The Assistant Director of Communications at the North East Ambulance Service (NEAS) will be in attendance to provide a performance update to the Committee.
The Chief Executive and the Assistant Director of Communications at the North East Ambulance Service (NEAS) were in attendance to provide a performance update to the Committee.
In terms of 111 call handling it was advised that the call volumes coming into the service had spiked dramatically at the start of the Covid-19 pandemic. In respect of the calls received at that time, the average time to answer was within usual boundaries until April 2021. At that time call response times began to deteriorate and the service was impacted by waves of Covid-19 on the NEAS’s workforce. There was a very large scale recruitment campaign, which was current at the moment to recruit 152 health advisors into the 111 and 999 service. NEAS was on target to meet demand and this month alone the service had welcome 53 new health advisors into the control room. A third call handling site was also opening on Teesside and the centre would handle both 111 and 999 calls. In particular there had been a large increase in the number of patients contacting the 111 service looking for dental help and NEAS had been working hard with NHS England to double the number of dental appointments the service was able to offer to patients each week, where they had an urgent dental concern.
The 111 outcomes chart (December 2021) showed that almost half of the calls (46 per cent) received by the service were referred back into Primary Care services (including the patient’s own GP). Dental calls made up approximately 10 per cent of all calls to the 111 service. It was noted that although the outcome figure for calls to the 111 service where an ambulance was required indicated 17 per cent it was explained that the actual ambulance response figure was closer to 7 or 8 per cent. The reason for the difference was that these calls were revalidated by clinicians, which included a call back, to check on the level of need. The remaining specialist services included, for example, eye services, children’s A&E and maternity suite referrals.
In respect of the 999 calls there had been a significant increase in the call volumes. Before the Covid-19 pandemic call volumes were quite high. During the first lock down in 2020 999 calls actually eased off a little bit. Over the last year or so the volume of 999 calls had started to increase again. A key mechanism to monitor the number of patients being handed over to A&E services was the hear and treat rates. These were patients that were either treated on the phone or passed onto an alternative service. The hear and treat rates both for the ambulance service as a whole and for the Tees Valley were almost identical. The rates had increased significantly over the last year.
Where an ambulance response was required it was noted that the service was measured against four different categories. The first category was average response standards to life threatening calls and the response data was provided for the Tees Valley and across NEAS. Category 1 calls needed to be responded to in an average of seven minutes and over the last year the graph indicated that this had very much been achieved on the vast majority of occasions. It was advised that a significant amount of attention was given to this category, as it included the most serious calls. Over the period January 2021 to January 2022 NEAS was the only ambulance service, alongside the London Ambulance Service to achieve the seven minute target. NEAS was one of the best ambulance services in the country for responding to Category 1 calls.
The second measure was response standards to 90 per cent of life-threatening calls within 15 minutes. It was advised that NEAS had achieved that target for the Tees Valley and across NEAS. There were 5 ambulance services across the country that had achieved this response target for the period January 2021-22. While that news was very positive there had been significant challenges for NEAS in respect the average response standards to Category 2 calls. There were emergency calls but not necessarily life threatening calls and this category accounted for a large proportion of NEAS’s overall activity. This target had not been achieved for quite some time and over the last year that NEAS’s response rates had deteriorated over the summer. The rates were now improving as the volume and demand were beginning to return to some sort of normal level. However, NEAS was still above the 18 minute target for an average response time for all of those particular cases. The Tees Valley area was in line with the response time across the whole of the service and in some months was outperforming the rest of the service as a whole.
It was advised that no Ambulance Trust in the country was currently achieving the Category 2 target. Whilst NEAS had not achieved the target, which was regrettable, it was at least the fourth best performing ambulance Trust nationally. There was a further target of response standards to 90 per cent of emergency calls within 40 minutes and performance was similar to the previous Category 2 target. Similarly there was no Ambulance Trust in the country that was achieving this target. However, NEAS was again one of the better performers in respect of that particular standard.
The third target on which the service was measured related to Category 3 calls i.e. urgent calls. These were non-emergency or life threatening calls and the response target was that 90 per cent of urgent calls had to be responded to within 2 hours. Demand coupled with winter pressures had resulted in poor response times in relation to Category 3 calls. However, there had been significant improvements in respect of this standard over the last two months. It was noted that again there was no Ambulance Trust in the country that was achieving this standard. NEAS remained one of the fastest Trust’s in the country at responding to Category 3 calls.
In terms of Category 4 calls – i.e. non urgent calls NEAS was the only Ambulance Trust in the country to be achieving the target of 90 per cent of non-urgent calls to receive an ambulance within 3 hours.
Reference was made to the see and treat rates and it was noted that the rates in the Tees Valley were approximately 5 per cent higher than the rates across the whole of the NEAS service area. Another option for the ambulance service was to convey patients directly to a ward, rather than an emergency department, and again conveyance rates to non-emergency departments in the Tees Valley was considerably higher than it was across the rest of the area. This was good, as it demonstrated direct admission for patients into the place where they needed to receive their care.
The Committee was advised that in terms of handover at hospital the standard was that a patient should be handed over by the ambulance within 15 minutes of arrival at hospital. The ambulance crew then have a further 15 minutes after arrival to clean, restock their vehicle and be ready to respond to the control room for the next call. However, average handovers had increased and consequently NEAS’ handover to clear time had decreased. The most recent data showed that the average handover time, as recorded for these figures in December 2021, was 23 minutes 19 seconds against the standard 15 minute target. The most recent figures for the average handover to clear time was 13 minutes and 54 seconds against the standard 15 minute target.
In terms of handover delays at Darlington Memorial Hospital it was noted that in February 2022 NEAS lost 282 ambulance hours for the handover delays that occurred. There had been over 100 ambulance delays over the course of the month with a small proportion waiting for over 2 hours. Reference was made to the handover delays experienced at James Cook Hospital in Middlesbrough, which was a much bigger hospital and accepted patients from a wider area. Since June 2021 the handover delays at James Cook Hospital had gradually increased and in February 2022 NEAS had lost 517 ambulance hours as a result of the delays. At North Tees and Hartlepool Trust the picture was much better. In February 2022 NEAS lost 64 ambulance hours due to handover delays on 10 occasions.
Reference was made to the patient transport service and the Trust’s level of activity over the last 2 years was highlighted. In terms of the impact of Covid on staff sickness absences it was noted that this had been significant. It had probably been one of the hardest winters in living memory for the ambulance service. The issues that had impacted on performance had included increases in both the demand and acuity of patients presenting to the service. The impact of Covid particularly sickness, shielding and cleaning. In addition there were other risk factors that would continue to put pressure on the service including the wider system pressures, primary care capacity and the long Covid impact on staff and wellbeing.
It was noted that NEAS had refreshed and refocussed its vision, mission and goals. NEAS’s vision was to deliver unmatched quality of care and its mission was to deliver safe, effective and responsive care for all. The organisational values were CARE - Compassion, Accountable and responsible, Respect and Excellence and innovation. Underpinning the strategy were nine plans including those relating to planning and finance, quality and safety, clinical model and operations and performance.
In relation to the issue of assaults on ambulance staff it was advised that work continued and it was sad to report that during Covid those numbers increased significantly. A campaign had been undertaken in the North East in 2021 to tackle this issue and in the last month a nationwide campaign had been launched to raise the profile on this issue and let staff know they were fully supported.
Following the presentation Members were afforded the opportunity to ask questions and the following points were raised:-
· Members expressed their thanks to all of the staff at NEAS for the amazing work they had undertaken in the most challenging of times over the last year.
· In response to a query regarding staff training the Chief Executive of NEAS advised that the organisation had endeavoured to maintain all core clinical training throughout the pandemic to maintain staff skill levels. Staff had been amazing, many had undertaken training in their own time to minimise any reduction in ambulance hours. NEAS continued to recruit and from a qualified paramedic perspective the organisation was over established. A decision was taken to employ at risk, which had paid dividends over the last several months. There was a higher turnover in terms of call handlers, which was a relatively young workforce when compared with qualified paramedics. Members were very encouraged to know that a full establishment had been achieved.
· In terms of the campaign to prevent abuse to ambulance staff and the support available to staff to deal with any abuse they faced was available to everyone included call handling staff. A full time Psychologist was employed within NEAS to support staff’s mental well-being and NEAS was extremely focussed on providing staff with the appropriate support. Debrief opportunities were available for call handlers. Currently all areas were being upgraded to ensure that a quiet area was available for any staff that may have experienced a difficult clinical or abusive call.
· In terms of tracking patients that were treated via hear and treat it was explained that the systems were not available to track whether a patient attended their GP in place of a local pharmacist. However, where there were recurrent calls from the same patient these were monitored and tracked in case anything had been missed. In addition patients were regularly surveyed about their treatment experience. Satisfactions levels amongst patients that had received a hear and treat, see and treat service or ambulance dispatch service was very high. Despite the long delays that had recently been experienced by patients, which NEAS was working hard to rectify.
· Sustained efforts were being made with the acute hospital trusts to reduce delays in ambulance handover times. The Chief Executive reassured the Committee that NEAS had extraordinarily good relationships with each of the Trusts.
The Chair thanked the Chief Executive and Assistant Director of Communications at NEAS for all of the hard work undertaken and requested that the Committee’s appreciation be passed onto all staff.