Agenda item

Attending for this Item from West Midlands Ambulance Service University NHS Foundation Trust (WMAS) were:

Mark Docherty, Executive Director of Nursing and Clinical Commissioning

Murray MacGregor, Communications Director.

By way of background, Members were referred to the Agenda Report and reminded of the salient points.

West Midlands Ambulance Service University NHS Foundation Trust (WMAS) response times were recognised as not being good enough and ambulance handover delays at hospitals was a contributing factor alongside the continuing impact of the COVID-19 pandemic.  Of the 10 Community Ambulance Stations (CAS) due to close across the region, 2 were in Worcestershire (Malvern and Evesham).  WMAS had planned to review the CAS sites in 2022, however, the review had been brought forward as a matter of urgency to try to improve the current situation.

When WMAS was formed in 2006, there were initially around 70 ambulance stations, however, in recent years, a new model of operation had seen 15 ‘Make Ready’ Hubs and a fleet of rapid response vehicles being utilised.  In Worcestershire, the Hubs were in Worcester and Bromsgrove.  The rapid response vehicles had now been replaced with additional ambulances. 

WMAS Staff were exhausted and had been on high alert since the winter of 2019/2020.  Initially, there was severe flooding throughout the region, then from late January 2020, WMAS was involved in transporting citizens returning from China in the UK, followed by over eighteen months of working with COVID-19 procedures and infection control measures.  Staff had often had no holiday,  no opportunity for furlough and had often been working with COVID-19 positive patients and were still working in situations requiring personal protective equipment (PPE).

Reassurance was given that the same number of ambulances and the same number of staff would continue to operate in the area and all ambulances would start and end at a Hub, meaning they would be fully stocked and fuelled for a full 12 hour shift.  Ambulance crews that operated from a CAS, lost around 2.5 and 3 hours of ambulance time over each 24 hour period mainly due to travelling back to the CAS for meal breaks and to swap vehicles.

Delays at hospitals were putting patients at risk of death, with over 15,000 ambulance crew hours lost in just one month.  Worcestershire hospitals often had more delays than the whole of the UK combined and it was not uncommon for 40% of the Worcestershire fleet to be waiting at a hospital. 

On behalf of the HOSC, the Chairman thanked WMAS and all NHS staff for the work everyone was doing every day.  Members were invited to ask questions and in the ensuing discussion, the following main points were made:

·       WMAS believed that it was important to look at the role of the ambulance service rather than the buildings they operated from.  Buildings were very rarely occupied given the role of the service and the buildings did not provide patient care

·       5,000 – 6,000 hours of crew time would be released across the 10 CAS sites

·       Saving money was not the driving factor for the CAS closures, however, the savings made would be reinvested across the whole region.  WMAS had invested heavily in resources and staffing, recently recruiting 300 students

·       WMAS reported that there were no issues with staff welfare, with most staff accepting that the decision was better for patient outcomes as WMAS could improve response time

·       Discussions had taken place with staff and union representatives, however, no report was produced

·       Productivity could be measured in a number of ways, however, WMAS had, prior to the pandemic, always hit its targets.  Paramedics had more skills now than ever before and therefore the number of A&E visits could potentially be less.  The number of hours lost in a 24 hour period was estimated to be 2.5 to 3 for crews based at CAS sites.  It was noted that controlled drugs, such as morphine, were only available from a Hub

·       All ambulances were modern and less than 5 years old, however, they were not equipped for delays at hospitals.  They had no ventilation nor heat unless the engine was running and the vehicle was designed for transport and not comfort 

·       WMAS had not undertaken any consultation with the HOSC as it did not believe the changes to the CAS were a substantial variation, defined by the Health and Social Care Act.  However, Representatives acknowledged that it should have undertaken more informal consultation and apologised for not doing so

·       A Member suggested that whilst accepting that WMAS had acknowledged that more informal consultation should have been undertaken, it was disappointing to learn about the decision from media articles and not WMAS directly, which left the public feeling let down

·       It was noted that generally, around 45% of calls resulted in a trip to a hospital.  After a handover, and when available, an ambulance would be routed to the next nearest incident.  As vehicles were not place based, it was possible for the nearest crew to respond to an incident, such as an available crew from Dudley responding to a call from Malvern.  If a more serious call was then received, the vehicle could then be diverted again

·       At the time of the discussion, 407 ambulances were on duty, with 301 patients assessed to be in need of a crew, however, none were available at that particular time.  46 crews were delayed at hospitals across the region, with the longest wait being 3 hours in Shrewsbury

·       During a usual October period, WMAS would have around 350 crews on shift, but handover delays were resulting in a larger number being required

·       Given the part rural nature of Worcestershire, the HOSC was concerned about response times.  WMAS acknowledged the concern and stressed that they were always mindful of response times in rural areas, deploying additional resource, both staffing and the number of vehicles, if required.  It was noted however that in reality a rural response was likely to take longer

·       The vacated CAS sites were mainly rented spaces and therefore the lease would not be renewed.  Buildings owned by WMAS would be sold

·       WMAS did not see themselves as a blue light service, rather a mobile health service, with highly trained health professionals on board

·       Representatives guaranteed the HOSC that the savings made, would be invested across the region and therefore Worcestershire would see more investment

·       WMAS wanted to return to the time when their performance was good and welcomed the opportunity to work with partners to achieve better patient outcomes.

Simon Adams, Managing Director of Healthwatch Worcestershire welcomed any investment in patient care, however, stressed the importance of good public communication.

The Chairman thanked all present for a helpful discussion and suggested that the HOSC should look further into ambulance handover delays.

The meeting was adjourned between 3:10pm and 3:15pm.