Agenda item

11:00

As a follow up to the discussion at the November 2014 meeting, and following some recent incidents, representatives from the South Central Ambulance Service (SCAS) will attend to discuss key issues. These include working practices, staffing, response rates (specifically in relation to the rural dimension) and partnership working. A report produced by SCAS is attached at JHO7.

A letter from SCAS responding to the continued concerns expressed by members at the last meeting (Min. 64/15 refers) with regard to the road traffic collision incident in Faringdon in April 2014 is also attached at JHO7.

Prior to discussion of this item, Councillor Pete Handley addressed the meeting calling on the Committee to do a vote of no confidence in the South Central Ambulance Service (SCAS) on the grounds that the service was not fit for purpose in rural areas. He stated that insufficient money was being put into the service both nationally and locally, and, as a result, SCAS was still trying to find £15m in cuts. Moreover, Wales currently offered free paramedic training to students, compared to a cost of £3k per student in Oxfordshire. He urged the Committee to put pressure on commissioners to introduce fines for Ambulance Trusts who were not meeting their targets, the outcome of which may lead, in time, to a second provider being sought. Councillor Handley had circulated to members of the Committee, for their own information, a personal account of his own family’s experience of SCAS.

Richard McDonald, Interim Area Manager, SCAS, and Sue Byrne, Chief Operating Officer, attended as a follow up to the Committee’s November 2014 meeting. The Committee had before them a report produced by SCAS (JHO7) which addressed the issues raised at that meeting. Members also had before them a letter, produced by SCAS, which responded to the continued concerns expressed by members at the last meeting with regard to the road traffic collision incident in Coleshill in April 2014, as reported by Councillor Mrs Judith Heathcoat.

In response to a question about staff sickness and whether plans were in progress to manage sickness absence better by drafting in staff in particular circumstances, Sue Byrne stated that the Trust tried to forecast demand and then to plan staff numbers. Moreover, additional cover was also added to what they believed was required, to accord with this. She explained that this was a resource issue and that there was a national shortage of paramedics. Notwithstanding this, the Trust had in the last few months, successfully managed to recruit a high number of high quality paramedics into the service using a number of recruitment and retention measures. She added that paramedics were to be added to the list of professionals where there shortages.

A member of the Committee asked if there was a shortage of vehicles.  Richard McDonald responded that there was no shortage of vehicles and that it was unfortunate that, in respect of the Coleshill incident, 4 out of 16 vehicles were out of service and the others were fully utilised on other calls and not available to respond to the emergency call.

The Committee queried the target handover time from ambulance care to Accident & Emergency care (70%). Sue Byrne directed the Committee’s attention to the information provided in their report pointing out that the Trust had improved the vehicle availability following handovers.

Sue Byrne confirmed that ambulances would not refuse to go out to establishments even if they had a defibrillator in the premises.

Sue Byrne also agreed to check if it would be possible to provide additional detail to reflect average response times. This would enable the Committee to focus on any anomalies.

A member asked if it was due to a lack of local knowledge or lack of technology which sometimes caused delays in getting ambulances to incidents in rural areas within the correct time. Richard McDonald responded that a vast array of technology was available to ambulance crews and control centres, but that there was more of a need to look at what else could be done to get an ambulance to incidents as quickly as possible.

A member asked why the Coleshill incident was classed as a green call which was non - life threatening when the patient had sustained head injuries, had difficulty in breathing and was asking for an air ambulance. Sue Byrne reported that she had checked and found the dispositions to be correct, adding that this was not a life-threatening call and was therefore triaged as green based on the nationally defined risk stratification levels. Furthermore, the Trust factored in consideration of the use of air ambulance, in particular in rural areas, if it was considered that there would be a delay in getting to an incident. Richard McDonald added that the risk analysis measures were produced by the national patient agency and designed for hospital use – and were therefore not provided by the Trust.

Members welcomed confirmation from Sue Byrne that management procedures had been addressed and altered in response to the Coleshill incident and that future reports would contain clearly labelled statistics and graphs and would be jargon – free. The Committee were also pleased to hear that meetings already took place looking at individual cases, and the consequences for all concerned, as a learning exercise. Furthermore that individual cases were also shared with the Trust’s commissioners at Board meetings at which sometimes members of the family and friends were invited to attend. In response to further questioning with regard to long waits experienced by some patients living in rural areas, and poorer outcomes for patients, Sue Byrne explained that these were not currently mapped as being of urban or rural consequence. Part of the problem was one of density. If more of the resources were to be focused onto rural areas, with smaller populations, it would affect more people detrimentally. Moreover, SCAS did not have access to patient outcomes as it was the responsibility of hospitals to bring the data together. She added, however, that this would be a worthwhile exercise.

A member asked if there was acceptance generally within Health organisations that patients living in rural areas would receive a worse patient experience and outcomes than those living in urban areas. Sue Byrne responded that work was in progress to review whether the targets were appropriate and whether their use was appropriate to actual patient outcomes. It was hoped that the outcome of this review would allow ambulance services to take a little more time at the outset to ensure that the correct resource is sent to an incident. She added that to ensure that each red call met the correct response time would require a very significant rise in resources, particularly as Oxfordshire was showing a steady increase in demand for red calls year on year.

The Chairman thanked Richard McDonald and Sue Byrne for their attendance and comprehensive response to the Committee’s concerns about the Coleshill incident, adding that it was hoped that there would not be a repeat of the catalogue of errors as experienced on that occasion.