·       To receive an update on progress with the four strands of work to improve the service discussed at the 21 March 2016 meeting.

·       To receive the ambulance response times for Shropshire

The Chairman welcomed Barry McKinnon, Shropshire  -  West Midlands Ambulance Service, Julie Davies, Director of Strategy and Service Redesign - Shropshire CCG, and Sara Biffen, Deputy Chief Operating Officer - Shrewsbury and Telford Hospital Trust, to the meeting.

Mr McKinnon gave a presentation which covered:  WMAS Visions and Values; the Ambulance Response Programme Pilot; New Call Categories and comparing performance; Operational Performance to 8 June 2016; Ambulance Turnaround delays at hospitals and lost hours.

A copy of the presentation is attached to the signed minutes.

During the presentation he reported that from June, WMAS had been implementing the national pilot of the Ambulance Response Programme. The objective of the pilot was to increase operational efficiency whilst maintaining a clear focus on the clinical need of patients, particularly those with life threatening illness and injury.  He explained the new call categories and the reasons that these would not be comparable with previous categorisations.

With regard to hospital handover he referred to the charts in the presentation which highlighted the significant challenge presented by total time lost in hospital turn arounds and the number of handovers over 1 hour.  Work was underway with Shrewsbury and Telford Hospital Trust (SATH) to address this but the issue was demand.   

He also referred to issues around retention of staff as recently five paramedics had been recruited by the GP Out of Hours Service as urgent care practitioners.   

A Member referred to when he had been on the WMAS Board in 2006 at which point delays over 60 minutes would be very unusual.  He said that WMAS had then been able to claim from the Regional Health Authority to pay overtime to maintain services.  He asked what had happened over the past 10 years which had led to the current situation.  He also said it would be interesting to know how many emergency response vehicles there were in 2006 compared to now and the growth in demand over the last decade. 

Mr McKinnon reported that in 2006 there had been a fine system in place which meant Hospitals would have to pay £1000 for every delay over 1 hour.  This system had ceased.  He also referred to the high demand on A&E facilities that had limited capacity.  There were no set times that these problems occurred.  

The Deputy Chief Operating Officer, SATH, emphasised that there was no set pattern to demand, and spikes could happen at any time.  The Regional Capacity Management Team attempted to predict demand but what historically had been predictable was no longer so.

Diane Steiner, Acting Consultant in Public Health, reported on a productive meeting held recently with Mark Docherty, Director of Clinical Commissioning and Service Development, WMAS. She reported that it had been agreed that Public Health would do some analysis to understand more behind the nature of calls to WMAS.  This might help to identify how Public Health could help, for example, through targeted fall prevention work.  She referred to one area the Committee had asked WMAS to look into, a co-response pilot with the Fire and rescue Service in rural areas of the county.  The Committee had hoped that the presentation would provide more of an explanation from WMAS why it appeared to be reluctant to undertake co-response with the Fire Service. 

The Portfolio Holder for Health drew attention to the WMAS Strategic Objectives, one of which was Working in Partnership. She reported that the Health and Wellbeing Board had expected WMAS to take up the opportunity of a six month pilot working with the Fire Authority, which would be of no cost.  The Director of Strategy and Service Redesign, Shropshire CCG emphasised that  it was necessary to constantly find ways to make better use of resources in the context of all public services struggling to meet the needs of the population.  It was confirmed that the Fire Service were very interested in undertaking the pilot. 

It was agreed that a letter be sent to the Chief Executive, WMAS, asking him to inform the Committee as to whether such a pilot could be trialled, and if not, why not, and whether there were other ways in which WMAS and the Fire and Rescue Service could work together to make best use of resources.

Members expressed concern that a change in performance measurement would mean that comparable information would be lost and it would lose sight of whether there had been an improvement or deterioration in performance.   They asked if anything could be done to maintain this view on direction of travel, the Committee wanted to be able to understand this especially in the context of Future Fit.  The Healthwatch representative emphasised that integrating information on outcomes and travel times was important in terms of Future Fit and Community Fit work and Dr Davies noted that point. 

Mr McKinnon said that the pilot was aimed at identifying patients acutely in need of the very most urgent response. He added that cardiac patients from Shropshire were often transported to Stoke or Wolverhampton where clinical outcomes would be better.  It was important to transport the patient to where they would get the service they needed and the service was clear that it could take stroke and cardiac patients much further to get better outcomes for these patients.

A Member representing a rural division emphasised that Community First Responders were unable to carry out the work of highly trained paramedics.   Although there was an 8 minute target for red calls, there was no measure of how long it did actually take to attend.  She also highlighted the need to look at outcomes against how long it took to transport a patient to hospital and  the need to have that information available when building an argument to ask for more funding for rural areas. 

Mr McKinnon explained that Criteria were set nationally and the Chief Executive of WMAS had requested differential funding for urban and rural areas. 

Dr Davies, Director of Strategy and Service Redesign, said there was a problem linking WMAS data with SATH data to help identify outcomes.  It it were possible to demonstrate demonstrable worse outcomes for patients from rural areas this would help support the case for more funding.

It was agreed that a letter be written to the Lead Commissioner for Ambulance Services seeking a way to link this information up. 

A Member asked about the pilot, how long it would run for and whether data was currently being recorded in the old format as well.  She also asked whether the demand for paramedics by the Out of Hours Service had been foreseen and what was being done about it.  Members noted that there would just be one data set available at the end of the pilot which was running to the end of September.   The demand for paramedics by another organisation had not been foreseen.  WMAS did not have any current vacancies but the organisation was losing experienced paramedics and having to bring on new ones with a 30 month lead in time.

Dr Davies then presented a Shropshire CCG Ambulance Update – a copy is attached to the signed minutes.  She reported on actions, progress, latest performance and next steps stemming from the Risk Review on ambulance handover.  There had been a slight delay with this work due to the CQC Inspection of WMAS but a clear Divert Protocol between hospitals was due to be agreed by the end of August.  The presentation also provided an update on the Physician Response Unit and the High Intensity User Project. 

Referring to performance figures, a Member pointed out that although performance had improved since March, compared with a year ago it was 50% worse.  He asked if the reasons for this were understood.  The Committee heard that the Emergency Care Improvement Programme team had been in and viewed all the data and there had been no obvious explanation.  The Deputy Chief Operating Officer, SATH, reported on departments experiencing difficulties coping with the density of demand.  They had been designed to cope with 5 – 8 patients an hour but at times this number could be 10, 12, or 14.  The Welsh Ambulance Service also delivered patients, and work was underway to try and allow access to their systems. 

The Acting Consultant in Public Health emphasised the need to work with WMAS colleagues to reduce demand but that there was a need to ensure the work put in by Shropshire would have an impact locally and not get lost over the West Midlands region.

The Chairman thanked Julie Davies, Sara Biffen and Barry McKinnon for attending the meeting and agreed that they be asked to return to the meeting on 26^th September to provide a further update covering outstanding issues.