South Central Ambulance Service NHS FT Scheduled Report

30 Pages·2012·0.37 MB·English

SSoouutthh CCeennttrraall AAmmbbuullaannccee
SSeerrvviiccee NNHHSS FFTT
Quality Report
Unit7-8TalismanBusinessCentre
TalismanRoad
Bicester
Oxon
OX266HR Dateofinspectionvisit:8–12,30Septemberand1
Tel:[phone] October2014
Website:www.southcentralambulance.nhs.uk/ Dateofpublication:14/01/2015
Thisreportdescribesourjudgementofthequalityofcareatthistrust.Itisbasedonacombinationofwhatwefound
whenweinspected,informationfromour‘IntelligentMonitoring’system,andinformationgiventousfrompatients,the
publicandotherorganisations.
LetterfromtheChiefInspectorofHospitals
SouthCentralAmbulanceServiceNHSFoundationTrust operationscentre(EOC)where999andNHS111callsare
(SCAS)wasformedon1July2006,afterthemergerofthe received,clinicaladviceisprovidedandfromwhere
RoyalBerkshireAmbulanceServiceNHSTrust,the emergencyvehiclesaredispatchedifneeded.Therewas
HampshireAmbulanceServiceNHSTrust,theOxfordshire aPTScontactcentreateachEOC.
AmbulanceServiceNHSTrustandpartoftheTwoShires
Ourinspectiontookplaceon10and11September2014
AmbulanceServiceNHSTrust.ItprovidesNHS
withunannouncedvisitson30Septemberand1October.
ambulanceservicesinBerkshire,Buckinghamshire,
Weinspectedthetrustaspartofourfirstwaveof
HampshireandOxfordshireintheSouthCentralregion.
comprehensiveambulanceinspections.Welookedat
Thisareacoversapproximately3,554squaremileswitha
threecoreservices:accessviaemergencyoperations
residentialpopulationofover4million.On1March2012,
centres,patienttransportservicesandemergencyand
thetrustachievedfoundationtruststatus.
urgentcare.The111serviceprovidedbythetrustwasnot
Thetrustprovidesanaccidentandemergency(A&E) inspectedonthisoccasion.Thelogisticaland
servicetorespondto999calls,a111serviceforwhen commercialtrainingserviceswerealsonotinspectedas
medicalhelpisneededfastbutitisnota999emergency, thesedonotformpartofthetrust’sregistrationwiththe
patienttransportservices(PTS)andlogisticsand CareQualityCommission(CQC).
commercialservices.ThereisalsoaHazardousArea
Theteamof48includedCQCinspectorsandinspection
ResponseTeam(HART)basedinHampshire.Servicesare
managers,ananalystandinspectionplannersanda
deliveredfromthetrust’smainheadquartersinBicester,
varietyofspecialists:Theteamofspecialistwas
Oxfordshire,andaregionalofficeinOtterbourne,
comprisedofaconsultantphysicianinintensivecare,two
Hampshire.Eachofthesesitesincludesanemergency
nursesworkinginaccidentandemergencydepartments,
1 South Central Ambulance Service NHS FT Quality Report 14/01/2015
Summary of findings
fourparamedicstaff,oneemergencycarepractitioner,a • Publicengagementtookplacethroughavarietyof
paramedicclinicalsupervisoranddevelopmentmanager, means,suchasliaisonwork,useofsocialmediaand
threemanagerswithanoperationsrole,aheadof throughitsmembership.Patientfeedbackthrough
governance,adirectorofservicedelivery,twochief surveys,interviewsandliaisonwork,wasbeingused
executives,apharmacist,asafeguardinglead,two toimprovetheservice.
peoplewitharoleinanoperationscentresandthree • Staffwerepositiveaboutworkingforthetrust.They
expertsbyexperience. saiditwasafriendlyandpositiveplacetoworkbutnot
withoutitschallenges;namely,managingtight
Wedidnotprovideratingsforthistrustbecausethis
resourcesagainstanincreasingdemandforservices.
inspectionwaspartofourfirstwaveofambulance
TheNHSstaffsurvey2013demonstratedthatthetrust
inspectionstoapplyourmethodologyanddevelopour
wasbetterthanaverageforstaffengagementwhen
understandingofinspectinginthissector.
comparedtootherambulancetrust.Staffengagement
waswelldeveloped,althoughstaffindicatedtheneed
Keyfindings
formoreongoingdialoguearoundservicechanges.
Isthetrustwellled?
• Thetrusthadahighlyinnovativecultureandstaffwere
• Thetrusthadavisionandclinicalstrategytoprovide encouragedtosuggestnewideastoimproveservice
excellent,sustainableservices,andtocoordinate delivery.Thiswasseenasimportantagainsta
mobileresponsivehealthcareservicessothatpeople backgroundoftighteningresources,butalsoessential
receivedtherightcareattherighttimeintheright todevelopservicesinresponsetotheneedsof
place(includingcarethatcouldbeclosertohome). patients.Thereweremanyexamplesofservice
• Governancearrangementswereclearandtherewas improvementsdevelopedbythetrustanditsstaff.
anintegratedperformancereporttobenchmark • Thetrustdemonstratedproactiveandeffective
quality,operationalandfinancialinformation.The financialmanagementtoinvestinnewtechnology
trusthadalsoidentifieditsqualityprioritiesandcould andservicedevelopments,andtoensurethatservices
demonstrateprogressagainstthese.However,much weresustainable.Costimprovementprogrammes
ofthedataonriskandqualitywasatahighleveland weredemonstratingsavingsandweremonitored.
someriskissues,suchassafeguardingandsignificant Mitigatingactionswereidentifiedtoreducethe
delaysinpatienttransportservices(PTS),neededa potentialimpactalthoughtheactiontakeninsomeof
betterfocus. theseareasneededtoimprove.
• Manyareashadteammeetingsandmonthly
Keyfindingsacrossthecoreservices:
operationalperformancemeetingstoreviewquality
andoperationalissues.Thesereportedtothetrust’s • Staffwerecaringandcompassionate,andtreated
Level2meetings(operationalleadershiplevel)and patientswithdignityandrespect.
thenseniormanagementmeetings.Thisstructure • Staffwerepositiveaboutthequalityofcarethey
neededtobereplicatedinallareastoconsistently providedforpatientsandwereproudtoworkforthe
identifytheactiontakeninresponsetorisksand trust.Therewaslowmoraleinplacesandthe
performanceissues. pressuresfacedbythetrustwererecognised.Staff
• Theleadershipteamshowedcommitment, however“lived”thevaluesoftheorganisation:
enthusiasmandpassiontodevelopandcontinuously “Towardsexcellence–Savinglivesandenablingyouto
improveservices.Moststaffreportedthatthetrust getthecareyouneed”.
culturereflectedaneffectiveandresponsiveservice • Patientstoldustheirexperiencesofcareand
ratherthanatarget-drivenorganisation.Leadershipat treatmentwasgood.Theywerepositiveabout
teamlevelvariedintermsofeffectivenessandthe emergencyambulanceresponsetimesbuttherewere
trustneededtoimproveinthisareatodevelopits concernsaboutthepunctualityofpatienttransport
strategicpriorities. services.
• Incidentreportingwasincreasingonthenewly
introducedreportingsystem.Thetrustwastaking
actionfollowingincidents,butthereneededtobe
2 South Central Ambulance Service NHS FT Quality Report 14/01/2015
Summary of findings
earlierandquickerinvestigationforsomeincidents. Valleyareainearly2013.TheHazardousArea
Learningwassharedviaclinicalbulletins,thetrust ResponseTeam(HART)hadworkedthroughoutthe
intranet,noticeboardsandemail.Thetrusthad regionandspecificallyinWraysbury,Berkshire,24
introducedSCAScadetoimproveorganisational hoursadayover4days,toassistwiththerescueand
learningfromwhenthingsgowrong.Thisincluded supportoperation.
anonymouscasesandreflectivetoolsforstafftouse
EmergencyOperationcentres(EOC)
onthetrustintranet.However,staffintheEOCandPTS
neededtobeencouragedtouseandtake • Emergency999callsweretriagedthroughNHS
responsibilityforreportingincidentsandalsorequired Pathways(whichisasoftwaresystemof
feedbackandsharedlearningintheirareas. clinicalassessmentfortriagingtelephonecallsfrom
• Staffintheemergencyandurgentcareservicehad thepublicbasedonthesymptomstheyreportwhen
goodknowledgeoftheMentalCapacityAct2005,but theycall).Therewasgoodcompliancetoprioritiseand
staffinEOCandPTSneededtohavebetterknowledge categorisecallsforambulancedispatchaccordingto
toensurethebestinterestofpatients. theclinicalneedsofpatients.However,staff
• Safeguardedprocedureswerebeingusedbutneeded knowledgeofappropriatedispatchtimesformental
toimproveandthesafeguardingleadhadalimited healthpatientsincrisesunderaMentalHealthAct
capacitytodeliverthesafeguardingagendaacrossthe Section136andneedingaplaceofsafety,neededto
organisation.Safeguardingchampionsingeographical improve.
areasweretobedevelopedbutthisneededtobe • TherewerededicatedtriagelinesforGPsand
prioritised. healthcareprofessionals,andforpatientswhowere
• Staffhadgoodtrainingopportunitiesandspecialist criticallyunwellandneededtheairambulance(the
trainingondementiacare,learningdisabilitiesand HelicopterEmergencyMedicalServices,[HEMS])or
mentalhealthwasbeingimproved.Staffwere otherspecialistservices,suchastheHazardousArea
supportedwithfundingforfurtherqualificationsand ResponseTeam(HART).
professionaldevelopment,However,somestaffdid • Safetyprocedureswerefollowedbutsomeneededto
notalwayshaveaccesstocomputerfacilitiesto improve,suchasincidentreportingandraising
undertaketrainingorthededicatedtimetocomplete safeguardingconcerns,andsomestaffneededa
it,andattendanceatmandatoryandstatutorytraining betterunderstandingoftheMentalCapacityAct2005.
waslow. • Staffinglevelswereaconcernandstaffworkedlong
• Mostcomplaintswererespondedtowithinthetrust’s hours,sometimeswithoutbreaks.Actionwasbeing
targettimeof25daysandactionwasbeingtakento takentomanagepeaksindemandbutstaffwerenot
improveservicesasaresult.Complaintswere meetingtargettimestoansweremergencycalls.
analysedtoidentifythemesandthetrustaimedto • Overall,thetrusthadreferralratesof8%fromNHS111
sharelearning,forexample,throughteamsand to999services,andthesewerebetterthantheservice
noticeboards.Therewasevidenceofactionstakenas levelagreementperformanceof10%andoneofthe
aresultofcomplaintsinallservices.However,staff lowestinthecountry.Staffidentifiedtheneedfor
toldustheydidnotalwaysgetfeedbackon furtheractiononmanagingthedemandcreatedby
complaintsorconcernsraised. theNHS111service,andthetrust’slong-term
• ThetrustunderstooditsdutiesundertheCivil planningagainsttherisingincreaseindemandfor
ContingenciesAct2004andallstaffwereawareof serviceswasongoing.
whattodointheeventofamajorincident.Staffhad • Thestaffweresupportivetopatientswhocalledin
appropriatetraining,therewasjointworkingwith distress.Theylistenedcarefully,explainedtheir
partnerorganisations(suchasthefireservice,police actionsandinvolvedpatientsintheirdecisions.
andmilitary),andrehearsalswereundertakenaspart • Clinicaladvisorswereavailabletohelpstaffandto
ofpreparationandplanningexercises. supportpatientstomanagetheirownhealthwhen
• Thetrusthadworkedwithpartnerorganisations appropriate.Theclinicaladviseralsoundertook
includingfireandrescue,police,andthe welfarechecksoverthephonetoensureapatient’s
environmentalagencyduringthefloodsintheThames conditionwasnotdeterioratingwhiletheywere
3 South Central Ambulance Service NHS FT Quality Report 14/01/2015
Summary of findings
waitingforanambulance.Thetrustwasbelowthe thetimelyhandoverandsafetyofpatientsinA&E
nationalaveragefor‘hearandtreat’,whichisthe departments,andtomonitorandrespondto
proportionofcallsthataredealtwithbasedon situationsparticularlyattimesofincreaseddemand
provisionoftelephoneadviceonly.There-contactrate forservices. Therewaseffectiveplanningand
within24hoursof‘hearandtreat’washigherthanthe preparationformajorincidentsandthetrusthad
nationalaveragein2013-14buthaddecreasedthis workedeffectivelywithpartnerorganisations.
yearandwasbelowthenationalaveragein(Aprilto • Thetrustwasmonitoringlongwaitingtimesandhad
July2014). introducedmeasurestoensurethatpeoplewere
• Engagementbetweenthetrustandthepublicand monitoredwhilewaitingandthathigh-prioritycalls
patientswasbeingdevelopedfurther. tookprecedence.Therewasanimpacthoweveron
• ThetrusthadaclearstrategyfortheEOCtoprovide peoplewhomaybeinahealthcaresettingbut
clinicalcoordinationofcareacrossarangeofhealth awaitingtransfertoanotherhospitalforacutecare
andsocialcaresettings.However,moststaffwerenot andforpeopleatadistancefromanambulance
awareofthisstrategyinrelationtotheirservice. station.Thetrustwastakingactiontoreducethese
Governancearrangementsneededtoimproveto waitingtimesandprojectswereplannedindifferent
supportstafftosharelearning,raiseconcerns,manage areas.
riskandactonperformanceinformation.Staffworked • Theservicefollowedsafetyproceduresoverall,but
wellintheirteamsbutsomewantedbettersupport neededtoimproveinfectioncontrolpracticeandthe
frommanagers,particularlyinthenorthernEOC. managementofmedicines.Staffhadagood
understandingoftheMentalCapacityAct2005andof
EmergencyandUrgentCare
safeguardingproceduresalthoughthetimelinessof
• Front-line999servicesprovidedanemergency reportingconcernsandreferralsneededtoimprove.
responsetopeoplewithlifethreateningemergencyor Theperformanceoftheexternalcontractorto‘make
urgentconditions.Overall,during2013/14,thetrust ready’ambulances(thatis,toprepareambulances,for
wasmeetingnationalemergencyresponsetargetsfor example,intermsofcleanlinessandappropriate
75%ofcallstoberespondedtowithin8minutes. The equipment)wasmonitoredbutthequalityoftheir
nationalcategoriesareforRed1calls(forpatientswho workrequiredbettersupervisionandmonitoring.
havesufferedcardiacarrestorstoppedbreathing)and Ambulancecrewshadallocatedtimetocheckvehicles
forRed2calls(forallotherlifethreatening buttoldustheyspentmoretimerecheckingvehicles
emergencies). Red1andRed2callsaddedtogether toensuretheywerereadyforuse.
andarereferredtoasCategoryAcalls. ThecategoryA • Thetrustwasaffectedbythenationalshortageof
targetistohaveavehiclethatcouldconveyapatients paramedicsandtherewereahighnumberof
tohospitalarriveatthescenewithin19minutesfor vacancies.Theallocationandskillmixofstaffwere
95%ofcases.Thistargetwasalsomet. appropriatebutstaffworkedlonghoursandsome
• Thetrusthadthehighestpercentageof‘seeandtreat’ reportedstressandfatigue.Therewasarisingdemand
inthecountry(thatis,managingpatientsatthescene forservicesthatwasabovepredictedlevels.Thetrust
withouttheneedforambulancetransfertohospital). hadintroducedshiftchangestohelpmanage
There-contactratewithin24hoursofthistreatment resourcestomeetdemandinemergencyservicesand
washigherthanthenationalaveragein2013-14but newrotaswerebeingintroducedtofurtherimprove
wasdecreasing. theworklifebalanceofstaff.Thetrustusedprivate
• ThetrustusedaResourceEscalationActionPlan providerstoensureservicecoverandtheseproviders
(REAP)asawayofforecastingperformanceand wereappropriatelymonitored.
servicedelivery.Therewasmoderatetohighpressure • Nationalevidence-basedguidelineswereusedto
ontheserviceduringourinspectionandthetrustwas assessandtreatpatients.Patientsexperiencinga
communicatingeffectivelywithhospitalstoalign heartattackdidreceivepainreliefalthoughthiswas
conveyancingdecisionsagainstwaitingtimesandthe notalwaysthepainreliefthatwasnationally
capacitytoreceivepatients. Thisincludedhaving recommended.Patientsexperiencingaheartattack
hospitalambulanceliaisonofficers(HALOs)tosupport weretransportedquicklytohospital.Patientsthathad
4 South Central Ambulance Service NHS FT Quality Report 14/01/2015
Summary of findings
hadastrokehadappropriatecarebuttherecouldbe dischargedfromhospital.Commissionershad
delaysintheirtransporttohospital.Somehospital identifiedeligibilitycriteriafortheserviceandthetrust
staffidentifiedtheneedforbetterpainrelieffor wasworkingwith12clinicalcommissioninggroupsto
childrenincertaincircumstances. monitorperformanceandcompliance.
• Thecoordinationofemergencycarewithhospitals • Stafffollowedtheeligibilitycriteriadesignedby
andGPswasgoodoverall,butneededtoimprovefor commissionersandwerealsoworkingtoimprovethe
heartandstrokecareinBuckinghamshireandfor signpostingofpeopletootherservicesiftheydidnot
mentalhealthpatientsincrisisacrossthefour meetthecriteria.
counties.Thetrustwasworkingwithitspartnersand • Procedurestoensurethesafetyofservicesneededto
hadactionplanstoimprovecareintheseareas. improve,specificallyaroundincidentreporting,
• Thetrustwasrankedthebestinthecountryfor equipmentchecksandsafeguardingprocedures.Most
patientswhohadhadacardiacarrestandstopped vehicleswerevisiblyclean.‘Donotattemptcardio-
breathing,whothenafterresuscitation,hadapulse/ pulmonaryresuscitation’(DNACPR)orderswere
heartbeatonarrivaltohospital.Thisiscalledreturnof understoodandusedappropriately,butstaffhad
spontaneouscirculation(ROSC).Thetrusthad limitedawarenessoftheMentalCapacityAct2005.
improveditseffectivenessofactiontakenwhenstaff • Therewerestaffingvacanciesandstafffeltstretched,
witnessedacardiacarrestandwasfourthbestinthe particularlyinthedispatchteamwherethishadan
countrythisyear(ApriltoAugust2014)achangefrom impactontheplanningandschedulingoftransport.
eighthbestin2013-14. Thetrustwasusingvolunteersandprivateprovidersto
• Thetrustwasrankedthebestinthecountryfor coverdrivingshifts.Thereneededtobebetter
patientswhohadhadacardiacarrestandsurvivedto governancearrangementsforprivateprovidersandfor
bedischargedfromhospital. drivingandemploymentchecksforvolunteers.
• Staffexplainedtreatmentoptionstopatientsinaway • ThetrusthadmadesignificantchangestotheIT
thatthey,ortheirrelatives,couldunderstand.Patients, systeminthePTSonthedayofourinspection.
andrelativesorcarers,receivedgoodemotional Anticipatedresourceandcapacityrisksneededtobe
supportiftheywereindistress.Therewassupportfor bettermanaged,forexample,problemswiththenew
vulnerablepatients,suchasthosewithalearning ITsystemhadcausedaseriousdisruptiontotransport
disability,bariatricpatientsandpeoplewhosefirst arrangementsformanypatientsduringourinspection
languagewasnotEnglish. • Dispatchstaffdidnotalwayshaveappropriate
• Engagementbetweenthetrustandthepublicand assessmentinformation,fromhospitalsorpatientsor
patientswaswelldevelopedthroughavarietyof fromtheirownrecords.Patientssometimesdidnot
channels,suchassocialmedia,surveys,newsletters haveanappropriatevehicleorequipment,and
andliaisonwork. transportsometimeshadtobereorganised.The
• Thetrusthadaclearvisionandstrategyfortheservice systemtoplanjourneyswasmanualandoften
toprovidemobilehealthcareandtocoordinatecarein reactivebasedonalackoftimelyandcoordinated
hospital,thecommunityandpeople’shomes.Staff informationandthishadcauseddelaystopatient
weresupportiveofthestrategyandworkedwell transport.
togetherinteamsandwiththeirmanagers.Therewere • Thetrustwasnotmeetingperformancetargetsand
goodgovernancearrangementstomonitor thiswashavinganimpactonpatients’careand
performanceandqualityandtomanagerisks treatment.Patientswereexperiencingdelayedand
althoughmoreactionwasneededonongoingrisks. missedappointmentsforoutpatientconsultationsand
diagnosticscans,andrenaldialysis,andsomewere
PatientTransportServices
choosingtocurtailtheirtreatmentinordernottorisk
• Patienttransportservices(PTS)providednon- missingtheirtransporthomeforfearsofexcessive
emergencytransportforpatientswhoattend,for delay.Somehospitalshadreorganisedclinics,for
example,outpatientclinicsordayhospitals,orwere example,tofinishearlytoaccommodatethevagaries
ofthePTS.Thereweregoodexamplesofmulti-
5 South Central Ambulance Service NHS FT Quality Report 14/01/2015
Summary of findings
disciplinaryworkingwithGPsandhealthprofessionals centreandfilmcentreatBracknell.Thestaffwere
inhospitals.Thetrusthadbeenworkingwithother involvedinmakingfilmswhichsupportedlearning
providerstoimprovethecoordinationofcareand aroundnewguidelinesfromtheJointRoyalColleges
someprogresshadbeenmade. AmbulanceLiaisonCommittee(JRCALC).
• Patientsurveyswereregularlyundertaken;thesewere • Thetrusthadintroducedalifesavingautomatic
positiveabouttheservicebutidentifieddelays. externaldefibrillator(AED)locatormobilephone
Patientswespokewithwerepositiveaboutthecare application.ByusingGPS,thisapplocatesthenearest
andcompassionofstaff.However,theywere AEDintheeventofacardiacarrest.Intotal,theapp
concernedthattheservicewasnoteffectiveandthat identifiedover800AEDsacrossfourcounties.
theywerenotgivenenoughinformationaboutdelays, • Anewinitiativewastheintroductionofa‘Simbulance’:
missedappointmentsandtheeligibilitycriteria. alargecommandvehiclefullyequippedwith
• Manypatientstoldustheyhadbeendistressedand simulationlearningactivities.Itwasaninnovative
anxiouswaitingfortransport,butdidnotknowwhom virtualclassroomfacilityinthatitgaveambulance
tocontactwithintheservice.Callhandlerswere stafftheopportunitytoexperiencerealisticmedical
overwhelmedwithcallsaboutservicedelaysandonly situationsinsideanambulancesaloon.
halfofallcallswereanswered. • Operationcentreshaddirectaccesstoelectronic
• Therewasgoodsupportforvulnerablepatients(for informationheldbycommunityservices,including
example,thosewithdementiaoralearningdisability), GPs.Thismeantthatthestaffcouldaccessup-to-date
andcarersandescortscouldtravelintheambulances informationaboutpatients(forexample,detailsof
too.Apolicyforthetransportofchildrenneededtobe theircurrentmedication).
developed. • Traumariskmanagement(TRiM)wasinplaceto
• Thetrusthadaclearstrategyforthedevelopmentof provideconfidentialsupporttostaffwhomayhave
PTStosupportsafenon-emergencytravelbetween beenaffectedbytraumaticincidentsorconditions.
people’shomesandhealthcaresettings,butmoststaff Staffwereassessed3daysafteratraumaticeventand
wereunawareofthisstrategy.Governance againafter28days.Thirty-twoTRiMpractitionersgave
arrangementsneededtoimproveinordertoassess peersupportandadvice,andtherewasalsoan
andmanagerisks.Althoughstaffworkedeffectivelyin externalcounsellingservice.Theearlyintervention
teams,manywantedthemanagementandleadership hadbothreducedsicknessabsenceandimprovedthe
oftheservicetoimproveandforthetrusttoprioritise welfareofstaff.
PTSalongsidetheemergency999service. • TheHelicopterEmergencyMedicalServices(HEMS)
showedinnovativepracticesandlearningtakenfrom
Wesawseveralareasofoutstandingpractice:
combatzones.Theteamnowhadtheequipmentand
• Weobservedmanyexampleswherestaff skillstogivebloodtransfusionsandperform
demonstratedoutstandingcareandcompassionto ultrasoundandbloodgastests.Insome
patientsdespitesometimesworkinginverydifficult circumstances,thisbypassedorreducedthetimea
andpressuredenvironments.Staff“lived”thevaluesof patienthadtospendintheaccidentandemergency
thetrust“Towardsexcellence–Savinglivesand (A&E)department,andmeanttheycouldreceive
enablingyoutogetthecareyouneed”. treatmentimmediatelyonarrivalatthehospital.HEMS
• Representativesofthetrustattendedlocalyouth wasalsoplanningtointroduceanightservice,soit
organisationmeetings,villagefetesandschool wouldoperate24hourseveryday.
assemblies.Thetrusthaddevelopedachild-friendly • Theintroductionofamidwifetotheclinicalsupport
first-aidbookprintedspeciallyforschoolsandthe desk(CSD)intheSouthernHouseemergency
widerlocalcommunity. operationcentrehadimprovedtheoutcomesfor
• Thetrustprovidedaninnovativelearningresourceto expectantmothersandtheirnewbabies.The24-hour
theirfrontlinestaffusingtheeducationalresource labourlinestartedasapilotinMay2014.Itgave
womeninlabouraccesstoadviceandsupport,
6 South Central Ambulance Service NHS FT Quality Report 14/01/2015
Summary of findings
whereasthe‘professional’sline’enabledmedical Inadditionthetrustshouldensurethat:
professionalstospeaktoamidwife24/7duringa
• Proceduresforincidentreportingcontinuetoimprove
woman’slabourandbirth.Theservicehadover1,600
andstaffinEOCandPTShaveappropriatetrainingand
callsinthefirsteightweeks.
areabletoreportincidentsdirectly.Theremustbe
• ThetrustprovidedaserviceonFridayandSaturday
timelyinvestigationofincidents,staffmustreceive
nightsinthecitycentresofPortsmouth(SafePlace)
feedbackandlearningmustbeshared.
andSouthampton(ICEBus)toprovidesupport,first
• TherisksaroundITvulnerabilityintheEOCandPTS
aidandtransfertohospitalifrequiredforthepublic
areappropriatelymanaged.
enjoyinganightout.Thishadbeensetupin
• Infectioncontrolpracticesarefollowedand
partnershipwithotherorganisationssuchasthe
ambulancestations(resourcecentres)andvehicles
HampshirePolice,thelocalcouncil,volunteersand
areeffectivelycleanedanddeepcleaned.
thelocalstreetpastors
• Therearesuitablearrangementstoensurethat
• Thetrusthadaclinicalleadinmentalhealthand
equipmentisregularlycheckedandfitforpurpose.
learningdisability.Thisrolewasuniqueamong
• Staffareawareoftheappropriatestepstotaketo
ambulancetrusts.Theleadhadestablishedanational
reducetheriskstopatientsleftunattendedinPTS
mentalhealthgroupforambulancetrusts,andworked
ambulancesbecauseofstaffworkingalone.
withpartneragenciessuchastheRoyalCollegeof
• Appropriateequipmentisavailableinallareasforthe
PsychiatristsandtheCollegeofPolicing.The
transportofchildreninPTSandthiscontinuestobe
introductionofmentalhealthpractitionersintothe
rolledoutforemergencytransport.
EOCwassupportingoperationalpracticeandcareto
• VolunteerdriversinPTShavetheappropriatesafety
mentalhealthpatients.
andemploymentchecksbeforeworkingwithinthe
• ThetrusthadworkedinpartnershipwithOxford
service.
BrookesUniversitytoprovidestaffwithextra
• Thetrusttocontinuetoworkwithpartnersandensure
opportunitiestodeveloptheircareersbybecominga
theplanningandschedulingofPTSimproveto
paramedic,andtocounterthenationalshortageof
preventdelaysandmissedappointments,andto
paramedics.Afoundationdegreecoursewastostartin
reducetheimpactontheclinicalcare,treatmentand
January2015.Thetrainingcoveredan18-month
welfareofpatients.
periodandincludedin-hourstraining.Thetrust’s
• Thegovernanceandsecurityarrangementsforthe
investmenthadbeensignificantintermsofthetime
managementofcontrolleddrugsneedtobeimproved
takentonegotiatetheresourcesandfacilitiesforthe
inHampshire.
programmeandthereleaseofstafffromworkduties.
• Recruitmentofstaffinallareascontinuesandthere
However,therewerealsoareasofpracticewherethe arespecificstaffretentionplansinresponseto
providerneedstomakeimprovements. identifiedreasonsastowhystaffleave.
• StaffinPTSreceiveappropriatetrainingondementia
Importantly,thetrustmustensurethat:
care,learningdisabilitiesandallstaffcontinueto
• Staffuptakeofstatutoryandmandatorytraining receivedtraininginmentalhealthconditions.
meetstrusttargets • AnticipatedresourceandcapacityrisksinPTS
• StaffinEOCandPTSunderstandtheMentalCapacity continuetobeappropriatelyidentified,assessedand
Act2005 managed.
• AllEOCandPTSstaffreceivesafeguardingtrainingto • Painreliefcontinuestobeappropriatelyadministered
therequiredlevelsothattheyareabletorecognise forpatientswithSTsegmentelevationmyocardial
signsofabuseandensuretherearerobust infarction(STEMI)andpainreliefforchildrenis
arrangementinplaceforstafftoreportconcerns effectivelymonitored.
withintheagreedtimescale. • Continuetoworkwithacutetruststoreviewprotocols
• Emergencycalltakersanswercalls,andthe forthenon-criticaltransferofhospitalpatients.
emergencymedicaldispatchersdispatchan
ambulancewithintargettimes
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Summary of findings
• Thereisbettercoordinationofcarebetween • Staffhaveabetterunderstandingofthetrust’svision
providers,inparticularforcardiacandstrokeservices andstrategyasitappliestotheirserviceinEOCand
inBuckinghamshireandmentalhealthservices. PTSandstaffcommunicationcontinuesaround
• Complaintsarerespondedtowithinthetrust’starget servicechangesanddevelopment.
of25days.AllstaffinEOCandPTSreceivefeedback • LeadershipinthenorthernEOCandPTSsupportsstaff
fromcomplaintsandlearningisshared. andactionistakentoimprovestaffmoralewherethis
• OperationsstaffinPTSareappropriatelyresourcedto islow.
beabletoanswertelephonecalls. • StaffinPTSreceivefeedbackfromthecompleted
• Patients(orpeopleactingontheirbehalf)usingthe patientsatisfactionsurveys.
PTS aremadeofawareofhowtocomplainorsend • TherearebettergovernancearrangementswithinEOC
complimentsabouttheservice. andPTS toshareinformationwithstaff,sothatstaff
• StaffinPTShaveregularsupervisionandthetrust canraiseconcernsandrisksareappropriately
shouldraiseawarenessamongststaffaboutthe identified,assessedandmanaged.
professionalandcareerdevelopmentopportunities • Therearebettergovernancearrangementsforprivate
withinthetrust. providersinPTSandmakereadyservices.
• Theformalstructureofteammeetingsisinplacefor
ProfessorSirMikeRichards
allstaffgroupsandstaffaregiventheopportunityto
ChiefInspectorofHospitals
attend,shareinformationandraiseissuesorconcerns.
8 South Central Ambulance Service NHS FT Quality Report 14/01/2015
Summary of findings
BackgroundtoSouthCentralAmbulanceServiceNHSFT
SouthCentralAmbulanceServiceNHSFoundationTrust Thetrustcurrentlyownsorleases27ambulancestations
(SCAS)wasformedon1July2006,afterthemergerofthe (resourcecentres),twoHQ/operationcentresplus
RoyalBerkshireAmbulanceServiceNHSTrust,the additionalstandbypoints,aerialsitesandsupport
HampshireAmbulanceServiceNHSTrust,theOxfordshire buildings,aswellas312front-lineambulancesspread
AmbulanceServiceNHSTrustandpartoftheTwoShires acrossBerkshire(Berkshireconsistsofthefollowing
AmbulanceServiceNHSTrust.ItprovidesNHS unitaryauthorities:WestBerkshire,Reading,Wokingham,
ambulanceservicesinBerkshire,Buckinghamshire, BracknellForest,WindsorandMaidenhead,andSlough),
HampshireandOxfordshireintheSouthCentralregion. Buckinghamshire,HampshireandOxfordshire.South
Thisareacoversapproximately3,554squaremileswitha CentralAmbulanceServiceNHSFoundationTrust
residentialpopulationofover4million.On1March2012, operatesafleetoffront-lineemergencyambulances,a
thetrustachievedfoundationtruststatus. fleetofrapidresponsevehiclesandsupportsthe
operationoftwoairambulancehelicopters.
Thetrustprovidesanaccidentandemergency(A&E)
servicetorespondto999calls,a111serviceforwhen TheinspectionincludedtheemergencyserviceandPTS.
medicalhelpisneededfastbutitisnota999emergency, The111serviceprovidedbythetrustwasnotinspected
patienttransportservices(PTS)andlogisticsand onthisoccasion.Thelogisticalandcommercialtraining
commercialservices.ThereisalsoaHazardousArea serviceswerealsonotinspectedasthesedonotform
ResponseTeam(HART)basedinHampshire.Servicesare partofthetrust’sregistrationwiththeCareQuality
deliveredfromthetrust’smainheadquartersinBicester, Commission(CQC).
Oxfordshire,andaregionalofficeinOtterbourne,
Hampshire.Eachofthesesitesincludesanemergency
operationscentre(EOC)where999andNHS111callsare
received,clinicaladviceisprovidedandfromwhere
emergencyvehiclesaredispatchedifneeded.
Ourinspectionteam
Ourinspectionteamwasledby: comprisedofaconsultantphysicianinintensivecare,two
nursesworkinginaccidentandemergencydepartments,
Chair:LeslieHamilton,ConsultantCardiacSurgeon,The
fourparamedicstaff,oneemergencycarepractitioner,a
NewcastleuponTyneHospitalsNHSFoundationTrust
paramedicclinicalsupervisoranddevelopmentmanager,
HeadofHospitalInspections:JoyceFrederick,Care threemanagerswithanoperationsrole,aheadof
QualityCommission governance,adirectorofservicedelivery,twochief
executives,apharmacist,asafeguardinglead,two
Theteamof48includedCQCinspectorsandinspection
peoplewitharoleinanoperationscentreandthree
managers,ananalystandinspectionplannersanda
expertsbyexperience
varietyofspecialists:Theteamofspecialistwas
Howwecarriedoutthisinspection
Togettotheheartofpatients’experiencesofcare,we •Isitsafe?
alwaysaskthefollowingfivequestionsofeveryservice
•Isiteffective?
andprovider:
9 South Central Ambulance Service NHS FT Quality Report 14/01/2015
Summary of findings
•Isitcaring? pharmacist,thesafeguardinglead,theinfection
preventionandcontrollead,thementalhealthlead,
•Isitresponsivetopeople’sneeds?
operationalmanagers,emergencyoperationcentre
•Isitwell-led? managers,resiliencestaffandstaffatdirectorlevel.
Theinspectiontookplaceon10and11September2014 Wevisited10ambulancestations,thenorthernand
withunannouncedvisitson30Septemberand1October. southernEOC(wherewelistenedintocallsandobserved
dispatchersfortheemergencyserviceandPTS.Wealso
Beforevisiting,wereviewedarangeofinformationwe
visited10acutehospitalsandonecommunityhospital:
heldandaskedotherorganisationstosharewhatthey
JohnRadcliffe,Oxford;Churchill,Oxford;WexhamPark,
knewabouttheSouthCentralAmbulanceService.These
Slough;BicesterCommunity,Bicester;StokeMandeville,
includedlocalclinicalcommissioninggroups(CCGs);
Aylesbury;Wycombe;RoyalBerkshire,Reading;Milton
localqualitysurveillancegroups;thehealthregulator,
Keynes;SouthamptonGeneral;BasingstokeandNorth
Monitor;NHSEngland;HealthEducationEngland(HEE);
Hampshire,Basingstoke;QueenAlexander,Portsmouth.
CollegeofEmergencyMedicine;GeneralDentalCouncil;
Atthesehospitals,weobservedtheinteractionbetween
GeneralMedicalCouncil;Health&SafetyExecutive;
ambulancestaffandhospitalstaffintheaccidentand
HealthandCareProfessionsCouncil;Nursingand
emergency(A&E)areas,directadmissionwards,
MidwiferyCouncil;NationalPeerReviewProgramme;
outpatientareasanddischargelounges.Wenotedhow
NHSLitigationAuthority;ParliamentaryandHealth
peoplewerebeingcaredforandspokewithpatients
ServiceOmbudsman;PublicHealthEngland;themedical
usingtheemergencyambulanceserviceandPTS.We
royalcolleges;localauthorities,localNHSComplaints
spokewithstafffromthehospitalswevisitedaboutthe
AdvocacyService;localHealthwatchgroups;andlocal
ambulanceservice.Werodeandobservedonthree
healthoverviewandscrutinycommittees.Wealso
emergencyambulancesandtwopatienttransport
reviewedinformationcollectedbySpeakOutwhohosted
vehicles.
alisteningevent.
Wewouldliketothankallstaff,patientsandother
Duringourinspection,wespokewitharangeofstaffin
stakeholdersforsharingtheirbalancedviewsand
theorganisationincludingcallhandlers,dispatchers,
experiencesofthequalityofcareandtreatmentprovided
paramedics,ambulancetechnicians,emergencycare
bytheSouthCentralAmbulanceService.
assistants,emergencycarepractitioners,communityfirst
responders,patienttransportservices(PTS)staff,thelead
Factsanddataaboutthistrust
SouthCentralAmbulanceServiceNHSFoundation • Theserviceshas40sites;27ambulancestations;489
Trust:Keyfactsanddata vehiclesofwhich312arefrontlineambulances;and
supportstheoperationoftwoAirAmbulance
1.Context
helicopters.
• Servicecovers-Berkshire,Buckinghamshire, • Theservicescovers10acutehospitalsites,2Major
Hampshire,OxfordshireandMiltonKeynesandthe TraumaCentres,7specialistsite,5mentalhealth
residentpopulationapproximately£4million trusts.
(Significantruralareas). • Staff:3,000.
• HealthSummary:Healthofpopulationgenerally • CommunityFirstResponders:946
betterthanEnglandaverage;Deprivationislowerthan • Co-responders:359
average;lifeexpectancyishigherthantheEngland • Thetotalincomefortheservicewas£162,4millionin
average. 2013/14(£118mspentonemergencyservices)
• Costimprovementchallenge£6.2m(2013/14):Trust
achievedthistarget.
10 South Central Ambulance Service NHS FT Quality Report 14/01/2015