Skip to content

Agenda item

London Ambulance Service - Performance update - Presentation

Minutes:

Graham Norton, and Sen Brinicombe, London Ambulance Service, were present for discussion of this item, and made a presentation to the Committee, copy interleaved.

 

During discussion of the presentation the following main points were made –

 

·         LAS operate out of over 70 sites, have 2 Emergency Operations Centres, a Motorcycle response unit, 2 HART teams, Hear and Treat, and a Cycle response unit

·         There were 772,262 111 calls in the previous year

·         The LAS attended 1.14 million incidents, handled approximately 5000 emergency calls every day, has 6000 staff, of which 65% are frontline staff. There is a growing aging population with complex health needs

·         The LAS has introduced a new five-year strategy, designed to build a world-class service for a world-class city

·         The LAS purpose is to provide outstanding care for patients, be a first class employer, provide the best value for the public, and partner with the wider NHS, and public sector, to optimise healthcare, and emergency service provision across London

·         Patients – LAS playing a larger role in 111/Integrated urgent care provision across London. Integrating 999, and 111 call answering, and clinical support, in order to provide better, and faster care. Working with patient groups, and other providers, to introduce more specialised models of care for a greater proportion of patients. Reducing unnecessary conveyances to emergency departments

·         People – LAS recruiting and retaining talent, improving engagement to make sure it is listening to staff, ensuring a healthy workplace, aspiring to excellence in leadership and management, championing inclusion and equality, and recognising and rewarding excellence

·         Public value – integrating 111 and 999 call answering will provide a more cost effective service. Pioneer services will reduce unnecessary hospital conveyances, delivering savings for system partners. Detailed internal programme of work to implement the recommendations of Lord Carter’s review into unwarranted variation within the NHS. There is also a new partnership with South Central Ambulance Service

·         Partners – work closely with a range of partners across London, the Metropolitan Police, London Fire Brigade, and increasingly with other public sector bodies in London, including the Mayor, TfL, and other Local Authorities

·         LAS is rated as good by CQC, and has exited special measures. A range of initiatives have been instituted, including reducing avoidable conveyances, upskilling the paramedic workforce to increase see and treat rates, increasing clinical effectiveness in clinical hubs, and increasing opportunities for patients to be conveyed to alternative care pathways

·         Leadership – There are CEO roadshows, and LAS has created a Leadership Development Programme, Visible and Engaging Leadership programme, and launched 2 mentoring schemes

·         Staff – in 2018/19 – recruited over 850 people across the front line – vacancy rate on 31 March 2019 was 4.6%, compared to 5.9% in previous year. 15% of workforce is from BME community. Launched second WRES action plan – senior trust leadership, workplace experience, and recruitment and development schemes. Freedom to speak up – staff survey indicator score has increased 18% between 2015-2019. Dignity at work – raising awareness and addressing bullying

·         Engagement – LAS has had highest ever response to staff survey - 65%, and significant improvements have been made

·         Quality and safety – increased Board oversight for clinical effectiveness, with the appointment of two non-executive clinical directors. Quality priorities 2018/19 were achieved, and priorities for 2019/20 agreed. Introduced senior clinical leads to address quality, clinical effectiveness, supervision and compliance against quality and standards.  There have been improved risk management systems, and processes, introduced. LAS also completed an independent review of training across the organisation, and agreed a quality improvement training programme

·         Patient experience – Developed and piloted Pioneering Services, offering specialised responses for more patients. LAS is carrying out closer working with community services, in order to send an appropriate specialist, and refer without conveyance. Mental health calls have continued to increase, and initiatives have taken place in response to this

·         Quality priorities 2018/19 Patient safety – Improve assurance processes, improve hospital handovers, roll out secure drug rooms, increase number of defibrillator downloads

·         Quality priorities 2018/19 Patient Experience –  to achieve a reduction in calls from frequent callers, patient quality improvement, improve knowledge, and training in maternity care

·         Islington focus – Increased appropriate care pathways, and Direct access to urgent care centres. Whittington ambulatory care – LAS has had direct access to the Ambulatory Emergency Care Unit since 19 August. This is a significant step forward in managing ever increasing demand, also there has been an upload to i Pads, showing full acceptance criteria, the bypassing of Emergency Department, and enabling streaming of patients to where they need to be

·         Since July, LAS have been working towards having access for crews to bring patients to urgent care centres, and to treatment centres directly, avoiding the Emergency Department. There is hospital agreement that, if direct access is not possible, crews will only do one handover in Emergency Department, and leave the hospital to move the patient, as appropriate. There is benefit to patients going to the right treatment locations first time

·         LAS has had a direct access to the Ambulatory Emergency Care Unit since August, and this is a significant step forward in managing ever increasing demand. This enables the Emergency Department to be bypassed, and to stream patients to where they need to go

·         Islington CCG areas – Conveyances – conveyances to Emergency Department have increased from the 2018/19 year to 2018/19 year, purely because of increased demand. The % figures of patients conveyed to Emergency Department from 2017/18 to 2018/19 has dropped dramatically, as work takes place on increased appropriate care pathways, to enable patients to be treated in their own home, and in the community

·         Conveyances – there has been a considerable increase in figures for non-conveyance, dealing with patients in the community. There has been a considerable decrease in figures for See and Convey, bringing fewer patients to hospital. There has also been considerable, and sustained increase, in figures for See and Treat

·         More locally for LAS North Central London region – there is senior representation, and engagement, with all external partners, bespoke education is being delivered continually in 2018/19, and a shadowing scheme is being repeated in 2019. There is also increasing, and enhanced appropriate care pathways across the sector, financial initiatives have been won to support Best Care, there are month on month debates with Emergency Departments, and partners, on Care flow, design, capacity and LAS concerns

·         It was noted that performance in all categories is excellent

·         In response to a question it was stated that most pathways had a clinician involvement, and paramedics provide a triage service

·         In response to a question, it was stated that there had been significant improvements in staff training, morale, and support, and this was reflected in improved staff recruitment and retention rates

·         Members were informed that staff were being trained in the handling of mental health, and that a pilot is taking place where a mental health nurse accompanies a paramedic on calls. This has proved successful, and it is hoped will be more widely introduced in January/February

·         Reference was made to the forthcoming winter pressures, and that more staff were now available than last year, and that training is taking place to clearly identify pathways, and keep patients out of hospital, where possible. The Control Room also carries out more hear and treat

·         A Member of the Public enquired as to the problems with the algorithm around seriously injured children, and whether this would affect the LAS. The LAS stated that they would respond to him thereon

 

The Chair thanked Graham Norton and Sen Brinicombe for attending

Supporting documents: