Agenda item

Graham Norton (Assistant Director of Operations, London Ambulance Service) and Philip Powell (Stakeholder Engagement Manager, London Ambulance Service) introduced the latest ambulance attendance performance times to the Committee, the following key points were noted:

• A number of issues had been highlighted during the CQC inspection of the service. Staff retention, morale and a culture of bullying had been significant issues that the Service had been working to address.
• The Service had struggled with recruitment and retention of staff. The demand for staff in some areas had been a significant limiting factor in attendance times.
• 770 new staff had been recruited in 2015/16, which meant the Service would meet its full establishment of 3169 staff.
• All recruits had to go through significant training, classroom study and the advanced driving and well as a period of close supervision before they would be able to work as paramedics.
• Lewisham and Bromley had both faced challenges in recruiting and retaining staff.
• Response times would improve as more staff became available.
• All of the Services’ Hazardous Area Response Teams (HARTS) were now all fully staffed.
• 326 managers in the Service had received training about bulling and harassment.
• All managers has also been trained in risk management.
• Not all of the improvements were to do with figures. The service had also looked at the working of the control room and boosted confidence through the mental health hub.
• Work had also been carried out to address issues with multiple responses to calls – and improvements to the backup systems designed to ensure systems resilience.
• The service had seen four of the busiest months on record since January 2016. March was the Services’ busiest month ever.
• As well as the high volume of cases, the Service was also dealing with more acute cases.

Graham Norton and Philip Powell responded to questions from the Committee – the following key points were noted:

• Turnaround times at hospitals were affected by both the volume and the seriousness of case being dealt with by the Service.
• The most recent figures indicated that there were 2058 cases in the previous month, where the delay was over an hour.
• Huge amount of operational hours were lost at hospitals that are unable to discharge well patients.
• Partners were working together (for example at the recent ‘South East summit’) to develop means of reducing handover delays, improving admission avoidance and making better use of urgent care centres.
• In Lewisham there had been 1500 hours of lost time at Lewisham hospital in the past year. There had been 31,420 hours lost across the London Ambulance Service.
• The service was also developing work to deal with frequent callers. There was one patient who had called 1000 times in three months. This was a complex issue to deal with, and required action from a range of services, including mental health.
• The Service was working to make sure that additional resources were put into the areas in which they were needed most.
• The Service expected that performance would continue to improve across London. LAS officers would continue working with clinical commissioning groups and in system resilience groups.
• Work was also taking place to make referral pathways simpler and easier.

Sister Josephine Udine (Vice Chair of the London Ambulance Service Patient’s Forum) addressed the Committee about the work of the Patients’ forum. The forum was monitoring the CQC improvement programme. The Forum also provided support for the Service on recruitment from the local population. The Forum was also monitoring queuing at hospitals – and working with commissioners to consider how this could be improved.

Graham Norton and Philip Powell responded to questions from the Committee, the following key points were noted:

• As one A&E become full, ambulances diverted to another location. Which ran the risk that the patient would end up in the wrong hospital. Officers from the LAS met with senior hospital management weekly to discuss pressures.
• South East London’s geography meant that it was susceptible to problems caused by shortage of staff. There was a substantial distance between hospitals unlike some other parts of London, which might be able to improvise when there were fewer staff.
• The LAS had struggled in recruiting staff – but work had taken place to improve this. Only four staff left the Lewisham service in the previous month.
• Significant work had been done to improve the address finding system. The LAS control room was unique and award winning.
• Work was also taking place with public and patient involvement groups were advising on how the Service might recruit and retain local staff to work in local areas.
• Merton has the best response time in London – this was largely to do with its demographics and its geography. Because it was so busy in the vicinity of the hospitals the turnaround times could be quicker. The staffing levels in Merton were also higher.
• In July 2016, 68% of Lewisham ambulances took over 15 minutes to turn around at hospital. There were 760 handovers, 25 took longer than an hour.
• Resourcing was looked at regularly. Work predicting call volumes was most effective when every ambulance in an areas was resourced.
• A recent ruling by the coroner meant that the nearest available ambulance had to be sent to a call – even if it was likely that a nearer ambulance (such as one scheduled to be finishing a call) might be able to attend more quickly. This meant that sometimes, ambulances had to travel long distances to attend calls. The LAS medical director and the senior operatives kept the situation under review.

Resolved: that the Committee welcomes the improvement in ambulance attendance performance times and that it looks forward to continued improvements; that the work of the LAS patients forum to engage with patients be welcomed; that the Committee requests a further update on improvement works in six months; that the Healthier Communities Select Committee be invited to look at the Services’ CQC improvement report; that the officers from the London Ambulance Service and the Patient’s forum be thanked for their contributions to the meeting.