Agenda item

Daryl Lutchmaya (SCAS Chief Governance Officer) has been invited to present a report with an update on South Central Ambulance Service’s CQC improvement journey.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

PLEASE NOTE: There are 9 documents attached to this item, the first being the main report submitted by SCAS, and the remaining 8 constitute additional supporting information documents provided by the Ambulance Service.

Daryl Lutchmaya (Chief Governance Officer, SCAS); Kirsten Willis- Drewett (Assistant Director of Operations, SCAS); Dai Tamplin (Senior Transformation Programme Manager, SCAS); and John Dunn (Head of Risk and Security, SCAS) were invited to present a report providing an update on the South Central Ambulance Service’s Care Quality Commission improvement journey.

The South Central Ambulance Service (SCAS) Chief Governance Officer informed the Committee that the Trust had an ambition to be an outstanding team, and to deliver good outcomes through innovation and partnership. The SCAS mission was that ‘the right care is delivered as best as it can’. In order to achieve these ambitions, the Trust had 4 key values which are to be:

Ø  Caring.

Ø  Innovative.

Ø  Professional.

Ø  A teamworking organisation.

The Chief Governance Officer highlighted that in order to achieve the results that the Trust was striving toward, it had formulated six strategic objectives:

Ø  High quality care and patient experience.

Ø  Partnership and stakeholder engagement.

Ø  Sustainability.

Ø  People and Organisation.

Ø  Technology Transformation.

Ø  Being well-led.

The Committee were informed that SCAS had received some assistance from the NHS National Improvement Team, who had put together an improvement plan for SCAS to work to.

The Assistant Director for Operations explained that SCAS was in a challenging position in relation to the increase in volume of workload coming through, particularly category 1 and category 2 calls (immediately life-threatening calls). The service had to declare a critical incident on the 23 January, which occurred due to the sudden increase in category 1 and 2 calls. Over the course of two or three days, these had constituted 72 percent of calls; which was an incredibly high number. Such high levels of category 1 and 2 calls would have a knock-on effect on the system, particularly the acute Trusts, as most of those patients who were calling in would require hospital admission. This also had knock-on effects in creating ambulance service handover delays.

The Committee were informed that there was good work within the system to try to keep patients away from Emergency Departments. There had been an increase, on average, in 8 patients a day who were able to be referred into other areas or departments. SCAS were grateful for the good partnership working that existed within the Oxfordshire system.

The Committee enquired as to whether there was any progress in improving structures of governance within SCAS. The Chief Governance Officer outlined that the recent CQC inspection and report rightly highlighted that there were a number of issues that were not operating appropriately. Whilst trying to address the issues of the improvement programme, a governance team was being established. The service also received support from the governance institute, which had helped the service with its risk management solutions.

The Committee also queried whether there were independent members on the SCAS governance board. It was explained to the Committee that initially, the board was comprised of executive as well as non-executive directors, which felt top heavy. The service sought to make the improvement programme a ‘business as usual’ practice, which meant that the improvement programme board was led by the chief executive. There was representation from a national improvement director, who provided direct challenge to the chief executive. There was also membership from Hampshire and Isle of Wight Integrated Care Board (ICB).

The Committee enquired as to whether SCAS would look to other authorities or areas for the purposes of identifying and learning best practice. The Chief Governance Officer outlined that having previously worked in a number of public Trusts, he had brought insights of good practice alongside him when he initiated his role at SCAS. There was also regular communication with other ambulance services nationwide, where comparisons as well as identifications of best practice were made in that context. The Trust’s terms of reference were also being reviewed.

The Committee queried as to how well resourced the internal audit function of the Trust was, and how this had fit in the broader context of the structures of governance in general. It was responded that the Trust had experienced some delays in completing internal audit functions. The Trust had a risk insurance compliance group, which oversaw audit functions and brought executive directors into direct contact with internal auditors, where the auditors could speak directly to directors.

In response to a query regarding patient experience and how this was imputed into the Trust’s ways of working, it was explained that patient experience did not actually formulate one of the Trust’s improvement workstreams, but was swept up under the patient safety workstream. A system director was leading on this, and the Trust was implementing a number of new measures to ensure that the patient voice was heard all the way up to the executive level. There was a patient panel, and various members were recruited to this. There was also work within the Trust’s communications department to ensure that there was effective communication regarding an honest picture of the services and the experience of patients from the ground upwards. An observation from the CQC found that less positive stories regarding patient experiences had not been heard at the executive level; the Trust was actively seeking to address this.

The Committee emphasised that one concern identified by the CQC was that the service did not consistently control infection risk very well. The Committee enquired as to the measures the Trust were taking to address this, and how confident SCAS was that equipment, vehicles and premises were kept clean and that there was consistent monitoring of this throughout the service. It was responded that the Trust were actively monitoring infection risk and control, which was also a crucial element of the CQC improvement journey. The Trust’s IPC service was working closely with operational colleagues to minimise risks of infection and to ensure cleanliness. A company named Churchill had been contracted to provide a rolling rota of cleaning on the Trust’s vehicles; including deep cleans. The Assistant Director of Operations confirmed that every frontline vehicle was required to be cleaned once every 24 hours as part of a standard clean and restock service. Additionally, vehicles received a deep clean every 6 weeks. There had also been an observed process of handwashing for frontline staff, and staff were being trained and educated in cleanliness and infection control.

The Committee referred to the importance of risk assessments, and queried how extensive and sophisticated the Trust’s risk assessments were, as well as the level of frequency with which such assessments were undertaken. It was responded that the Trust carried out task based assessments in operations. The risk assessments had to legally identify all foreseeable hazards for patients. Therefore, some of the risk assessments could be relatively extensive in their nature and scope. In terms of how risk assessments were reviewed, it would be ideal to have annual reviews with some of the task-based risk assessments, although the Trust had not managed to undertake such a review in over two years. In terms of the display screen equipment work station assessments, these had to be - and had been - undertaken annually.  

The Committee referred to page 142 of the report, which highlighted that the Information Technology supporting SCAS’s operational function (including safeguarding) remained a significant concern, challenge and reputational risk. The Committee Chair therefore enquired as to what the enablers and barriers were in relation to resolving this area of risk. It was responded that one of the significant challenges with safeguarding referrals was that there were server facilities on the premises that handled such data transmission. This had begun to fail, and in November 2023 the Trust had transitioned to a cloud-based server, which was designed to resolve many of the outages and delays to referrals experienced previously. However, since early December 2023, the Trust then suffered a number of outages not with the server, but with the actual transmission process. The Trust currently utilised a mailbox system, and had undertaken due diligence. The Committee were informed that the Trust had been actively exploring ways to improve the process around the above. There was a risk of patient harm if safeguarding referrals were delayed, but that significant enhancements in the safeguarding service had been made. The safeguarding service was operating smoothly and efficiently, and monitored the occurrence of outages to minimize harm to patients. All delayed referrals also received risk assessments. The Committee queried as to whether patients and their families who were affected by such IT challenges were clearly communicated with, and the Trust responded that any affected patients were clearly communicated with. 

The Committee queried how effectively staff were being provided with training to equip them with the basic skills of how to deal with patients who may be mentally ill. All frontline clinicians were trained to support people experiencing a mental health crisis. Call handlers also had the ability to pass calls onto clinical staff within the control room. It was emphasised that the service would always act with immediacy in circumstances where it dealt deal with mentally ill patients. From a force negotiation perspective, the service would also engage and liaise with the Police force.

The Committee highlighted that the CQC inspection outcome outlined that some people were not given the necessary pain-relieving medicines. It was queried as to whether staff had been sufficiently trained in this regard, particularly given the importance of ambulance staff being able to provide pain-relieving medications promptly and appropriately. It was responded that paramedics were trained in what is known as a step-wide approach in the management of pain, and that the Service was ensuring that paramedics would be adequately trained in pain management and in the administering of pain relieving medications.

The Committee referred to how the report outlined the Trust’s commitments to staff wellbeing, and enquired as to whether the Trust had sufficient resources  to maintain or potentially enhance the support provided to staff. It was outlined to the Committee that there was a comprehensive support package for staff, and that there was a fully-staffed health and wellbeing team that supported staff; including staff who required additional interventions such as Occupational Health. Trauma risk management was also prevalently utilised to support staff members who may have had to deal with traumatic incidents. The Committee were also informed that the Trust had good access to psychological medicines, and that there was an unfortunately high uptake of these amongst some of the Trust’s staff. 

The Committee enquired as to how the Trust was performing in the realm of staff recruitment and retention. It was responded that the Trust was widening its recruitment drive in order to attract and recruit staff from oversees. There were a cohort of SCAS personnel who would be travelling to Australia in March to help facilitate further recruitment of staff from Australia and New Zealand. It was explained to the Committee that in Australia in particular, there was a shortage of employment opportunities for ambulance service staff, and that SCAS were utilising this as an opportunity to enhance recruitment from that region.

The Committee AGREED to finalise a list of recommendations offline subsequent to the meeting, and to then issue these recommendations to SCAS.