Agenda item

1pm

To receive a presentation, from Will Hancock, Chief Executive Officer, and Martin Chester, Clinical Operations Manager, South Oxfordshire, on the service provided by South Central Ambulance Service (SCAS), performance and the Care Quality Commission (CQC) improvement programme.

The Committee is asked to consider the presentation and agree any further action it wishes to take in response

The Care Quality Commission report, which acts as a background document to this item, is included in the agenda pack.

Will Hancock, Chief Executive Officer of South Central Ambulance Service, and Martin Chester, Clinical Operations Manager, South Oxfordshire, made a presentation to the Committee on the service provided by South Central Ambulance Service (SCAS), performance and the Care Quality Commission (CQC) improvement programme. They were supported by Tom Stevenson, Comms and Engagement Lead for the SCAS Improvement Programme, Mike Murphy, Director of Strategy and Governance at SCAS, and Kirsten Wells-Drewitt, Head of Operations in Oxfordshire at SCAS.

Will Hancock, SCAS Chief Executive introduced the report. The August report from the CQC, giving SCAS an ‘inadequate’ rating, was a significant departure from the organisation’s pre-pandemic trajectory, where it had been moving towards an ‘outstanding’ rating. The Board was disappointed to see the change in direction, but were committed to addressing the issues raised as a matter of urgency. The key issue of concern focused on emergency and urgent care, and an improvement plan had been developed to address the areas of concern highlighted by the CQC. A comprehensive governance structure was in place to hold the organisation to account, as well as ensure planned activities complemented other areas of the health care system. Broadly, the improvement plan focused on four key areas: culture and wellbeing, governance, patient safety and experience, and performance recovery. A number of priority actions had already been undertaken as part of the improvement programme, including increasing capacity in safeguarding teams, ambulance crews and amongst call-centre staff, enhanced equipment checks and provision, staff-support measures and a governance review. The CQC report did note some areas of outstanding work, highlighting the pride and hard work of staff, the kindness shown by staff, and the level of innovation shown. The organisation’s improvement plan needed to be delivered in the face of significant national pressures around recruitment and retention, as well as increasing demand for services. In terms of performance, SCAS was performing below the national for category 1 calls (the most severe) but was exceeding it in categories 2-4.

In response to the presentation the Committee raised multiple questions. More information was sought regarding the mechanics of how meaningful culture change would be effected. Whilst national surveys indicated that ambulance services were prone to poor cultural practices, the CQC report acted as a conversation starter with staff. Embedding appropriate values within the organisation was a strong component of the organisation’s leadership development programme. Taking measures to support the increasing the diversity within the workforce were being taken at staff-level and at Board level. Kirsten Wells-Drewitt, as a Chair of one of the People of Culture boards, confirmed their value in giving voice to staff to feedback on policies and practices, and making the workings of the organisation more transparent.

The Committee questioned whether sufficient financial resource was available to cover the work outlined in the improvement programme. It was confirmed that for the current financial year it was, and additional funding from NHS England meant that future funding was not currently a concern.

The importance of challenge from the Board to senior management and holding them to account was recognised by the Committee and assurance was sought on how this might be improved. An externally-led review was being undertaken by NHS England experts, which would report to the Board. This would especially focus on risk classification and escalation. Actions would need to be determined from the feedback arising from the review. SCAS was also working with exemplars of governance best practice to learn ways to improve. 

The Committee sought to know whether the CQC result was a surprise to the Board. It had been recognised that the organisation had been running very thin over Covid, with resources being diverted away from training, coordination and performance management towards simply maintaining front-line services for an extended period. As a consequence, a higher level of risk that performance would eventually drop did exist. The Board were aware of this risk.

It was recognised by the Committee that hearing from staff how the report had been received was incredibly important, and the degree to which structures existed to enable this feedback was raised. The Board had begun to take the opportunity with the reduction in Covid of visiting ambulance stations to hear directly from staff. Overall, however, the feedback was one of a shared frustration across the organisation at the results of the report.

Reported problems for younger and more junior female colleagues were noted by the Committee and the actions taken to address them were challenged. Simply, the reports were accepted to be unacceptable. Awareness and education campaigns were being put into place to challenge bad-but-normalised behaviours towards women across the organisation. Further investment in developing manager understanding of the non-acceptability of behaviour which abused positions of trust and responsibility was also being implemented.  Measures to protect particularly vulnerable staff, students in particular, were also underway. It was also reported that long-serving female staff had noted that although there were issues, the trajectory towards the treatment of women was improving, particularly as the numbers grew and more were represented as senior leadership levels. It was recognised that there were areas in the service, however, where female representation at manager and senior manager level was not increasing at the same rate, particularly around Operations, and this had been identified as requiring further work.

Given the impact of the operation of the wider healthcare system on the ambulance service’s performance, the working relationship with partners was discussed. The Integrated Improvement Programme would not necessarily be a silver bullet for the ambulance service, but the real-time date provided was expected to make marginal improvements across multiple areas. Overall, relationships and cross-working in Oxfordshire was reported to be extremely well-functioning and were being copied by other localities.

The Committee wished to know more about how non-mandatory recommendations from the CQC report were being prioritised. Many of the non-mandatory recommendations were already in hand given that they matched the organisation’s own priorities, but the process was being managed overall using its performance improvement methodologies.

To ensure sufficient staff were working to deliver the service’s objectives the Committee asked about support for staff, particularly in relation to stress and mental health. In response, it was noted that ambulance staff face multiple elevated risks to their wellbeing, be it through lifting, infection, shift-pattern induced fatigue or driving-related risks. Relating specifically to mental health, however, the issue was one taken particularly seriously at SCAS, as reflected by Will Hancock’s involvement in national-level activity to improve mental health within the ambulance sector. The starting point was trying to reduce stigma and normalise conversations about mental health. The organisation was participating in a number of national campaigns which were promoting multiple conversations. The close relationship with Oxford Health also meant easy access to high quality advice and support for staff.

Finally, clarification was sought on how long the CQC rating would remain without being re-evaluated, given that the Committee was keen to see the trust re-upgraded. Backlogs at the CQC meant the expectation was that a re-inspection was likely to take a frustratingly long time, though no specific timeframe was put forward.

The Committee AGREED that SCAS return to the Committee and give an update on progress in February 2023.