To consider an update on the response to the efficiency review of the West Midlands Ambulance Service NHS Trust and the response to the findings of the Committee’s scrutiny review of the ambulance service in the light of the Lightfoot Review.

The Committee considered an update on the response to the efficiency review of the West Midlands Ambulance Service NHS Trust (the Lightfoot Review) and the response to the findings of the Committee’s scrutiny review of the ambulance service in Herefordshire, taking account of the inter-relationship between the findings of the scrutiny review and some of the findings of the Lightfoot Review.

Mr M Gough, A&E Operational Service Delivery Manager (South),presented the report discussing progress in the areas covered by the Committee’s recommendations. 

In discussion the following principal points were made:

·         It was observed that response times in Ledbury and Ross-on-Wye remained below target.  Asked about steps to improve performance Mr Gough commented that the appointment of a Community Response Manager for Herefordshire would improve the focus on hotspots in the County where response times were below target.  Two new standby points had also been identified for ambulances.  He noted that the severe winter weather had had an effect on response times.

Members commented on the importance of the County receiving a service that was comparable with other parts of the Region and requested a further report on performance in six months time.  It was acknowledged that performance against targets might not tell the full story and information on patient outcomes should therefore be included in the report.

The practicality of meeting the national targets in parts of the County was discussed, noting that at the moment the targets were consistently not met in some areas.  It was confirmed that the ambition remained to meet the national targets within all areas of the County.   A more detailed breakdown of performance was requested showing by what margin targets were being missed, enabling the Committee to judge the scale of the challenge faced in seeking to meet the national targets.

The Director of Public Health commented that ultimately the level of performance was dependent on the resources available.  The findings of the Lightfoot Review and the Scrutiny Committee’s review were consistent and negotiations over the commissioning contract recognised the desire to ensure that no part of the County was disadvantaged and that capacity was increased.

·         The WMAS response to the scrutiny review commented that the Community First Responder (CFR) schemes were significantly funded by charitable arrangements.  Members acknowledged that charitable funding was welcome.  However, they considered the Scheme should not be dependent on such funding and provision should be made by the NHS.  It was requested that the Committee be provided with information on contractual arrangements with Community First Responders and the overall funding arrangements. 

·         It was noted that CFRs were issued with mobile phones but these did have shortcomings as a communication tool.  Mr Gough said the matter was under review, but a digital radio system carried a significant cost.  Members requested that the report on Community First Responders include details of the communication links with CFRs.

·         That the Local Involvement Network was undertaking a survey of the patient transport service and if any issues came to light these would be reported to the Committee.

·         Concern was expressed that the level of cross-border support to the Welsh Ambulance Service (WAS) was not reciprocated.  Mr Gough said that the issue had been raised with the Welsh Service.  Data was being collected on the previous 12 months of incidents where WMAS had helped the WAS, in particular in the Monmouth area, and further discussions would take place if the findings revealed a disparity.

·         Asked about the out of hours GP Service the Head of Contracting commented that the service was closely monitored and he was not aware of any significant issues with the Service’s operation.  It was also noted that no particular problems had been reported to the Local Involvement Network.

·         Disappointment was expressed that a significant amount of time had elapsed since the Committee’s review but issues raised by that review were still not resolved.  Responding to a question as to whether it was simply the case that there were not enough resources available to meet targets in the County, the Director of Public Health commented that simply providing additional resource was not the answer.  Whilst there had been an improvement in service and more resources had been allocated, an assessment had to be made of a number of complex challenges, to which additional resource was not a realistic solution.  Services had to be affordable and sustainable.  The PCTs in the Region were still negotiating the 2010/11 contract with WMAS and consideration was being given to how this contract could be made locally responsive.

·         It was noted that performance against the target for ensuring all emergency ambulance arrivals are accommodated safely in the hospital and ambulance was improving.  An update was requested from Hereford Hospitals NHS Trust.

RESOLVED:

That    (a)        a further report be made in six months time reviewing performance against targets including comparative information for the West Midlands Region and a more detailed breakdown showing by what margin targets were being missed, and also providing information on patient outcomes;

            (b)       a report be provided to the Committee on the Community First Responder funding plan and communication links with Community First Responders and the Community Response Manager be invited to attend the meeting;

            (c)        the Committee be advised of the amount and nature of cross-border work with the Welsh Ambulance Service and the extent to which this was reciprocated.

            (d)       an update be requested from Hereford Hospitals NHS Trust on performance against the target for ensuring all emergency ambulance arrivals are accommodated safely in the hospital;

                        and

            (e)       the invitation from WMAS to visit the Emergency Operations Centre at Dudley be accepted.