Agenda item

A powerpoint presentation is attached

The Committee received a presentation from East Midlands Ambulance Service (EMAS) which provided an update on their Ambulance Response Programme and the Demand and Capacity Review. A copy of the presentation slides, marked ‘Agenda Item11’, is filed with these minutes.

The Chairman welcomed Will Legge, Director of Strategy at EMAS, and Mark Gregory, General Manager for EMAS Leicester, Leicestershire and Rutland to the meeting for this item. The Chairman also welcomed Tamsin Hooton, Director of Urgent and Emergency Care, Leicester, Leicestershire and Rutland CCG to the meeting for this and other items.

Arising from discussions the following points were noted:

(i)        EMAS had been invited to take part in the National Pilot for the Ambulance Response Programme which aimed to improve the timeliness and appropriateness of response times. When calls were made to EMAS an algorithm automatically assessed the urgency of the call and allocated the best available vehicle to the incident taking into account the nature of emergency and geographical location of vehicles at the time. The most urgent categories of patients would generally require a double crewed ambulance as they were likely to require conveyance to hospital. It was therefore intended that Rapid Response Vehicles would be diverted to other types of call where conveyance was less likely.

(ii)       The Ambulance Response Programme was designed to prevent patients from deteriorating whilst waiting for an ambulance. However, should there be a delay in attendance by a paramedic on the scene, the Clinical Assessment Team made welfare calls to monitor the condition of the patient. In more urgent cases these calls would take place after 20 minutes and less urgent cases the welfare call would take place after 30-45 minutes. It was expected that there would be less need for these calls as response times improved.

(iii)      Based on data of previous calls EMAS were able to predict future demand very accurately and therefore allocate resources accordingly. It was noted that there was a demand curve everyday starting from a low point at 7:00am every morning, peaking at mid-day and maintaining that level until 2:00pm. There was then a drop in demand until around 5:00pm where there was a further spike until 11:00pm. With this knowledge EMAS were able to allocate more resource at these peak times.

(iv)      There was no single standard response to mental health issues, such as when a drug overdose had been taken. The response would depend on the information received over the phone and the patient’s clinical condition. A Mental Health Triage Car was being developed which would see a trained Mental Health Professional attend Mental Health related incidents alongside a paramedic. In effect this meant that the Mental Health Crisis Team would be brought to the patient whereas the traditional practice had been to bring the patient to the Crisis Team at the Emergency Department. EMAS would make sure that this initiative was joined up with the Leicestershire Police Mental Health triage car and did not duplicate work.

(v)       The Committee was pleased to note that the staffing position was improving. There was currently a small number of vacancies which would be filled by EMAS staff that were currently in a training plan and would become operational during the autumn of 2017.

(vi)      EMAS were trying to provide more of the Hear and Treat, and See and Treat, type of response to incidents rather than the See, Treat and Convey (to Emergency Department) types of response. However, whilst the biggest challenge for EMAS was still handover times at Leicester Royal Infirmary Emergency Department, the relationship between EMAS and University Hospitals of Leicester had improved and handover times at Leicester Royal Infirmary Emergency Department were shorter than they had been previously. This enabled EMAS to attend to more patients in the community.

(vii)    The Care Quality Commission had conducted an inspection of EMAS in February 2017 and whilst the overall rating given by CQC remained at ‘Requires Improvement’, the report identified that there were several areas where improvements had been made since the previous inspection in November 2015.

RESOLVED:

(a)       That the implementation of the Ambulance Response Programme and the findings of the Demand Capacity Review be supported;

(b)       That the improvements made since the Care Quality Commission inspection of EMAS in November 2015 be welcomed.