Agenda item

12:25

Representatives from SCAS will attend to provide information about various issues which have arisen recently with regard to the Trust’s performance (JHO12).

Mark Ainsworth, Director of Operations and Richard McDonald, Locality Director for the Thames Valley Region attended the meeting to respond to questions on the latest progress report submitted by the Trust.

Members questioned Mr Ainsworth and Mr McDonald on the recent fines imposed in respect of response rates. Mark Ainsworth responded that within most NHS services there were penalty clauses. The Trust was working with the DoH to consider how £1m could be reinvested into the service to cover the fines and to address the reasons behind the penalty. He added that there was a possibility that the Trust would not incur the full extent of the penalty.

They were asked what impact the decisions made by the localities with regard to patient transport services would have on the finances of the Trust. Mark Ainsworth responded that the Trust had been successful in gaining all patient transport services across the whole of the Thames Valley region. However, it would have to take care in applying the criteria, or it would have to pay costs if it exceeded other providers. It would depend on whether activity levels increased or decreased.

In response to a question about whether outcomes involving delays since 2011 had been publicised at Board level (for example, delays getting patients to Stroke Centres), Mark Ainsworth stated that data had previously been published nationally and was in the public domain. He added that this was a target that all Trusts struggled with nationally and a significant amount of work was being undertaken with contact centres to identify which calls involved stroke to ensure classification as a red response. National reports only required data on the Trust’s performance – but from Monday next week the Trust was due to go live with Electronic Patients Records in Oxfordshire, to enable more data on patients to be seen more quickly.

A member of the Committee asked if data existed in relation to incidents where a crew had missed their targets, particularly where they were 30 miles away from hospital (page 179 of the Agenda papers). Mark Ainsworth explained that there are typically 40 – 50 red calls across the Trust per day, and each required an 8 minute response. The 8 minute response began on the close of the call. A sample of patients outcomes was taken by the control team/and clinicians, and risk scored according to the level of impact experienced. The intention was to look at the process followed, and if identified correctly, to talk to the patient about his/her experience. A member suggested that the question to be asked was what the impact was for the patient. Mr Ainsworth reported that the Trust did not receive data from the hospitals – any data was received after the patient had left hospital. Dr McWilliam explained that nobody would be able to ask such questions as it implied randomised enquiry which was deemed to be not ethical and unknowable.

A member asked if all calls were met with the same standards. Mark Ainsworth responded that a part of the work of the National Ambulance Response Programme was to look at other categories of calls to try to move them onto a clinical outcome basis.

Mr Ainsworth was asked in what category outside falls were classified as. He explained that they were a green 30, particularly if the patient had fallen outside and they had sustained injuries.

A member asked if the primary care based Out of Hours service was putting a strain on the service. Mark Ainsworth reported that this was being monitored closely and there was to be a national review on the issue. In his view this area was improving despite overnight primary care being limited and GPs not always being available to provide response times. This added to adverse response times for the Trust.

When asked about the 15 minute turn around period from handover of the patient at hospital to the ambulance being ready to leave, Mark Ainsworth stated that this time scale could be variable depending on which hospital the ambulance was at. It was generally looked at on a ward basis. Some hospitals were showing improvements. For example, the John Radcliffe Hospital had dramatically improved the queuing situation by moving their triage to the front of the Accident & Emergency doors. The Horton Hospital was very good and had a 90% achievement rate. The Committee asked to know where and how improvements were being registered.

It was the view of the Committee that there was a need to look at restructuring the 111 service, which was putting a stress on an already very challenged ambulance service, who were one of the largest providers of 111. They AGREED that 999 and 111 response rates be brought closer together and to review the part that primary care brings to these services.

A Member asked what happened if the IT service failed. Richard McDonald explained that there were two contract services, one in Bicester and one in Otterbourne, working virtually and independently. This provided a resilience. In addition to this, the IT linked with other providers, giving a default to landlines.

The Committee congratulated the Trust on the hard work undertaken on workforce recruitment, making it now well staffed. Members also congratulated the Trust on the service given over the Christmas period and the good response from the CQC in relation to the 111 service.

A member asked how the Trust was tackling rural response rates in the west of the county. This was being monitored by the Committee. Mark Ainsworth explained that this was being undertaken by increased numbers of staff on the road in both ambulance and response cars. The Trust was also working with the Oxfordshire Fire Service, by placing co-responders in Abingdon and Didcot and by increasing the number of community first responders. The RAF was also providing a response service. The Trust was also managing demand  into the call centres by increasing the numbers of clinicians to sieve calls. Currently, in Oxfordshire there were two clinicians short. The Trust was looking at efficiency in the call cycle times by sorting out the most appropriate calls and the most appropriate car response times and time saving vehicles. The ambulances had stand-by points which gaves a better response to an area. For example, in Witney, cars were based 24/7 on one of the industrial sites with a view to attending all of the Witney and Carterton area within the 8 minute response time.

Councillor Martin Barratt, the Committee’s Deputy Chairman, who had been asked by the Committee to look into the data submitted by the Trust, asked a number of questions and received the following responses:

-       Why were response times at variance with statistics from the OCCG? – the OCCG present their figures grouped in calendar months;

-       In the past the Committee had received data in tabula form for each District, making it much easier to read. Would it be possible to have tabular information for each district, this making comparisons much easier? Mr McDonald agreed to supply the information in this form;

-       In the past, the Committee had information on the overall success rates for red calls. This information does not tell us how often a red 8 and 19 response fails? – Mr McDonald agreed that in the future  he would try to split out and show the whole number of patients the response vehicles can get to within 19 minutes;

-       It is useful to see turn - around times and the allocations to each hospital site. It makes it easier to see the trends – Mr McDonald commented that this could only be done on A & E sites;

Mr McDonald was asked if he could provide turnaround times for the Thame area (Stoke Mandeville Hospital). Mr McDonald stated that the information submitted would include all for local patients, not just Oxfordshire patients.

Mr Ainsworth and Mr McDonald were asked for a plan of improvements to be made that would, in particular, indicate those for the west of the County. A request was also made, as part of the Trust’s work to build a whole team of responders; if all parish councils in the county could receive defibrillators? Or should they only be given to first responders? They stated that first responders would deal with calls as first on the scene. Training would be given.

Mr McDonald confirmed that if there was a call to the west of the Faringdon area, it would be put through simultaneously to the South West Ambulance Service. He also confirmed that he was not aware of any response time statistics from April 2014 being revised.

Mr Ainsworth and Mr McDonald were thanked for their attendance.