Agenda item

3.1       The Chair informed the Committee that the Overview and Scrutiny Committee had agreed to proceed with an Emergency Services Review, and that Select Committees will take evidence as part of the review in line with their Terms of Reference.

3.2       Kevin Brown, Assistant Director Operations London (South), London Ambulance Service (LAS) and Graham Norton, Lewisham Operations Manager, LAS, introduced the report and the following key points were noted:

·         The LAS has published its consultation document ‘Our plans to improve the care we provide to patients’.

·         The College of Emergency Medicine also published ‘The Drive for Equality: How to Achieve Safe, Sustainable Care in our Emergency Department’.

·         The LAS recently received £14.8 million of extra funding, £7.8 million of which is for this year to enable the recruitment of 240 more frontline staff to deal with the increased demand for services.

·         The additional funding has been provided because demand for the service has increased every year for the last 10 years, by 6.4% last year with an increase of 12.2% life threatening (category A) calls.

3.3       In response to questions, the Committee were advised:

·         The current break time arrangements for LAS staff are existing and accepted practice. However the new proposals are to try to enable more staff to get a break when and where appropriate, rather than attempting to bring staff back to the station to take their breaks. The planned changes to managing staff breaks should greatly increase the amount of staff able to take their allocated break during their shift, currently staff are often unable to take their break due to operational demands.

·         The breaks proposed are in line with the EU Working Time Directive and have been discussed and agreed with the staff representatives.

·         85% of LAS staff’s day consists of treating patients and patient care.

·         There is an “active area cover policy”, which means ambulances, bikes and staffs are placed in “demand hot spots” where the next emergency calls are likely to come from, increasing the speed of response times – LAS plans to increase the house of active area cover to continue to improve responsiveness.

·         999 calls are immediately triaged. LAS have a national target of getting to the patient within 8 minutes where it is assessed as being a life threatening situation 75% of the time. The LAS is currently achieving this target. If calls are assessed as not being life-threatening the future aim is to reach the patient within an hour. Depending on the categorisation, there are different target response times. In many instances it is assessed that the call does not require an ambulance, and therefore another service such as clinical telephone advice is used.

·         UNISON and GMB are the main representative unions at LAS.

·         The consultation concludes on 24 May.

·         The target for patient handover from the ambulance to the hospital is within 15 minutes. In Lewisham the current average time for handover is 13.2 minutes. On occasion, such as high demand spikes, this can take significantly longer, increasing the time before the ambulance and crew are available to respond to another call.

·         Ambulances are fitted with a computerised data terminal system that will notify ambulance crews of the route to the nearest hospital, as well as urgent care, walk in, major trauma, cardiac or stroke centres (‘areas of excellence’) that might be more appropriate for the patient. The crew will use their judgement to decide which hospital is the most appropriate, including changing planned destination in cases where a patient may deteriorate while in the ambulance.

·         It is rare for Ambulances to be turned away from A&E. The two major reasons for this to happen are:                   

o   Clinical safety issues

o   An unexpected incident occurring at the hospital

·         There is a pan-London monitoring system in place that monitors how busy all A&E departments are and informs the routing of ambulances to hospitals when diverts may be in place

·         There is some cooperation between ambulance and fire services already, for example they help with training with defibrillators and immediate care, so that fire services can deal with situations at accidents if they arrive at a scene before the LAS. There could be opportunities to pool resources for carrying out effective community engagement work.

·         The LAS has its own facilities where staff and assets are based. There are some joint arrangements of standby points that the LAS use at LFB premises. However, collocating is not a simple option. For example, 20 ambulances are based at Deptford Ambulance Station where as most fire stations have space for two or three fire appliances.

·         LAS liaise closely with Lewisham Clinical Commissioning Group (CCG), including a number of conference calls, steering group meetings, and other ad-hoc meetings.

·         Lewisham CCG commissions services from LAS via a central commissioning team for London CCGs through a CCG consortium agreement, but Lewisham CCG also work locally with the LAS to manage and monitor the commissioned services and interfaces between services for the local emergency care system.

·         Lewisham CCG needs to maintain and manage resources to provide adequate ‘rapid response’ services and urgent care and community based services to continue to support delivery of good local emergency care services and assist the LAS in its role within this.

·         LAS intends to employ an additional 240 members of staff over the next two years, with 120 starting in January 2014, and the other 120 in January 2015. Training takes three years in total.

·         In terms of the use of private staff, the LAS use private ambulance companies to provide support staff when necessary at times of high demand, as hospitals use “bank” (agency staff) in the same way. LAS are carrying out modelling to plan for the introduction of 240 more staff, so less alternative support provision should be necessary in the future.

·         There have been a number of consultations events with staff, and staff representatives, and there will be further consultations once the results of the review have been completed.

·         A key improvement on demand in acute emergency care would been seen if the public were better supported to access services more appropriately to their needs, rather than going to A&E/calling an ambulance for a matter that should be treated via primary care or urgent care.

·         Lewisham CCG has a key role in ensuring that appropriate community based urgent care services are available to meet demand to assist in more appropriate healthcare being accessed, as well as working jointly with partners like Lewisham Council on integration between health and social care services to support people on discharge from hospital, More encouragement and information is needed so that the public use the most appropriate services rather than always going to A&E.

·         If the Secretary of State’s proposals in respect of Lewisham Hospital go ahead after the Judicial Review, it may lead to increased journey times on some occasions, and may impact on how long staff take to get to the next call in Lewisham once they have become available at the A&E unit out of the borough. Modelling will be required to be carried out between the LAS and commissioners to fully understand the potential Implications. Approximately one-third of patients who call 999 for an ambulance do not end up going to A&E as they do not medically need to.

3.4      Martin Wilkinson, Chief Officer, NHS Lewisham Clinical Commissioning Group, advised that:

·         There have been 1-2 ‘diverts’ from Lewisham Hospital A&E this winter due to capacity issues, there have been significantly  more diverts from Queen Elizabeth Hospital(QEH) in Woolwich and Princess Royal University Hospital (PRU) in Farnborough, with Lewisham Hospital A&E receiving some of these ‘diverted’ ambulances.

·         Lewisham Hospital has not been meeting the target of 95% of patients being seen, treated and discharged from A&E within 4 hours of arrival in A&E over winter. Performance has improved significantly since the end of April 2013 with joint work across the local system and actions by Lewisham Hospital against an action plan.

3.5       RESOLVED: that the Committee:

a)    Welcomes the clarity of the LAS consultation document, particularly the case study examples used to help people understand the aims of the service and the potential impact of changes.

b)    awaits the CCG’s Action Plan on A&E targets to consider as evidence.

c)    will make its recommendations after considering all the evidence presented.

d)    will take note of the decision of the Judicial Review if delivered before it makes its recommendations.