The Committee has asked West Midlands Ambulance Service to attend the meeting to respond to questions about:   the WMAS proposed withdrawal from the 'Physician Referral Unit'; Progress on working with the Fire and Rescue Service; Performance in Shropshire by postcode.  Information provided by WMAS for the meeting is attached, marked:  6

Michelle Brotherton, General Manager, West Mercia, Mark Docherty, Director of Clinical Commissioning and Strategic Development/Executive Nurse and Pippa Wall, Head of Strategic Planning, will attend the meeting to answer questions.

The Chairman welcomed Michelle Brotherton - General Manager West Mercia, Mark Docherty – Director of Clinical Commissioning and Strategic Development and Pippa Wall, Head of Strategic Planning, West Midlands Ambulance Service (WMAS) to the meeting.  He congratulated the service on achieving ‘excellent’ in the recent CQC inspection. 

The Chairman said there some concern that this was not reflected in the more rural areas of the WMAS area.    The Director reported that WMAS was the only acute organisation in the West Midlands to achieve the rating of excellent and was the only ambulance service to achieve all mandated targets in 2015 – 2016.

The aspiration was to have a paramedic in every front line vehicle for 95% of the time and the figure for Shropshire was 95.2%.  He went on to present the information pack which had been supplied for the Committee and this provided:  an overview of the service, CQC rating, Vision Strategic Objective and Strategic Values, detail of the two year operational plan; draft Quality Account priorities; activity, demand and performance information.

In response to a series of questions from Members, WMAS officers explained:

·         At the peak time of day there would be 24 double crewed ambulances in Shropshire.

·         There were no current paramedic vacancies and if one was to occur it would be filled immediately.

·         The front line resource was being increased and there were 300 people in paramedic training

·         Staff were not moved between areas for the purpose of hitting targets.

·         The amount of ambulance resources coming into the county was always greater than that going out.

·         80% of the area covered by WMAS was classified as rural and issues around sparsity were recognised, the challenges in Shropshire being greater than other rural areas.

·         The Air Ambulance helicopter was the asset of the Air Ambulance Charity and raised money for the platform, running costs and pilot, but WMAS supplied the clinical resource.

·         The demand on the service was increasing, but major trauma cases were declining.  It appeared that people were using the service in a different way and the conveyance rate was declining.  If the service was used as it should be, the conveyance rate would be 100%

In response to a question about Mangar Elk lifting equipment, it was confirmed that there was one on every front line ambulance and that two people were required to use it.  A Member suggested that this might be something that nursing homes could buy and then train their staff to use which might help avoid ambulance call outs.   

A Member said it sounded as if WMAS was doing as well as it could internally and questioned why public perception was not more positive.  The Director emphasised that the Service was under great pressure and additional winter pressures had been high this year despite the mild weather and absence of a big flu or norovirus outbreak.  There were simply not enough resources and finances were stretched to the limits.

The Chairman asked if there was anything the Scrutiny Committee was in a position to help with WMAS officers said that the education of the public on appropriate use of the service was essential and any help in spreading that message would be appreciated.  Access to primary care was a factor, also younger people demanded a more immediate response than had ever been expected before.

Vanessa Barrett, Healthwatch representative, commented that one of the services priorities of last year had been ‘to engage with rural communities’.  Healthwatch was very keen to be involved with this work but not as much progress had been made as it would have liked.  She added that Healthwatches across the region were well placed to help in developing dialogues in local communities around response times. The Director agreed that variation in response times was an important issue as was variation in conveyance rates. 

A member asked if it was thought that changes to Minor Injury Unit availability and services might increase demand on WMAS, particularly as people often did not have transport to take them to Shrewsbury or Telford.  The Director said that there was more of a link between access to GP services for frail elderly people particularly at weekends and Bank Holidays. 

Members heard that activity was increasing at a rate of 4.7% a year but that WMAS was ready for this.  The Director of Performance and Delivery, Shropshire CCG, confirmed that for 2015/16 the activity increase had been predicted at 4.5% and this had been fully funded.  She expressed concern about the neighbouring CCGs who did not fully fund growth and the need for issues with regional commissioning to be addressed.  The Director of Clinical Commissioning, WMAS reported that Shropshire CCG did a good job in commissioning and estimating growth in activity. 

WMAS officers went on to explain the Ambulance Response Programme, a national response programme linking response times to clinical outcomes.  The view was that the right response to the patient first time was the most important factor, even if this meant not attaining an 8 minute target.  WMAS had been asked not to share the data in public until after the end of the pilot.  The Committee looked forward to receiving more information once the trial was complete. 

Members asked about handover challenge at the acute hospitals, and the reasons for the different performance at Royal Shrewsbury Hospital and Princess Royal Hospital.  The Shropshire CCG Director of Performance and Delivery explained that there were different pressures on each hospital site and a shortage of beds at RSH. 

WMAS officers added that handover delays presented a considerable challenge in Shropshire and far too much ambulance resource was being lost in these delays which were the result of complex circumstances.   It was possible to cope with a long delay every now and again but these delays had been going on too often and for too long and the percentage of delays over 1 hour was significantly greater in Shropshire than other in areas. 

Members heard that a root cause analysis was carried out on every single ambulance delay.  Although Shrewsbury and Telford Hospital Trust had declared zero tolerance on over one hour ambulance delays there had been little progress. This was a priority area for all concerned.  Corridor nurses did operate at the hospital when staffing levels permitted and there were also HALOs but this had still not been enough to cope with the unprecedented pressure.  . 

Members felt that in the face of the handover delays and inappropriate call out of ambulances, WMAS was doing well within the constraints it faced. 

Physician Referral Unit

The Committee asked for an explanation as to why WMAS had withdrawn from the Physician Referral Unit which appeared to have been a scheme that was working well.  The Director of Clinical Commissioning explained that although the scheme had been successful there had been concerns around doctors going beyond the scope agreed and attending trauma cases. WMAS had a well established and successful trauma model which was very tightly governed.  It had offered to run a similar model to that in Worcestershire in which doctors would respond to calls in their own cars, blue lights would not be used and the response model would predominantly be a secondary response. 

The Director of Performance and Delivery, Shropshire CCG, said the scheme had worked very well with some 300 – 400 hospital admissions prevented.  She added that advice was being sought in relation to the PRU appointments made and a decision would be made by the CCG on the scheme’s future in mid-March.   

Fire and Rescue Service

Ambulance service officers reported that the Chief Executive of WMAS had hosted a meeting before Christmas of Chief Fire Officers from the region and proposals had been discussed with regard to retained fire and rescue locations becoming part of the Community First Responder Service.  Another meeting was planned for mid-March. 

The Director of Public Health reported that Shropshire Fire and Rescue Service had indicated that it would be willing to pilot a scheme at no cost to others.  Concerns had been expressed at the slow progress in taking proposals forward.  WMAS officers commented that the scheme would not provide any financial benefit to the ambulance service and queried what would happen if Fire Officers were acting as CFRs at the time of a fire. One way of working together could be for the Ambulance Service to handle Fire and Rescue calls.  The Committee said that they would want a progress update on developments in the near future. 

WMAS officers went on to explain substantial developments with the Electronic Patient Record which were transformational and very much welcomed by the Committee.  The CCG Director of Performance and Delivery identified some potential useful links to the High Intensity User Project.  

The Committee thanked WMAS for all of its good work and the Chairman also expressed appreciation to WMAS officers for attending the meeting and answering questions. 

It was agreed that the following areas be considered by the Committee in future:

·         Physician Response Unit update

·         Update on working with the Fire and Rescue Service

·         Ambulance Response Programme - results be made available once evaluation is complete

·         Handover times at hospitals (CCG, WMAS and SATH to be in attendance)

·         Consideration of whether the Council had a role to play in encouraging the public to make correct use of WMAS