Agenda item

To update members on the performance of the North West Ambulance Service (NWAS) commissioned by Blackpool Clinical Commissioning Group (CCG).

Ms Yvonne Rispin, Director of Ambulance Commissioning, BCCG presented details of NWAS’s annual performance for 2015-2016 and up to the end of July 2016.

Ms Rispin explained that BCCG was responsible for commissioning ambulance services across the region on behalf of all the thirty-three CCGs. In addition to Paramedic Emergency Services (PES) provided by NWAS, BCCG commissioned the NHS 111 contract (for non-emergency calls) and the five Patient Transport Services (PTS) for non-emergency transport. NWAS jointly delivered the 111 service and provided PTS to three county areas including Lancashire.   She advised that NWAS’s annual budget totalled £320m of which £250m was for PES, £40m for PTS and £20m for NHS 111.

Ms Rispin referred to the headline national ambulance targets and NWAS’ performance regionally and locally in Blackpool and explained the different call categorisation targets set out in the report.

In response to concern expressed that fast response vehicles were not always being available, Mr Newton stated that targets had to be pursued and vehicles deployed appropriately. He added that sometimes it was assessed that incidents were not critical and were downgraded. Ms Rispin added that there could be double-counting impacting upon targets, i.e. multiple callers for an incident but each having to be recorded separately.

Ms Rispin explained that although Red 1 and Red 2 performance were significantly challenging and that activity had increased by 13%, NWAS had the highest national performance for Red 1 and was second for Red 2. She added that there were various issues to manage such as frequent callers and patients with care plans.

Ms Rispin re-iterated earlier references to initiatives to divert people from unnecessary hospital trips, the pressure to ‘turnaround’ patients effectively at accident and emergency with ‘knock-on’ impact. She added that proposed clinical care hubs would prove effective in tackling various issues.

Members noted that during 2015-2016, there were over 1.217m paramedic call-outs requested of which Red 1 incidents accounted for 2.5% of the total, Red 2 for 39% and the remainder for 57.5%. Ms Rispin reported that from April to end July 2016, there had been 405k calls resulting in 402k incidents.

Regionally, NWAS came in at 74% for Red 1, 66% for Red 2 and 91% for Red ‘All’. She emphasised that nationally ambulance services were struggling against ever increasing demand.  NWAS had experienced a rise of 13% for total Red activity but still had nationally the best performance for Red 1 and second best for Red 2. Performance in Blackpool was even better due to it being a densely populated area within a relatively small terrain.

The Chairman noted that Red 1 performance had been boosted by support from the Fire and Rescue Service but seemed an unreliable approach given that Fire and Rescue would also have their own pressures. Mr Newton explained that often the Fire and Rescue Service would arrive first at incidents so might be in a position to give immediate aid. There were 2,300 such incidents in 2015-2016 which amounted to under 1% of all incidents. Ms Rispin clarified that the support was not usually included in the performance figures. However, Red 1 performance had been at 74% which was just short of the 75% target required to secure 20% of the quality performance funding premium from NHS England. Therefore NHS England accepted that the 75% target had been achieved by including the additional support and £7.5m funding was secured.

The Chairman referred to a recent article in the Lancaster Post which had reported significant staffing issues with ambulance crews experiencing severe degrees of stress and low morale.  Mr Rigby stated that staff turnover was low although it was recognised that ambulance crews undertook a lot of training and were highly specialised roles which were much more complex than in previous years.   He added that demand for ambulances had increased significantly in recent years and therefore a range of health and wellbeing support was in place to support staff Furthermore patient treatment options needed to be considered other than hospital trips which might not be necessary.

Ms Rispin explained that a number of initiatives had been developed to tackle the growing demand to identify whether earlier alternative options were better more effective than transporting people to hospital. Members noted that the ‘Hear and Treat’ service had managed 11% of calls by ascertaining whether a vehicle was needed and offering telephone advice ‘See and Treat’ required observations at the scene which led to no need for hospital trips and alternative support amounting to 22% of people. The remaining tier was ‘See, Treat and Convey’ which meant taking people to hospital and was 67% of patients. Mr Newton added that GPs’ awareness of care plans and the need to avoid hospital admissions unless required was also helping manage pressures. Mr Rigby referred to other initiatives such as community defibrillators as a valuable resource in saving time, costs and ultimately lives.

Ms Rispin clarified that whilst overall demand and activity had increased, the number of trips required to go to hospital had reduced. However, if demand pressures grew then as well as the current initiatives further consideration would need to be given to use of resources and further options.

Ms Rispin referred to the ‘knock-on’ demand pressures particularly with demand also rising in accident and emergency hospital wards. There was a handover and turnaround time of 30 minutes for hospital crews to pass on patients to clinical hospital staff. The same time requirement applied to acute hospital trusts to ensure space was made available to take patients. Fines could be imposed on the ambulance and acute trusts for breaches of time. Times were averaging 35 minutes for the North West but concordat agreements were being developed to press the time down.

The Committee noted that the NHS 111 service was for non-emergency calls and incorporated an advice line for patients including sign-posting to the right care service. The current five year contract started in 2015. There were four KPIs relating to prompt call answering and, where appropriate, ensuring callers were directly transferred to clinicians. Most 111 calls resulted in primary care non-emergency services with 14% requiring an emergency vehicle. There were plans to build a ‘virtual’ call centre hub.

PTS was generally for pre-booked services with 2.2m patients carried annually for routine journeys Monday to Friday. There were five KPIs devised by BCCG for planned trips relating to answering calls in good time, maximising eligible bookings, waiting time for vehicles and travel time. Unplanned bookings could be at short notice and including weekends and bank holidays. Enhanced priority service trips were for renal and oncology treatment with more enhanced KPIs.

NWAS’ PES coverage was geographically the largest in the country covering urban and rural areas with the second greatest population of 7.5m people. Patients were delivered to twenty-three acute hospital trusts including mental health sites. There were eighteen out-of-hours (OOH) services.

Ms Rispin referred to transformational work which also linked to NMC. There had been a national review of urgent and emergency care. A single pathway of service was being created which would be co-ordinated through clinical care hubs.

The Committee queried how the emergency services’ Red 1 and other Red targets would be achieved in the event of a major incident and the impact on the wider community. David Rigby explained that all the emergency services and other key partners, including hospital trusts, ambulance services and health centres, had emergency plans, including cross border plans and undertook exercises. He highlighted the Cumbrian floods earlier in 2016 as a good example of major emergency co-ordination. There were various other initiatives such as ‘night safe havens’ offered by local authorities and open to visitors affected and he added that resources could be freed up such as the NHS 111 service. 

With regard to a question of major incidents at local hotels, Mr Rigby replied that the Fire and Rescue Service deployed a lot of resources and sometimes only specific agencies were required.

The Committee referred to charges for PTS and how the system was managed for patients using PTS from outside the area.  Ms Rispin explained that patients were not charged, but were directed towards the most appropriate form of transport based on their needs and that cost-effectiveness was considered, for example oxygen support might be needed or a taxi might be the best option. She added that patient choice and GP referrals from outside the area needed to be included in the criteria for use of PTS.