Agenda item

In attendance for this item were:

West Midlands Ambulance Service University NHS Foundation Trust: Mark Docherty, Director of Clinical Commissioning and Strategic Development / Executive Nurse

Worcestershire NHS Clinical Commissioning Groups: Mari Gay, Chief Operating Officer and Lead Executive for Quality and Performance

Worcestershire Acute Hospitals NHS Trust: Paul Brennan, Chief Operating Officer and Deputy Chief Executive

West Midlands Ambulance Service University NHS Foundation Trust (WMAS) had been asked to provide an update and the Director of Clinical Commissioning and Strategic Development/Clinical Nurse outlined the following key points from an information pack which had been circulated to HOSC members (available on the website).

·         The organisation centred on strong values.

·         This year’s Quality Account had been published and summarised WMAS achievements during the year and priorities for 2019/20, for example improving the performance for the National Ambulance Clinical Quality Indicator for Sepsis, a life-threatening condition.

·         WMAS served a population of 5.6 million, and a large geographical area which was 80% rural and which generated more than 4000 999 calls a day.

·         The fleet of over 1000 vehicles was the newest in the country.

·         WMAS had no vacancies and had the lowest sickness rate in the country, whereas nationally there were 2500 paramedic vacancies. This was attributed to having its own academy to train and develop staff.

·         WMAS had been working towards having a paramedic on every ambulance, which this year had been achieved.

·         WMAS was rated outstanding by the Care Quality Commission (CQC).

·         Many other initiatives were in progress, such as supporting anti-knife crime, aspiring to be paperless through use of electronic records and partnership work with universities to help establish the Ambulance Service as a graduate entry profession.

·         Efficiency and effectiveness were very important and WMAS was the highest performer in almost all metrics in two recent national reports (Lord Carter’s Report and the National Audit Report) including cost and productivity.

·         The Service was keen to regain the NHS111 service, so that it could be integrated with 999 calls and ideally reach a level where 20% of calls were emergency and 80% responded to at a slightly slower rate.

·         The Patient Transport Service had been focused on this year and was performing well although Worcestershire’s rural nature presented problems.

·         Ambulance handover delays at hospitals in Worcestershire were not a good news story however and WMAS was working with colleagues at Worcestershire Acute Hospitals Trust and the CCGs; this was an area where patients were being let down.

·         WMAS’s digital journey continued using electronic patient records to integrate with other organisations, and the Emergency Department could see all electronic records of patients likely to be taken there, allowing pre-assessment and liaison.

·         A Directory of Services supported clinicians, call handlers, commissioners and patients and included every service and was integrated with NHS pathways and electronic records.

·         Work was also taking place on a plan for patient flow through additional clinical input, which aimed to ensure patients were routed to the right place.

The Chairman invited questions and the following main points were made:

·         HOSC members praised the information provided and the continued high performance of WMAS. When asked what kept the organisation consistently ahead of the field, the Director believed the most significant factors were a consistent and strong management team which worked well together, an ambitious, forward-looking and efficient culture, supported by staff who wanted to get things done.

·         It was agreed that WMAS running NHS11 would be a positive move and a HOSC member asked about the vision for this service. The Director could only speak in broad terms at this stage but referred to the value of more experienced call handlers in avoiding unnecessary ambulance despatch – current levels were 15% compared to 7% under the previous NHS 111 contract with WMAS. He suggested that WMAS’ strong public brand would also instil public confidence. Members agreed that integrated call handling would be very helpful.

·         When asked about the success of NHS campaigns to educate the public about where to go for medical help, the Director felt that campaigns tended to increase demand and it may be better to structure pathways based on how people wanted to use services.

·         A member asked about the effectiveness of triage and was advised that it was working but that there was more to do, for example regarding underuse of the frailty unit at Redditch.

·         The Chairman referred to previous updates and asked whether issues around hospital handover delays were being responded to, and the Director confirmed that discussions with the Acute Hospitals Trust were ongoing, although it was not just the Acute Trust which could solve the issue; what was needed was to look at different ways of managing patients and a more risk-confident culture with older people. Currently too many people were going through the Emergency Department. More conversations were needed as the situation could not carry on and all partners had a part to play, but he emphasized that everyone involved was working very hard to find solutions.

·         Cllr Rayner, the HOSC’s lead member for WMAS, reported her continued admiration for the organisation but asked how WMAS was managing increased acts of violence against staff. The Director agreed that whilst he could accept the world in which his staff worked could be difficult, violence was unacceptable. Use of body cameras was now being piloted, which was regrettable but may help gain custodial sentences for offenders which would hopefully be a deterrent.

·         In response to a query about the availability of air ambulances and pilots including airtime and downtime, it was explained that this service was provided by two charities, with pilots being employed by a specific business. Any technical issues were quickly fixed so that downtime would only really be due to poor weather. The Air Ambulance Service was a fantastic asset, and one which WMAS did not have to pay for.

The Chairman thanked everyone for their attendance and reiterated praise to WMAS for its outstanding service.