To review the performance of West Midlands Ambulance Service NHS Foundation Trust (WMAS).

To enable the committee to fulfil its function to review and scrutinise the planning, provision and operation of health services (not reserved to the children and young people scrutiny committee) affecting Herefordshire, and to make  reports and recommendations on these matters.

Officers from West Midlands Ambulance Service gave a presentation to provide an overview of the key issues for the service including:

·         Activity in Herefordshire for the year to date: this had risen by around 3%, broadly consistent with overall activity for the region.

·         Non-conveyance: although the approach was to try and keep people at home, non-conveyance of patients was below the regional average. This was due to a tendency to address risk and ensure that patients’ ongoing health needs were met and appropriate pathway were followed.  

·         Ambulance usage per head of population: across the 22 commissioning groups for the region, Herefordshire did not have the highest level of use in comparison.

·         Response Programme trial: the service had taken part in this national trial designed to ensure that response standards were being met and this had informed national standards that were now in place. In Herefordshire a key challenge was to meet the 7-minute response time, and this was now measured as an average figure in recognition of the rurality of the county.

·         Response categories: changes had been made by NHS England, including differing response times for each category.

·         Performance for Herefordshire:  this was improving; category 1 responses remained a challenge, although the response programme trial had led to improved performance for every category.

·         Nature of calls: referred to as ‘chief complaints’, in Herefordshire, these were predominantly under the ‘medical / generally ill’ classification.

·         Service achievements:  the trust was the highest performing ambulance service. Estates rationalisation to develop operational hubs had led to better facilities to support response times and efficient working, and the service was working with commissioners to address demand management to ensure that calls were not being ‘stacked’.

Members responded with a number of questions and comments.

Commending the service for the achievement of a paramedic on every shift, a member asked about how this had been possible. It was explained that a graduate training scheme had brought paramedics through and their deployment supported each vehicle to be autonomous to make clinical decisions, supported by a clinical network for wider decision making.

Regarding a question on the impact of the national standard for responses to category 1 calls on staff morale, officers described that expectations were communicated to staff who were encouraged to make suggestions and provide feedback.

A member asked how the impact of moving the call centre from Worcester to the base in Dudley had been addressed as regards local knowledge and directing vehicles to calls. Officers explained that there was a despatch team working with the area to become familiar with it. There were good communications with the call centres and a dedicated Herefordshire desk to provide local focus which had improved integrated urgent care. The clinical hub was working to provide better care to make the most of care pathways.

The commissioner from Sandwell and West Birmingham Clinical Commissioning Group added that in order to support patients to access the most appropriate care there were links with the local hub and the GP out of hours service to enable close working to achieve the right level of response.

Referring to the figures provided in the presentation, a member noted an increase in activity in May 2017. Officers clarified that this was for the whole region, although there was no apparent reason for the increase. However, the service did seek to reduce demand for anticipated peaks. 

A member commented on the categorisation of diabetes-related calls being in category 3, and wondered about the opportunity to link this to the national diabetes framework and instead move it to category 2 in recognition of wider health implications. Officers explained they were governed by the nationally-defined categories but clarified that category 3 related to people who were well with their diabetes, but if someone with diabetes were unconscious, for example, this would be a category 1 call.

The vice-chairman welcomed the service’s achievements and thanked officers for the recent opportunity for committee members to visit the ambulance hub in Hereford. 

Referring to the use of defibrillators in public places, he asked about the training availability and its effectiveness for users in the community.  Officers described the arrangements for a dedicated trainer who was going out to groups which included community first responders. However, the defibrillators were technologically advanced and designed for use by someone with no training, although they could be supported by the call handler who could talk them through what to do.

The vice-chairman commented on the rurality of Herefordshire and the 7-minute response time standard for category 1 calls, which, in the context of roads and conditions differing from urban areas, was a lot to expect of crew to achieve in the county. He asked about the impact on morale for crew if unable to get to a call within the standard. Officers responded that staff would strive towards the 7 minutes as a target and do their best, focusing on outcomes.   The chairman noted the siting of ambulances around the area in order to be better-placed to get to calls more quickly.

A member asked whether it was the case that first responders were required to fund some of their equipment. Officers confirmed that some first responders were self-funded or charity status although the details needed confirming.

Members asked about modes of transport used by the service, such as motorcycles and 4-wheel drives, in meeting the response times. It was confirmed that there were a couple of motorcycles in Birmingham where it was deemed they would be more effective and that double-crewed ambulances achieved better outcomes against the response standards in Herefordshire. There were vehicles with 4-wheel drive capability based at the Hereford hub. Officers also gave reassurance that there was technology in place to ensure that mobile communications networks were protected to ensure coverage in remote areas. 

In response to a question from the chairman about the impact of the closure of the walk-in centre on the volume of 999 calls, there had been no identified correlation. 

Commenting on the impact of publicity in raising public awareness, the chairman asked about how the coverage by the recent BBC documentary series had affected recruitment. It was reported that the service had received around 3000 applications for student paramedics.

Responding to a further question, officers added that violence towards staff had increased nationally but was not as significant in Herefordshire, where there had been two incidents in the past 6 months.

RESOLVED

That:

(a)        the performance and service developments of WMAS be commended;

(b)       performance targets to be defined so as to be specific, measurable, achievable, relevant and time-bound (or ‘SMART’) as a presentable format for members to consider;

(c)       handover times at accident and emergency be monitored; and 

(d)       a performance update be included in the committee’s work programme for 2018 – 19.