Agenda item

The Committee considered a report of the East Midlands Ambulance Service (EMAS) NHS Trust, which provided the key performance information for the EMAS Divisional area of Leicestershire, split to Clinical Commissioning Group (CCG) level, an update on frontline staff recruitment and summarised the divisional priorities described in Local Delivery Plan 2015-16. A copy of the report marked ‘Agenda Item 10’ is filed with these minutes.

The Committee welcomed Tim Slater, General Manager of the Leicester, Leicestershire and Rutland (LLR) Division, EMAS to the meeting to present the report and answer questions.

The Committee was pleased to note that all targets had shown improvements during the current financial year and were continuing to improve. The Committee also welcomed the thorough analysis of performance being undertaken across all targets.  The Committee was pleased to have learnt that EMAS worked closely with the CCGs and the University Hospitals of Leicester NHS Trust (UHL) on issues such as understanding the causes behind the long waits and ambulance turnaround.  

Arising from discussion the following points were made:-

(i)              The Committee raised concerns over the delays in the handover of patients from ambulances to UHL sites. With respect to this issue the Committee was advised that the delays in transferring patients from ambulances amounted to 11,676 operational hours of an ambulance lost, which equated to the loss of working capacity of three ambulances per day. In the last fortnight a new handover system had been introduced which advised UHL in real time of patients en route to the hospital. This had demonstrated some improvements in turnaround times over the weekend, but they had not been sustainable. EMAS would continue to monitor the situation. The Health and Wellbeing Board was also considering a report on ambulance turnaround times at its next meeting.

(ii)             The Leicester Royal Infirmary (LRI) continued to be one of the country’s busiest hospital sites, with a limited capacity and a large proportion of patients self-presenting to the Accident and Emergency Department (A&E). To that end, the capacity at LRI was to be increased by the creation of a new emergency floor. Caution was advised on behalf of EMAS to ensure ‘future-proofing’ of the new facility in terms of patient capacity.

(iii)            There was limited space for patients to wait to be seen once the ambulance had arrived at A&E so it was not possible to have a single paramedic taking responsibility for a number of patients grouped together. It was felt that during busy periods UHL needed a more responsive escalation process as the provision of extra space for grouping patients under the care of a single paramedic would only be triggered if six or more patients were waiting in the back of the ambulances. It was hoped that new handover system would enable UHL to be more responsive to demand.  

(iv)           The Committee welcomed the high rate of patients treated by EMAS who were not then conveyed to hospital as this demonstrated the promotion of alternative pathways. However, concern was also expressed that 999 calls were being made inappropriately. The Committee was pleased to note that EMAS was working to educate clinicians with regards to the different service offerings in each CCG area. To that end a pilot mobile directory of services had been launched.

(v)            The 111 service was able to dispatch ambulances if, following an assessment, the call handler felt it was necessary to do so. The service had a mixture of call handling capability, including both clinical and non-clinical staff. It was not possible to identify if the introduction of the 111 service had led to an increase in demand for ambulances, although EMAS had undertaken an analysis of ambulances despatched by 111, and found that in many cases it was not appropriate.

(vi)           EMAS was not required to report the mortality rate of patients, so it was difficult to determine whether ambulance delays had an impact on life expectancy.

(vii)          EMAS had previously reported challenges in retaining qualified paramedics to the Committee. It was now reported that a number of qualified paramedics were returning to EMAS. The new staffing model included ambulance technicians as well as paramedics and Emergency Care Assistants; ambulance technicians were qualified staff who could progress to being paramedics. This was felt to be a safer model as it increased the number of qualified staff available and was also more sustainable.

RESOLVED:

(a)  That the Leicestershire (LLR) Divisional Update and improvements made at EMAS be noted;

(b)  That the joint report from the East Midlands Ambulance Service, University Hospitals of Leicester and the Clinical Commissioning Groups regarding ambulance turnaround times at the Leicester Royal Infirmary being submitted to the Health and Wellbeing Board on 16 July be shared with all members of the Committee.