At the meeting on 25 July 2016, it was agreed that West Midlands Ambulance Service, Shropshire CCG and Shrewsbury and Telford Hospital Trust attend the 25 July 2016 meeting of the Committee and present the following information:

·         Update on Performance – Pilot Figures

·         Feedback on co-working with the Fire Service

·         Detailed update on initial impact of Physician Response Unit

·         Update on handover performance

·         Update on High Intensity User Project

·         Data on Community First Responder Coverage in rural areas

The Chairman welcomed the following to the meeting:  Julie Davies – Director of Strategy and Service Redesign, Shropshire CCG, Gail Fortes-Mayer – Lead Commissioner Ambulance Service, Mark Docherty, Director of Clinical Commissioning and Service Development/Executive Nurse, WMAS, Barry McKinnon – Shropshire Area Manager, WMAS, Pippa Wall - Head of Strategic Planning, WMAS, and Sara Biffen – Deputy Chief Officer, SATH.

Mr Docherty gave a presentation explaining the three categories of response used by WMAS up to 2011 and from 2011 to 2016.   WMAS was now a pilot site for the ambulance Response Programme introduced in June 2016.  He explained that a very target service did not help patients and the new system was designed to separate responses and the time in which the patient received the correct response.  Some measures were still be perfected but it meant a move away from use of percentages to percentiles. The figures for August 2016 showed that Shropshire was in the 75^th percentile which was thought to be a good performance.

Members queried the way the data was set out and what it actually meant.  Mr Docherty explained that 90% of all red calls were responded to in 16 minutes.  Members asked what the longest time was for the remaining 10% and he acknowledged that the remaining 10% in the most rural areas was always the problem.  He explained that the aim was to get to patients with the right response as quickly as possible, and then to the right place, even if a target was missed.  The old system created behaviours which were not helpful. Figures were available broken into postcodes and the Committee requested that this data be made available in future.  

Members were pleased to note that a letter had been written by Dr Davies following the last meeting of the Committee to the Regional WMAS Commissioner encouraging work which would help link response times with outcomes.  The Committee agreed that outcome for the patient was the ultimate measure. 

Mr McKinnon continued the presentation in relation to Community First Responders in Shropshire, and setting out priority recruitment areas.  He confirmed that WMAS was rolling out training to upskill CFRs and this would be offered to all. 

A Member asked if recruitment of CFRs was a high priority and how they were recruited.  The Committee heard that the Community Response Manager made approaches as necessary to Councils.  Members suggested using Shropshire Association of Local Councils for targeting local parish and town councils in recruitment campaigns.  Dr Davies said support from elected Members in recruiting CFRs was always welcome. 

The Chairman referred to a letter he had recently received from the Chief Executive of WMAS in relation to working with the Fire Service.  He asked if this had been progressed.

Mr Docherty explained that one meeting of Chief Officers had been held locally with the Fire and Rescue Service.  Fire Officers would be required to complete the full role, receive training and have to log on as CFRs.  He said that WMAS was awaiting a response back from Fire and Rescue colleagues in relation to this.  The Regional Commissioner confirmed that she was involved in these conversations and was exploring co-response across the whole of the West Midlands and particularly Shropshire.   It was agreed that the Committee would be kept appraised of any developments. 

Vanessa Barrett, Healthwatch Representative, reported that Healthwatch had run WMAS as a hot topic.  27 comments had been received, 50% positive and 50% not so positive.  Negative ones were across a range of issues, some relating to the speed in which the ambulance arrived, some about loss of CFRs in rural areas.  The Committee suggested that it would be useful to differentiate urban and rural responses for future reports. 

Mr Docherty thanked the Committee and Healthwatch for the useful comments and said that he had noted WMAS needed to take more action regarding CFR recruitment.

Update on Physician Response Unit

Dr Davies and the Regional Commissioner explained that this scheme helped to get people into the right system with their care managed in the right place.  It avoided unnecessary visits to hospital and kept people out of the system who might then be difficult to discharge.  In response to questions from Members, it was explained that the doctors could be despatched by the control room direct, could self determine where they attended, and could be asked to attend or give telephone advice at the request of a crew.  The CCG was not sure whether the model would work in the more rural parts of the county, however it would help free up the ambulance resources to be more available for those areas.

The electronic patient record meant that crews could make a real time record which could be handed to GPs immediately.  The Committee commended the investment made in rolling this out. 

High Intensity Service Users

Members were updated on the scheme involving a paramedic working on a coaching basis, so far with the 10 of the most frequent WMAS callers.  Calls from these patients had now dropped by 50% and two patients no longer featured on the top 20 list of callers.  The challenge was to expand this work safely and it was hoped to resolve data sharing issues with SATH as soon as possible. 

The Portfolio Holder of Adult Social Care asked about the target numbers for this work.  The Committee heard that the project had been modelled on targeting the 100 highest users in the county.  The next stage was to grow to 25, but the issues of data sharing needed to be resolved before expansion was possible.  It was a very personal service which was helpful for people with complex issues.  The Committee looked forward to a progress update in the near future. 

Ambulance Patient Handover

Sara Biffen, Deputy Chief Operating Officer, SATH reported that there were still significant delays on handover at the hospitals. 

A workshop had been held on 15 August to consider ways to improve this performance, and visits had been made to other hospitals, for example to Worcester Royal Infirmary where ambulances queued out, rather than queueing in.  The aim was to have a corridor nurse in place every day but there was a 25% staffing gap in qualified nurses.  It was hoped that this would be addressed by the end of September and SATH was looking with WMAS at how Hospital Ambulance Liaison officers could work differently and perhaps be on duty later in the day.  A meeting had also taken place on the Directory of Services and it had been identified that this was not comprehensive.  Not all of the services in the directory were open all of the time.  A single point of referral system was needed and another meeting was to held on this in the next fortnight. 

Dr Davies said it was essential to work on the issues together and achieve improvement before the winter period.  The Deputy Chief Operating Officer said that the whole system was involved, there was not one action that could be taken to fix the problem, and being able to get patients out and discharged from hospital was part of the solution.  That morning there were 16 patients at Royal Shrewsbury Hospital waiting for a bed.  A handover concordat had been put together with the idea of having zero tolerance for 15 minute delays, with a target of 30 minutes in the first instance. 

The Committee thanked officers for their time and attendance at the meeting.  Mr Docherty said that challenge from the Committee was welcomed by all concerned. 

It was agreed to request that:

Performance information by postcode for Shropshire continue to be supplied to the Committee;

The Committee be kept appraised of developments in working with the Fire and Rescue Service;

The Committee be kept appraised of progress with the Physician Response Unit and High Intensity User Scheme;

The Committee be kept appraised of Ambulance patient handover performance.