCAS

·         Diane Hedges – OCCG

In response to a question regarding the reason for increased demand in the service, Sue Byre reported that the chief executives of ambulance services in the south east region had commissioned an academic survey of reasons for this, the findings of which were:

-       Implementation of the 111 service - public use of the service had doubled over the last 2 years;

-       Increases in the over 65 population and increases in complex conditions; and

-       Changes in the climate and climate conditions affecting demand. For example, the dust cloud which had occurred earlier in the year, combined with pollution, had affected and exacerbated breathing conditions, which, in turn, had led to an unusually high demand in the service.

At a former meeting of this Committee, reference had been made to a pilot project operating in the Witney area which intended to make use of the base and ambulance resource of the St John’s Ambulance Service, in order to expand the reach of SCAS. In response to a request for progress on this, Steve West explained that in reality St John’s had struggled to provide the resource. It had not got up and running until August, but since then it had improved and SCAS were looking to provide a responder vehicle with a view to working within 6 minute drive zones. Performance was now getting to 85% within 8 miles of the Witney area but it did not operate in rural villages outside that zone. This service would be monitored over the winter period. However, SCAS were not looking to roll it out to other areas of Oxfordshire as it was too expensive to achieve.

In response to a question as to whether electronic patient records were compatible with GPS, Sue Byrne explained that efforts had been made to integrate it as far as possible and it now offered special notes in short form. The idea was to fully integrate access to a patient’s summary care record in the future. The patient care record would give the paramedic an idea of care required but would also give access to a directory of services for that particular clinical area so that the most appropriate pathway of treatment could be selected.

Steve West referred to the quality aspect of the 8 minute call out statistics which had been published on the Department of Health website. He added that it gave a good indication of how the service compared with other services in relation to, for example, whether patients had been sent to the correct treatment centre. He added that SCAS had compared favourably with other services.

In response to a question about how services to rural areas were affecting patient clinical outcomes, Sue Byrne agreed that this was one of the major challenges for the service. She explained that there had been a huge increase in red incidents in some areas and a decrease in others. She added that currently there was no data on patient outcomes and the service was therefore working with the commissioners on opportunities to share data. She undertook to share the outcomes on this with the Committee, adding that performance rates would be given including an average on how far the outcome was outside performance targets. Diane Hedges confirmed that although there was no data on outcomes, the CCG would be able to drill down on some outcomes levels and this would be made available to SCAS.

With regard to a question on workforce recruitment, Sue Byrne informed the Committee that SCAS Oxfordshire had performed well on this issue, attracting more paramedics and new graduates to the service. It strived to be an employer of choice, making efforts to develop innovative methods of training people at a junior level and then later at degree level.

With regard to a question about how serious incidents had been reviewed and issues taken forward, Sue Byrne explained that over the last 16 months more scrutiny had been devoted to incidents that involved long waits. The Operations Team (Clinical Review Group) were now taking a detailed look at all of these incidents as part of the structure of clinical support with a view to learning from each incident and reducing problems. She added that there would always be spikes in demand when 3 ambulances might be required in a remote area – and this would always equate to a challenge – but there would be no complacency.

In answer to a question asking whether SCAS transported patients to hospitals outside of the region, Steve West responded that paramedics had full authority to take patients to the most appropriate treatment centre outside of the boundary, though this may depend on the patient’s previous medical history and the availability of medical treatment at the time. Patient choice was also factored in.

With regard to a question about whether there were flaws in the technology used by the service to locate calls, Steve West explained that it was easier to locate calls coming in from a land line than from a mobile phone, which was not as fast or as accurate. Work was ongoing on an app which would improve accuracy. Sue Byrne added that work was ongoing on a continuous basis to improve technology.

SCAS were asked about their arrangements for winter pressures outside Oxford City. Sue Byrne informed the Committee that there were a number of plans for winter work with the CCG for each area. There was some national funding available specifically for the Oxfordshire area for schemes such as the SOS Bus and other schemes. Steve West advised that they were working on it and three schemes were in train:

-       New vehicles – 40% of patients did not require ambulances and transport could be provided in smaller cars. This would release what was a very limited ambulance resource;

-       Introducing the aim of conveying patients to hospital earlier in the day so that they could be assessed and discharged the same day. This would require a very integrated service and the freeing up of resources; and

-       Installing a liaison manager in hospital to manage the flow of patients. This had worked well last year and SCAS was doing it again this year.

In answer to a question about what SCAS learned from their collection of comparative information from other ambulance trusts (see Appendix for comparison), Sue Byrne commented that SCAS always aimed at sharing information and good practice at various levels, such as on - street triage (area linkage with police forces in order to give a better service).

The Committee AGREED to thank representatives for their attendance and requested the following in their next report to Committee in April 2015:

(a)  more information on what SCAS had learned from elsewhere and how this had been actioned in Oxfordshire; and

(b)  more detail on how they were integrating with the Fire Service.

The Committee also requested a formal response to the major incident which had been the subject of the address by Cllr Mrs Heathcoat, including what had happened, what had been learned and how the service had changed as a result.