Agenda item

The latest Care Quality Commission (CQC) report, published in August 2022, rated the South Central Ambulance Service (SCAS) as inadequate.  An improvement plan has been developed and the Committee will review this plan and evaluate the progress made to improving services to date.

Presenters

Will Hancock, Chief Executive

Steve Winfield, Clinical Operations Manager

Papers

Report attached

The Chairman welcomed Will Hancock, Chief Executive, South Central Ambulance Service.

During their presentation, the following key points were made:

·       In addition to the 999 emergency services and 111 service, South Central Ambulance Service (SCAS) also facilitated non-emergency transport services for vulnerable patients.

·       Many of the findings in the CQC inspection report related to concerns around safeguarding. In terms of the wider organisation and governance, there were concerns around managing safety within the organisation. Two factors identified as key risks leading to the inadequate rating were frontline delivery of emergency services and the safety domain for the organisation overall.

·       The ratings had considerably declined due to the pandemic. However, an extensive improvement programme had been launched to identify improvements to be made. Immediate concerns had been addressed, with a longer-term plan of quality improvement building on it. A wide range of stakeholders including safeguarding boards were involved in this process.

·       No further feedback had been received from the CQC, which was considered positive as any further concerns would have been addressed immediately.

During the discussion, Members raised the following questions:

·       In response to a Member question around the timeframe of the improvement plan, it was noted that SCAS were moving to business as usual. Due to the rating, SCAS had dropped from level two to four within the strategic oversight framework. A national oversight and scrutiny process had to be completed, starting with a meeting with NHS England in March to agree the exit criteria. There was an expectation that SCAS would move out of level 4 of the framework by September 2023 and remain on an improvement plan for the next 2-3 years.

·       In response to a question about the safeguarding issues raised in the CQC report, Mr Hancock explained that the safeguarding system had been completely overhauled in the past months and the team had been increased from three to nine.

·       There had also been issues with the 111 system as it had not being able to pass electronic referrals to local authorities but this had now been resolved.

·       A Member asked about workforce training and whether specific training around autism and learning disability was provided to staff. As an emergency service, there were occasions when training had to be cancelled due to extreme pressures. But level three safeguarding training was now protected, with 40 people a week being trained, and training was not cancelled even at the highest level of escalation. A response around specialised training for certain health conditions would be provided outside of the meeting.

ACTION: Will Hancock

·       In response to a question about staff appraisals, Mr Hancock confirmed that staff received appraisals and these were reported annually to the Board. The appraisals included a section on health and wellbeing which provided an opportunity to ensure mandatory training had been completed.

·       Mr Hancock went on to say that significant interventions to protect the wellbeing for frontline staff had been introduced, such as an end of shift policy outlining which types of patients can be seen by ambulance crews in the last hour of their shift.

·       A Member raised concerns about the use of private ambulances.  Mr Hancock explained that a strategy was in place to manage private ambulance usage, which included how and why they were being used and monitoring the quality and safety. He went on to say that private providers were regulated and inspected by the CQC.

·       In response to a question about workforce challenges, Mr Hancock explained that SCAS had decided to focus more on local recruitment, with paramedics completing training through Buckinghamshire New University in High Wycombe. SCAS also had an apprenticeship programme for paramedics, with many internal employees moving onto the programme. Over 500 students were currently enrolled both internally and externally. There was currently no mechanism in place to ensure that qualified paramedics and clinicians remain with the NHS on completion of their training although there were incentives offered to try and get them to remain with the NHS. 

·       Mr Hancock went on to say that recruiting and retaining call handlers continued to be challenging as there had been an unusually high turnover following the Covid pandemic. The NHS was due to publish a workforce plan later in the year.

·       In response to a question about the quality of the fleet, Mr Hancock said that SCAS had made good progress in terms of modernising its fleet.

·       The CQC report found equipment did not always work and medicines were not always being managed safely and effectively.  A Member asked how these concerns were being monitored. Mr Hancock responded by saying that an audit of all equipment had been completed and SCAS had invested in an asset tracking tool which monitors the age, location and maintenance record of the equipment. The new system would allow for better identification and reporting of risks. Medicine management was a challenge, but investments were being made in bigger teams and more resilient infrastructure.

·       A Member commented that there had been no connection between the improvement plan and the potential impact on SCAS due to current industrial action.  Mr Hancock explained that the current industrial action had had very little impact on SCAS in terms of patient care and ability to deliver services. Mr Hancock emphasised the importance of the Board taking responsibility for the CQC overall rating and he reassured Members that the improvement plans were well underway.

·       A Member asked for further clarification around the management of safeguarding and the review and governance around it which were identified as areas of concern in the CQC report. Mr Hancock explained that the size of the team had increased in line with additional activities, as had staff training around safeguarding. Members suggested that different pathways could be utilised to decrease pressure on social care. Ms Quesada further emphasised the importance of distinguishing between safeguarding and welfare concerns to ensure that residents are provided with the right care at the right time.

·       In response to concerns around staff turnover, particularly at director level, Mr Hancock said that building a permanent team had been difficult, and interims were filling those roles. The Chairman suggested that the recruitment and concerns around the current safeguarding referral process should be discussed further outside the meeting between adult social care colleagues and SCAS.

·       In response to a question about call abandonment rates, Mr Hancock explained that the abandonment rate of 40% was in line with other parts of the country.  He went on to say that the demand on the 111 service had led to SCAS seeking support from other areas.

·       In response to a Member question about serious incident reports, Mr Hancock explained that the process had was now consistent with the national system. SCAS also had a cascade system to inform staff about risks, improvements and changes made as a result of incidents, both through a route of clinical notices and through the education and training update programmes. 

·       A Member raised concerns around the level of communication issued by SCAS. It was noted that updates on the improvement programme were issued on a regular basis to stakeholder management groups. Mr Hancock confirmed that he would ensure the Select Committee and Healthwatch received these updates.

ACTION: Will Hancock

·       A Member asked about SCAS’s strategy for implementing the use of electric vehicles Mr Hancock explained that a range of electric non-emergency vehicles were currently being introduced and tested. A number of national trials were being conducted which also included the use of other fuels.

·       A Member raised concerns around the time taken to answer category two calls, which should be answered within 18 minutes. Mr Hancock explained that performance across the country, in December, was the worst on record. However, there had been a significant improvement in January, with the average of category 2 response times decreasing to 19 minutes and 6 seconds.

·       Mr Hancock went on to say that 8100 hours were lost in December due to delays in handovers. The average handover time was 36 minutes, but 1700 patients took longer than an hour to transfer.

The Chairman thanked the presenters for their attendance and participation and asked that more data, particularly around the improvement plans be provided to the Committee so that progress could be monitored more closely.

ACTION: Will Hancock