Yorkshire Ambulance Service NHS Trust HQ NewApproachFocused Report PDF
Preview Yorkshire Ambulance Service NHS Trust HQ NewApproachFocused Report
Yorkshire Ambulance Service NHS Trust YYoorrkksshhiirree AAmmbbuullaannccee SSeerrvviiccee NNHHSS TTrruusstt HHQQ Quality Report Springhill2,BrindleyWay Wakefield41BusinessPark Wakefield WestYorkshire WF20XQ Dateofinspectionvisit:13-16September2016,6 Tel:08451241241 October2016 Website:www.yas.nhs.uk Dateofpublication:01/02/2017 Thisreportdescribesourjudgementofthequalityofcareatthisprovider.Itisbasedonacombinationofwhatwe foundwhenweinspected,otherinformationknowtoCQCandinformationgiventousfrompatients,thepublicand otherorganisations. Ratings Overall rating for this Good ––– ambulance location Emergency and urgent care services Good ––– Patient transport services (PTS) Requiresimprovement ––– Emergency operations centre Good ––– Resilience planning Good ––– 1 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017 Summary of findings LetterfromtheChiefInspectorofHospitals YorkshireAmbulanceServiceNHSTrust(YAS)wasformedon1July2006whenthecounty'sthreeformerservices merged.ThetrustcoversNorthYorkshire,SouthYorkshire,WestYorkshire,HullandEastYorkshirecoveringalmost6,000 squaremilesofvariedterrain,fromisolatedmoorsanddalestourbanareas,coastlineandinnercities.Thetrust employsover4,670staffandprovides24-houremergencyandhealthcareservicestoapopulationofmorethanfive million. Thetrustprovidesanaccidentandemergency(A&E)servicetorespondto999calls,anNHS111serviceforwhen medicalhelpisneededfastbutitisnota999emergency,patienttransportservices(PTS)andemergencyoperation centres(EOC)where999andNHS111callsarereceived,clinicaladviceisprovidedandfromwhereemergencyvehicles aredispatchedifneeded.Thereisalsoaresilienceandhazardousarearesponseteam(HART). Wecarriedoutafocussedfollowupinspectionofthetrustfrom13-16September2016,inresponsetoaprevious inspectionaspartofourcomprehensiveinspectionprogrammeofYorkshireAmbulanceServiceNHSTrustinJanuary 2015.Inaddition,anannouncedcomprehensiveinspectionoftheNHS111servicewascarriedouton10-12October 2016. Focusedinspectionsdonotlookacrossawholeservice;theyfocusontheareasdefinedbytheinformationthattriggers theneedforthefocusedinspection.Wethereforedidnotinspectallofthefivedomains:safe,effective,caring, responsiveandwellledforeachofthecoreservicesweinspected. Weinspectedfivecoreservices: • Emergencyoperationscentres • Urgentandemergencycare • Patienttransportservices • ResilienceservicesincludingtheHazardousAreaResponseTeam • NHS111services. Overall,weratedallofthefivekeydomainsasgoodwhichmeanttheoverallratingforthetrustwasalsogood. Ourkeyfindingswereasfollows: • Thetrusthadundertakenanumberofinitiativestoimprovestaffengagement;thestaffforumhadbecome embeddedsinceourpreviousinspectionandwasviewedpositivelybystaff. • Relationshipsbetweenthetrustandtradeunionshadimprovedsincethepreviousinspectionbuttherestillmore workforthetrusttodo. • Staffinglevelsthroughoutthetrustwereplannedandmonitored.Thetrusthadchallengesduetonationalshortages however;itwasaddressingthisthrougharangeofinitiatives. • FromApril2016thetrustwasparticipatinginthenationaltrialoftheambulanceresponseprogramme(ARP)which helpedtheservicetodispatchappropriateambulanceresources.TherewerenoperformancetargetsfortheARP pilot.Thetrustmonitoreditsperformanceonresponsetimes. • Atthepreviousinspectiontherehadbeenconcernsinrelationtoequipmentchecks,maintenanceofequipmentand consumablestock.Atthisinspectionwefoundthetrusthadputinplaceasystemtoensureequipmentandstock wassuitabletouse. • Inmostofthecoreserviceswefoundinfectioncontrolprocedureswerefollowedandtheambulancestationsand vehiclesweobservedweregenerallyclean.Howevertherewerestillinconsistenciesinthewaystaffmaintained vehiclecleanlinessacrossthePTSservice. 2 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017 Summary of findings • Thereweresystemsinplacetosharelearningfromincidentsandadverseevents.Moststaffwespokewithconfirmed theyreceivedfeedbackbyemailafterreportinganincident.Asafetybulletinwasproducedandsharedacrossthe trusttosharelessonslearnt. • Therewerehighlevelsofcompliancewithsafeguardingtrainingatlevelsoneandtwoandallstaffwhowere determinedbythetrusttorequirelevelthreetraininginrelationtotheirrole,hadreceivedthis. • FromApril2016thetrusthadcommencedalocalreviewofmortalityandmorbidity,supportedbylocalauditslinked tothetrust’scommissioningforqualityandinnovation(CQUIN)targetstoexplorealldeathsinthecareofthetrust, whereRecognitionofLifeExtinct(ROLE)hadbeeninvokedbyYASparamedics. • WithintheNHS111service,callabandonmentratewas2%,comparedtothenationalaverageof3%.Wesawthat 89%ofcallswereansweredwithin60seconds,comparedtothenationalaverageof87%. • WithinthePTSservicetherewasaclearlackofmanagementoversightandlackofownershipofrolesand responsibilities,andgovernancesystemswerenotfullyembeddedthroughouttheservice. Wesawseveralareasofoutstandingpracticeincluding: • Theredarrestteamprovidedclinicalleadershipintheresponsetocardiacarrestpatients,whichhadimprovedthe successrateinthereturnofspontaneouscirculation(ROSC). • TherestartaheartteamwascommendedforitsCPRworkwithschoolchildren.Morethan31,000childrenwere trainedinhands-onlyCPRinconjunctionwiththeBritishHeartFoundation. • Communityfirstrespondersweretrainedvolunteerswhowereavailabletoattendemergencycallsandtoprovide initialcarebeforethearrivalofanambulance.Morethan300communityfirstresponderschemesworkedclosely withtheambulanceservice. • Theservicesupported670publicaccessdefibrillatorsacrosstheYorkshireregionwhichwereavailableforuseby membersofthepublic.Theschemeparticularlyhelpedpeopletoaccessdefibrillatorsinremotevillages. • AmemberoftheairambulancecrewhadcompletedtraininginCrewResourceManagement(CRM).Thequalification enabledthememberofstafftoundertakecritiqueandfeedbackofincidentswhilsttakingaccountofhumanfactors. • HARTstaffpresentedevidenceonthebenefitsofearlyantibioticadministrationinopenfractures.Thistreatment nowhasbecomestandardpracticewithinYAS. • Thetrustwaspartoftheurgentandemergencycarevanguardprogramme,tosupportthedevelopmentofnew approachestotheprovisionofurgentandemergencycare.TheWestYorkshireurgentandemergencycarenetwork aimedtodevelopanintegratedurgentcaremodelfortheregion,buildingontheservicesprovidedbyexistingurgent careservices. • ThetrusthadcontributedtothedevelopmentofaPharmacyUrgentRepeatMedicationScheme(PURM)acrossthe localitywhichenabledpatientstoaccessessentialmedicinesfromparticipatingpharmacistsoutofhours.This schemehadwona‘PharmacyInnovation’award. • TheNHS111servicehadimplementedaccesstopalliativecarenursesonweekendsandbankholidays,whowere abletoprovidesupporttopatientsapproachingtheendoflife. • Thetrusthadmadeuseofacomprehensiveworkforcemanagementtooltoforecastanticipatedcalllevelsand deploystaffaccordingly.Thedevelopmentofthistoolandthetransformationofplanningwithintheorganisation wasrecognisedbyaNationalPlanningAwardfromtheProfessionalPlanningForum. However,therewerealsoareasofpoorpracticewherethetrustneedstomakeimprovements. Importantly,thetrustmust: • Thetrustmustensureatalltimestherearesufficientnumbersofsuitablyskilled,qualifiedandexperiencedstaff. • Withinpatienttransportservices(PTS)thetrustmustensurethatallambulancesandequipmentareappropriately cleanedandinfectioncontrolproceduresarefollowed. • Thetrustmustensuresecureseatingforchildrenisroutinelyavailableinambulancevehicles. Inadditionthetrustshould: 3 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017 Summary of findings • ThetrustshouldreviewthetrainingrequirementsforoperationalstaffinthePTSserviceforvulnerablegroupssuch aspatientslivingwithdementiaandpatientsexperiencingmentalhealthconcerns. • Thetrustshouldreviewthearrangementsforoperationalstafftochecktheirvehicleandequipmentatthestartof theshifttoensuretheyhavesufficienttimetocompletethechecks. • Thetrustshouldreviewtheauditproceduresforreviewingtherecordingofcontrolledmedicines. • Thetrustshouldcontinuetoensurethatequipmentandmedicalsuppliesarecheckedandarefitforpurpose. ProfessorSirMikeRichards ChiefInspectorofHospitals 4 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017 Summaryoffindings Summary of findings Ourjudgementsabouteachofthemainservices Service Rating Why have we given this rating? Emergency AtourpreviousinspectioninJanuary2015,the Good ––– and urgent servicewasratedasRequiresImprovementoverall. care InSeptember2016weratedthiscoreserviceas services Goodbecause: • Thetrusthadputinplaceprocessesforrisk managementandclinicalgovernanceofthe service.Riskswereratedandareviewdate specifiedwhichshowedeachriskwasrecently reviewed. • Positivechangestotheexecutiveleadershipof theservicewererecognisedandappreciatedby staff;thechiefexecutivewasseenas approachable. • Thetrustwasparticipatinginthenationaltrial oftheambulanceresponseproject(ARP)which helpedtheservicetodispatchappropriate ambulanceresourcestopatients. • Outcomesforpatientshadimproved;for examplepracticetosupportthereturnof spontaneouscirculation(ROSC)and involvementwithregionalandnationalsepsis networkshadstrengthenedthesepsispathways andimprovedclinicalqualityoutcomes. • Staffworkedcloselywithhospitalprovidersof emergencyandotherprovidersofservices includingfireandrescueandcommunity responderstocoordinateappropriatepathways ofcareforpatients. • Staffwereabletoreportincidentsreadilyand learningfromtheinvestigationofincidentswas shared. • Infectioncontrolprocedureswerefollowedand ambulancestationsandvehicleswereclean.A vehicle“makeready”servicehadbeen introducedinsomestations.Therewereplans tointroducethisacrosstheservice. • Equipmentandconsumablesupplieswere readilyavailableandarrangementsfor disposingofoutofdateitemswereinplace. • Theworkforceplandevelopedduring2016-17 reflecteddemandprofilesforeachareaand 5 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017 Summaryoffindings Summary of findings plannedworkforcenumbersandrecruitment weremonitoredweekly.Theworkforceplanwas communicatedandunderstoodbystaffwhich helpedtosupportretention. • Recordscontainedappropriateandsufficient informationaboutthepatientandtheir conditionandwerefullymaintainedand audited. • Patientswithdeterioratingconditionswere identifiedpromptlyandescalatedfor appropriatetreatment.Pathwaysforassessing andrespondingtopatientswhoexperienced trauma,sufferedfromchestpainorexperienced asuspectedstrokewerefollowed. • Medicineswerestoredsecurelyand administeredsafely.Oxygenandanalgesic gasesweresecuredsecurelyandwereindate. Securestorageformedicineswasalso maintainedinacutehospitals.Wesaw medicinescabinetsweresecurelylockedwith accessonlypermissiblebyambulanceservice crews.Controlledmedicineswerestoredin ambulancestationsinalockedroomwithina lockedsafeandtheroomwasalarmed. • Thelearninganddevelopmentofstaffwas supported.Allstaffnewtotheservicereceived thoroughinductionandtrainingandtheservice wastakingstepstoensurestaffreceivedan annualappraisalandclinicalsupervision.Most staffhadcompletedtheirmandatorytraining. • Thecultureoftheservicehadimproved.Public engagementfortheservicehaddevelopedand includedroadshowsandcommunity partnershipevents.Localengagementevents hadattractedmorethan3,000membersofthe public.Consultationarrangementswithstaff includedanewlyestablishedmultiunion partnershipandthestaffforumwasembedded. • Staffknewhowtodealwithcomplaintsthey received,complaintswereinvestigatedandwe foundsomeevidencethatlearningwasshared withstaff.Forthe12monthspriortoour inspectiontheservicehadmetagreeddue datesin96%ofcasesandhasachievedan 6 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017 Summaryoffindings Summary of findings averageresponsetimeof21workingdaysforall services.Theservicehadastandardof85%for qualityauditoutcomes,andwasachieving86% atthetimeofourvisit. • Innovationwasencouragedthroughsupportfor nationalinitiativesandlocallybasedresearch projects. However: • Theallocatedtimeofsixminutesforcrewsto checktheirvehicleandequipmentatthestart oftheirshiftwasinsufficientforallessential equipmenttobechecked. • Therecordingofmedicinesadministration containedsomediscrepancieswhichwerenot alwaysidentifiedthroughauditprocedures.At anemergencydepartmentwevisited,whenwe checkedthestockofcontrolledmedicines,we foundtheitemsissuedhadbeenaudited incorrectly,sothatoneitemwasshown incorrectlyasinsurplus.Theserviceaddressed thisissueatthetimeofourvisit. • Recordswerenotalwayssecurelystoredon ambulancevehicles.Weraisedthiswiththe trustduringourvisitandatourunannounced inspectionwefoundthatprocedureshadbeen changedtoprotectthesecurityofrecords. • Itwasnotalwayspossibleforambulancecrews toaccesssecurevehicleseatingforchildren. • Disposalofclinicalwasteandsharpswas variableinaminorityofvehiclesand ambulancestations. • Furtherworkwasneededtoensureatarget numberofstaff(atleast85%)receivedan annualappraisal.Theservicehadinplacea recoveryplantoachieve90%appraisalratesby 2017-18. • Specialisedequipmenttosupportbariatric patientsneededtobemadeavailableand accessibletoallemergencyambulancecrews. • Frontlinestaffwespokewithcouldnot articulatethevisionandstrategyfortheservice. 7 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017 Summaryoffindings Summary of findings Patient Weundertookacomprehensiveinspectionofthe Requiresimprovement ––– transport YorkshireAmbulanceService(YAS)inJanuary2015. services Atthistime,weratedPatientTransportServicesas (PTS) RequiringImprovementinthedomainsofsafe, effective,responsiveandwell-led.Weratedthe caringdomainasGood. • Therehadbeensomeimprovementstoincident reportingandtherewerealsosomesystemsin placetomonitorrisks.However,therewasa lackofrobustprocessesandmanagement oversighttoensurestaffhadlearnedfrom incidentsorcomplaints. • Therewereidentifiedrisksmissingfromtherisk register,soitwasunclearwhatactionshad beentakentomitigatetheserisks. • Therehadbeensomeimprovementsinthe maintenanceandcleaningofvehiclesandthe replenishmentofequipmentvehicles.However, therewasinconsistencyinwhatwasstoredon vehiclesandwhereitwasstored.Storageof someequipmentwasnotsafeandposedarisk topatients.Therewerealsounsafevehiclesin useandfaultreportingwasnotrobust. • Insomelocalitieswefoundvehiclesecurityto bepoorwhichwasarisktotheservice. • Thereweresystemstomonitorqualityand performance.Therehadbeensome improvementsintheservice’sperformance againstsomeofthekeyperformanceindicators. However,concernsremainedregardingthe performancetargetsnotbeingmetforsome renaldialysispatientsandwithinthe communicationsandcontrolcentre. • Therecontinuedtobestaffingvacanciesinthe communicationsandcontrolcentre.Thishada negativeimpactonpatientexperienceand otherstakeholderscontactingtheservice.This alsohadanimpactontheplanningand schedulingofpatients’returnjourneys. • Thebusinesscontinuityplansforthe communicationandcontrolcentrewerenot welldevelopeddespiteactionsbeingidentified fromatabletopexerciseinOctober2015. However: 8 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017 Summaryoffindings Summary of findings • Moststafftoldustheyfeltproudtoworkforthe trust.Patienttransportservice(PTS)stafffelt theirimmediateoperationalmanagers supportedthemintheirrole,althoughthere weresomereportsofadisconnectionbetween staffandseniormanagers. • Therewererobustplansinplacefor fluctuationsindemand,staffingshortagesand foradverseweatherconditions. • Thecomplianceratesformandatorytraining andstaffappraisalsshowedasignificant improvementfromourlastinspection. • Duringthecourseofourinspection,wesaw examplesofstaffdemonstratingacaringand compassionateapproachtosupporting patients.Weobservedpatientsdignitybeing maintainedandpatientbeingtreatedina respectfulway.Wealsoreceivedsomevery positivefeedbackfrompatientsandtheircarers regardingthePTSstaffwhodemonstratedareal commitmenttodeliveringagoodservice. Emergency Overall,theservicewasratedasGood.Thiswas Good ––– operations because: centre • Theemergencyoperationcentre(EOC)usedan evidencebasedclinicaltriagesystemtoassess patients. • Theyhadaccesstoalanguageinterpreter serviceandtextrelayserviceforpatientswith impairedhearing. • Paramedicandmentalhealthsupportand advicewereavailable. • Staffknewhowtoreportsafeguarding concerns.Safeguardingreferralscouldbemade 24hoursadaythroughtheclinicalhub • Staffinglevelswerescheduledandplannedon anelectronicsystem,whichtookintoaccount previousdemanddataandforthcomingevents. • Governanceprocesseswereinplaceandthere werecleargovernancestructures.Riskregisters werereviewedandmanagementwereableto describethecurrentriskstotheEOC. • Thecultureoftheservicewasopenand transparentandstafftoldustheyreceivedgood supportfromtheirteamleadersandduty managers. 9 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017 Summaryoffindings Summary of findings • Thetrusthadbeeninvolvedinanumberof initiatives,suchas‘TheBlueLight’programme. Theaimoftheprogrammewastoimprovethe mentalhealthofstaffworkinginemergency servicebyhaving‘BlueLightChampions’toact assupporttostaff. • Theservicewasoneoftheleading organisationsinthepilotingoftheAmbulance ResponseProgramme(ARP)introducedinApril 2016.ARPaimedtoimproveresponsetimesto criticallyillpatientsbyensuringanappropriate responsetopatientsfirsttime. • Incidentswerereported,investigatedand lessonslearntsharedwithstaffacrossthe organisation.Althoughthemajorityofstaff receivedfeedbackfromincidents,therewere inconsistenciesassomestaffhadnotalways receivedindividualfeedback.Thiswasalsothe findingsatthepreviousinspection. Howeverwealsofound: • Notallstaffusingtheevidencebasedclinical triagesystemwereuptodatewithbasiclife support(BLS)training.Uptodatetrainingwasa requisiteforalicenceintheuseofthesystem. Followingtheinspectionthetrustwroteand assuredCQCthatbythe1December201685% oftheEOCstaffwouldhaveBLStraining.They alsoinformedusthattheyhadrecentlybeen re-accreditedbytheInternationalAcademyand givencentreofexcellencestatus.Trainingon BLSinstructionswithinthedispatcherrolewas partofthecriteriaforre-accreditation. • Notallnursingstaffwereuptodatewith safeguardingtraining. Resilience OverallweratedresilienceatYASasGood.Safeand Good ––– planning well-ledwasratedasGoodandeffectivewasrated asOutstanding. • Wefoundgoodevidenceoflearningbothin localandwiderresilienceteams.Thiswas supportedbygoodsystemsforreporting incidentsanddebriefs. 10 Yorkshire Ambulance Service NHS Trust HQ Quality Report 01/02/2017
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