Agenda item

To receive a briefing from John Divall, Director of Corporate Affairs, and Mark Ainsworth, Divisional Director for Berkshire, on the performance and priorities of the South Central Ambulance NHS Trust

John Divall, Director of Corporate Affairs, South Central Ambulance Service, was invited to bring to the Panel an update of the Service’s recent Care Quality Commission results. He thanked the Panel for inviting him, and indicated that the letter outlining the CQC results for SCAS, together with updates of the Trust’s performance in the second quarter of 2009/10 and a letter to stakeholders, had been circulated with the Agenda papers.

[Councillor Virgo arrived]

Mr Divall gave a visual presentation of key facts. He acknowledged that the Service had been rated as weak this year for quality of service, but good for quality of financial management. He outlined to the Panel the challenges with performance over the past year, and indicated that the Service had missed all its performance targets. The Ambulance Service nationally had experienced challenges with Call Connect. The Panel was given information on how 999 calls were categorised by the call centre and Mr Divall said that an additional 300 staff had been employed. There were further challenges , which included rising demand of between 5% and 6% per annum, turnaround delays in Accident and Emergency departments, referrals by Forestcare, and long delays at hospitals when Accident and Emergency departments were full. There were also seasonal risks including pandemic flu.

The Chairman thanked Mr Divall, and invited questions. In response to a question concerning ambulance response times in Bracknell, the Panel was informed that ambulances were placed in six-minute-response zones around the area to give the best possible response times to residents. Waiting times at hospitals were a continuing problem, with every extra minute over 30 being granted £2.60 from the PCT, but it was felt that this cost should be passed on to the hospital trusts where the delays occurred. For every delayed ambulance at a hospital, a manager was sent in to try to manage the delay and free up ambulances and crews.

On the subject of recruitment and retention, Mr Divall indicated that there were staffing problems, mainly due to the high cost of living in the south of England, and many staff were lost to London where extra weighting was paid. There was currently a 10% vacancy rate for emergency care assistants across Berkshire.

In response to a question about rising demand, Mr Divall told the Panel that it was difficult to ascertain why there was an increase; for the frail elderly, the ambulance service was often seen as a failsafe – there were other options but 999 was easy to remember. The Service was trying to support and manage demand, with a helpdesk in many centres. Low priority calls were passed to a clinical support desk and could be referred to an out-of-hours service. There was also a problem in some areas with high numbers of non-UK residents who had no GP registration and who saw the ambulance service as the best way to gain medical advice and attention.

With regard to ambulances queueing at hospitals, Mr Divall told members that this disadvantaged the Service. The performance indicator for response time began as soon as the call reached the call centre. One or two delayed vehicles in A&E did not necessarily present a huge problem, but could quickly escalate. Single responders sometimes went out to assess patients, and sometimes there was constant queueing.

Mr Divall confirmed that the merger of the former ambulance services had been successful, with the SCAS out-performing the former Berkshire service.

Councillor Mrs Shillcock asked about Forestcare incidents and suggested these would increase with the rising numbers of elderly people. Mr Divall indicated that in some places Rapid Access teams were used to go to patients, and Mark Ainsworth, Divisional Director for Berkshire SCAS, told the group that there was a review group looking at alternative care pathways, and that the biggest problem was access to social care, which currently had to be through GP surgeries. Some discussion took place around end of life care and the need to educate nursing home staff. Glyn Jones indicated that community equipment was available to health staff under the transformation agenda. Cllr Virgo told Mr Divall that the enormous challenge to the service was recognised by the meeting. Clare Colpin (Heatherwood Hospital) told the meeting that there was a gold standards network for those requiring palliative care, and the Liverpool Care Pathway empowered patients to choose where their life would end. At Heatherwood the A&E team was taking a whole team approach to solving problems and looking to manage more effectively.

The Chairman thanked the SCAS representatives, and they left the meeting.