Report to: Healthy Staffordshire Select Committee Accountability Session

Report of: Dr Anthony Marsh, Chief Executive Officer

Date: 16 November 2015 Subject: West Midlands Ambulance Service NHS Foundation Trust Purpose of To provide members with an overview and self assessment the report: of West Midlands Ambulance Service NHS Foundation Trust

Contents

Glossary ..................................................................................................................................... 3

1. TRUST PROFILE ................................................................................................................ 4

2. STAFFORDSHIRE DIVISION .............................................................................................. 5

3. OPERATIONAL PERFORMANCE ...................................................................................... 6

3.1 Regional and Staffordshire Specific .............................................................................. 6

3.2 Hospital Turnaround ...................................................................................................... 7

3.2 Transformation of Staffordshire Services ...................................................................... 7

4. CARE QUALITY COMMISSION .......................................................................................... 8

4.1 January 2014 Inspection ............................................................................................... 8

4.2 CQC Compliance assurance ......................................................................................... 8

5. QUALITY ............................................................................................................................. 9

5.1. Patient Safety ................................................................................................................ 9

5.2. Ambulance Clinical and Quality Indicators .................................................................. 12

5.3. Ambulance Clinical Performance Indicators ................................................................ 15

5.4. Patient Experience ...................................................................................................... 17

6. FINANCIAL PERFORMANCE ........................................................................................... 20

7. WORKFORCE ................................................................................................................... 20

7.1 Workforce Planning/Skill Mix ....................................................................................... 20

7.2 Sickness Absence ....................................................................................................... 20

7.3 Personal Development Reviews (PDR)......................... Error! Bookmark not defined.

8. SERVICE IMPROVEMENTS AND INNOVATION ............................................................ 21

Glossary

Clinical Commissioning Groups (CCG) Community First Responder (CFR) Emergency Operations Centres (EOC) Hospital Ambulance Liaison Officer (HALO) Learning Review Group (LRG) Family Liaison Officer (FLO)

1. TRUST PROFILE

West Midlands Ambulance Service NHS Foundation Trust (The Trust) was authorised as a Foundation Trust in January 2013. The Trust serves a population of 5.6 million people covering an area of more than 5,000 square miles made up of Shropshire, Herefordshire, Worcestershire, Staffordshire, Warwickshire, Coventry, Birmingham and Black Country conurbation. The region is full of contrasts and diversity. It includes the second largest urban area in the country yet over 80% of the area is rural. The Trust responds to around 3,000 '999' calls each day. To manage that level of demand, the Trust employs approximately 4,000 staff and has a fleet of over 850 vehicles that operate from 16 fleet preparation hubs across the region and a network of over 90 Community Ambulance Stations. The Trust is supported by a network of Volunteers. More than 800 people from all walks of life give up their time to be Community First Responders (CFRs). CFRs are trained to attend emergency calls within the local community in which they live or work and provide care until the ambulance arrives. In addition to this the Trust has worked with local communities placing lifesaving defibrillators across Staffordshire and supporting the public to use them. Less than 60% of the Trust’s patients are conveyed to an emergency department with the remainder of patients being treated at the scene, given advice over the phone or taken to another service such as a GP or minor injuries unit. The Trust has invested heavily in the skills of staff and is on course to become the first Trust in the country to have a paramedics on every ambulance or response car. The additional skills that the Trust paramedics have, enables them to carry out many more treatments at the scene or during transfers to hospital, which improves patient care. The Trust also provides non-emergency patient transport services across some parts of the region for those patients who require non-emergency transport to and from hospital and who are unable to travel unaided because of their medical condition or clinical need. Staff complete approximately 700,000 non-emergency patient journeys each year.

2. STAFFORDSHIRE DIVISION

The Staffordshire population is 1.1 million resident in the county, and a large transient population that travels through the county on a daily basis. The county stretches across 1,050 sq miles, and has a mixture of rural and Urban Communities.

The County has six Clinical Commissioning Groups (CCGs), with whom the ambulance service interact on a frequent basis. The CCGs are North Staffordshire, Stoke on Trent, Stafford and Surrounds, Cannock Chase, East Staffordshire, South East Staffordshire and Seisdon Pennisula. The formation of the University Hospital of North Midlands (the amalgamation of Royal Stoke and County) is part of the current reconfiguration of services taking place in the county which continues to offer challenges to the Trust. The Staffordshire Division consists of 3 Ambulance Hubs and 19 ambulance response posts, the Ambulance hubs are situated in Stoke on Trent, Stafford and Lichfield. Ambulance resources are deployed from the hubs to strategically situated response posts whereby ambulance resources are tasked to calls. The Hub is a centre where staff report to centrally, ambulances are restocked, refuelled, cleaned and serviced, and where training and education takes place. Ambulances are strategically deployed in line with a dynamic operational plan that changes each hour, this plan is based on emergency activity, and ensures that the ambulance resources are best positioned to meet the daily patient activity.

Staffordshire is also the site of one of the two Emergency Operations Centres, where emergency calls are received and triaged.

3. OPERATIONAL PERFORMANCE

3.1 Regional and Staffordshire Specific

The Trust consists of five operational areas Birmingham, the Black Country, Coventry and Warwickshire, West Mercia and Staffordshire. The Following table bench marks the operational performance in Staffordshire against the operational performance produced by the Trust. It is pleasing to note that the Trust remains the number one performing ambulance service in the Country, and Staffordshire has made a positive contribution to this overall performance.

The Trust is funded to achieve performance on a regional basis, not a county one. In the months that Staffordshire did not achieve the required standards in Red 1 and Red 2, this was attributable to an unstable demand profile with large peaks in demand.

The number of ambulance resources that are available at any one time is dictated by a forecasting system based on a supply versus demand model that has been successfully used in the ambulance service for many years.

RED 1 April May June July August September YTD

Staffordshire 77.5% 74.9% 75.6% 73.6% 82.9% 74.8% 76.30%

West Midlands 81.2% 78.1% 79.7% 79.4% 80.6% 78.6% 79.60%

RED 2 April May June July August September YTD

Staffordshire 75.0% 74.4% 73.8% 75.5% 77.9% 76.0% 75.50%

West Midlands 76.8% 76.8% 75.3% 76.0% 76.2% 75.1% 76.00%

RED 19 April May June July August September YTD

Staffordshire 96.6% 96.2% 96.8% 97.0% 97.3% 96.3% 96.70%

West Midlands 97.6% 97.6% 97.4% 97.4% 97.4% 96.9% 97.40%

Performance Target Definition

Red 1 75%

An immediate life-threatening situation requiring emergency assistance e.g. cardiac arrest. The objective is to provide immediate aid to apply life-saving skills supported by paramedic intervention. Arrival at the scene within 8 minutes.

Red 2 75% An immediate life-threatening situation requiring emergency assistance e.g. choking, uncontrolled haemorrhage etc. Arrival at the scene within 8 minutes.

Red 19 95% Arrival of a vehicle able to convey at the scene of a Category Red incident within 19 minutes.

Green 2 90% Less serious but not life threatening calls, e.g. falls in a public place. 30 minute response target.

Green 4 90% Callers must have a telephone triage within 60 minutes of the original call time, e.g. finger injuries, cough and colds.

Referrals 90% A patient must be picked up and conveyed to hospital within a specified time by a healthcare professional.

3.2 Hospital Turnaround

The Trust enjoys a close working relationship with the three hospitals in the County and has a Hospital Ambulance Liaison Officer commonly known as a HALO based at all three hospitals. The HALO assists with ensuring there are limited delays in hospital turnaround. The accepted time to turn an ambulance around from arrival at hospital to handover of patient and calling available for another case is 30 minutes

Royal Stoke University Hospital is the busiest hospital for ambulance activity in the West Midlands, and local managers in Staffordshire meet with the hospital on a regular monthly basis to discuss through items of operational importance.

3.2 Transformation of Staffordshire Services

The Trust has supported the transformation of services that has taken place at the County Hospital. This transformation has seen patients being taken mainly to Stoke on Trent and Wolverhampton as the services have moved from the County site.

In East Staffordshire, the Stroke network is still to be agreed regarding the ambulance transport and the impact on service change. There are discussions to be held regarding the required level of funding to ensure that there is no effect on the ambulance service provision through this change. Taking patients to hospitals other than their nearest one is shown to provide higher levels of clinical care, but has a knock on effect on the ambulance service. It is the right thing to do, but the Trust is clear that there is a cost implication for this Trust that needs to be met.

Average Longest

Royal Stoke 26 mins 1hr 23mins

County 23 mins 53 mins

Burton 24 mins 1hr 21 mins

Region 28 mins 4 hrs 38 mins

4. CARE QUALITY COMMISSION

4.1 January 2014 Inspection

The Trust has been registered with the CQC without conditions since 2010. This includes compliance with the Health and Social Care Act 2008 and Hygiene code (HC2008).

During January 2014, the CQC carried out a review of the Trust that included; inspections of premises and ambulances, interviews with patients, staff and managers, feedback from partner organisations and local authority scrutiny and safeguarding committees and review of compliance with other regulatory bodies.

The final report available from www.cqc.org.uk or the Trust website confirms the Trust remained compliant with all the requirements of registration except for a minor failure in Outcome 4 - 'Care & Welfare of people who use our Service'. The CQC determined the Trust was required to provide a short term plan for improvements in operational performance targets as some patients, whilst receiving excellent treatment from staff, had experienced delays in response times. The Trust agreed a plan to improve response times by July 2014 which was achieved. West Midlands Ambulance Service NHS Trust is the best performing Ambulance Service in the UK and the only one to be achieving all four statutory targets year to date.

4.2 Quality assurance

The Trust is proud of the high quality service it delivers and welcomes external and internal scrutiny and feed back in order to continue improving. To ensure high standards are maintained the Trust has a Quality Governance Committee (QGC) that oversees organisational quality and provides assurance to the Board of Directors that services are safe, effective and providing a good patient experience. The QGC holds the management team to account for the effective delivery of Trust strategies and policies in order to maintain CQC compliance and improve services. It expects good quality evidence that patients are receiving the best care possible to be presented and where there are any concerns or risks to quality QGC will make the Board of Directors aware and will then monitor improvement actions to completion.

5. QUALITY

5.1. Patient Safety

5.1.1 Learning The Trust takes safety of staff, patients and those that may be affected by Trust activities seriously and as such recognises the benefits of learning from its untoward events. These include all events identified through complaints, concerns, claims or incident reporting systems. In order to ensure effective analysis and learning takes place the Trust has a multidisciplinary Learning Review Group (LRG) that meets monthly to review all information relating to adverse safety and effectiveness incidents. They ensure that learning from serious incidents in previous years is reviewed to ensure changes have been effective and are still current. Each quarter LRG produces a report that identifies high risk incidents and trends and themes resulting from lower risk incidents. The report is shared throughout the Trust and with external stakeholders. During the first six months of the year the LRG identified regional learning as: Patient Safety/Experience

Harm Incidents: The Trust identified 30 patient safety incidents in Staffordshire during the first six months of the year. Of these there were 4 minor harm incidents associated with falls and collision / contact with objects including within the non-emergency patient transport service. Wheelchair Patient Transport Service patients will be a key safety focus for the Trust during Qrt3 to ensure raised awareness and to identify equipment, training and planning improvements.

Equipment: Thermometers recently introduced to ensure a wider scope of use has resulted in increased concerns raised by staff – our Education and Training department has reviewed and programmed in awareness sessions.

Bariatric: Dignity and safety of patients during moving and handling raised as a concern – the model for responding appropriate resources is under review.

Delays: Concerns raised by external care staff regarding PTS delays – these have reduced since a greater understanding of the contract arrangements was shared with hospital staff.

Staff Safety

Physical Assaults against staff have increased - Processes under review to see if earlier identification of risk can be made. Incidents reviewed so far have not revealed any concerns at the call taking stage.

Bariatric – Moving and handling of bariatric patients resulting in staff injury – The operational model for providing timely staff and equipment support is currently under review.

5.1.2 Serious Incidents

Between 1 April 2015 and 30 Sept 2015 the Trust reported nine serious incidents but only one in Staffordshire which related to the moving of a patient in a time critical situation. (2015-29172)

1. 2015-13832 – Management of an obstetric case – concerns reported by hospital staff were perceived and inaccurate, appropriate care given as confirmed by Obstetrician in attendance. This incident was downgraded as an SI by Commissioners.

2. 2015-7622 – EOC failure to convert to cardiac arrest pathway. Changes in breathing (agonal) not identified as a potential for cardiac arrest. Changes to WMAS training package implemented and a request for changes to the triage system has been made to the national team.

3. 2015 - 14811 – Failure to identify a spinal cord injury – Learning from missed flags has been shared across the Trust and the individual’s education needs are being addressed.

4. 2015 – 22513 – EOC failure to identify seriousness of call – The investigation identified that the patient had rare condition unlikely to have ever been detected until the patient was at critical point or during a surgical procedure.

5. 2015 – 25398 – Allegation of member of staff assaulting a patient – Ongoing Police investigation

6. 2015- 27723 – Allegation of member of staff assaulting a patient – Ongoing Police investigation

7. 2015-27794 – Call Management concern regarding non allocation of response to patient with breathing difficulties – Investigation ongoing

8. 2015 – 28942 – Faulty equipment - Potentially to be downgraded as device fault only minimally affected the equipment efficacy and would not have resulted in a different outcome for the patient.

9. 2015-29172 – Injury to patient during peri arrest situation – considered for downgrade of SI status by Commissioners as lifesaving care required urgent movement of patient.

Learning identified so far includes individual training needs and review of the national triage system to determine if question sets could identify a rare condition.

5.1.3 Duty of Candour

The Trust takes seriously its obligation to be open and honest when things go wrong and as such has embedded the principles of Duty of Candour over a number of years. All harm whether minor injury or serious is investigated, patients or relatives are contacted immediately and the plan to investigate and rectify issues is discussed and agreed with the patient or relative. Patients and relatives are kept informed of progress and for serious harm concerns a Family Liaison Officer (FLO) is offered. The FLO acts as the central contact for the patient and is their advocate within the Trust making sure contact remains as agreed and that the patient or relative has all of their questions answered openly.

5.2. Ambulance Clinical and Quality Indicators

5.2.1 Cardiac Arrest Quality Indicator – Return of Spontaneous Circulation

The definition of ROSC that the ambulance crews use is “Signs of return of spontaneous circulation include breathing (more than an occasional gasp), coughing, or movement. For the healthcare personnel, signs of ROSC may also include evidence of a palpable pulse or measurable blood pressure. There are two elements that are reported for Cardiac Arrest ROSC at hospital:

1. Overall Group - Reporting the number of ROSCs achieved at hospital where:

Resuscitation has commenced in Cardiac Arrest patients.

2. Comparator Group - Report the number of ROSCs achieved at hospital where:

Resuscitation has commenced in Cardiac Arrest patients AND

The initial rhythm that is recorded is VF / VT i.e. the rhythm is shockable AND

The cardiac arrest has been witnessed by a bystander AND

The reason for the cardiac arrest is of cardiac origin i.e. it is not a drowning or trauma cause.

In this element we would expect a higher performance than the first group. This is due to the criteria indicating that the patient should have a better outcome.

During 2014-15 WMAS attempted resuscitation in 4,040 patients that had a pre-hospital cardiac arrest. 1,150 of these patients arrived at hospital with a ROSC; 223 more than in 2013-14.

WMAS YTD Staffordshire YTD National Mean

ROSC on Arrival 31.26% 31.58% 27.30%

ROSC Comparator 50.43% 69.23% 49.40% Performance shown above is from the August Scorecard Containing April - June 2015 Data.

5.2.2 STEMI Quality Indicator

STEMI stands for ST segment Elevation Myocardial Infarction. A STEMI is a type of heart attack where a coronary artery suddenly gets blocked by a blood clot, and as a result virtually all the heart muscle being supplied by the affected artery starts to die. The treatment for this type of heart attack is Primary Percutaneous Coronary Intervention. This is a non-surgical treatment where a device is inserted into the artery to clear the clot. This should be performed as soon as possible aiming to achieve at least 75% of cases within 150 minutes; WMAS must ensure the patient is rapidly transported to an appropriate centre to achieve this.

The key areas that the ambulance crews should provide to STEMI patients are:

Administer Aspirin – aspirin has an anti-platelet action that reduces clot formation.

Administer Glyceryl Trinitrate (GTN) – this results in the dilation of the coronary arteries and pain relief from coronary spasm.

Assess patient’s pain – this will enable the management of the patient’s pain for both humanitarian reasons and it may prevent patient deterioration.

Administer pain relief – the patient’s pain should be managed. The options for WMAS staff to manage pain are Morphine, Entonox or Paracetamol.

Eligible patients should be transported to a centre as quickly as possible in order to provide PPCI in 150 minutes.

WMAS YTD Staffordshire YTD National Mean

STEMI Care Bundle 70.54% 75.00% 80.20%

STEMI CTB* 77.42% * 86.80% Performance shown above is from the August Scorecard Containing April - June 2015 Data. * The national data source obtained from hospital information only provides a regional performance score

For 86.64% of patient’s that are eligible for PPCI these patients were transported to an appropriate centre within 150 minutes. This data is reliant on a hospital database therefore the data available is delayed.

5.2.3 Cardiac Arrest Quality Indicator – Survival to Discharge

A cardiac arrest happens when your heart stops pumping blood around your body. If someone has suddenly collapsed, is not breathing normally and is unresponsive, they are in cardiac arrest. Since April 2012 Ambulance Trust now measure whether the patient was discharged from hospital following a pre-hospital cardiac arrest. The two elements are reported mirror those for ROSC above;

Overall Group

Comparator Group

Between the 1st April 2014 and the 31st March 2015 of the 4040 patients that had a pre-hospital cardiac arrest 334 patients were discharged from hospital alive, this is 78 more patients that survived than for the 2013/14..

The last reported national figure for the Overall Survival figure was 8.50% and for the Comparator Group it was 26.00%.

WMAS YTD Staffordshire YTD National Mean

Survival to Discharge 10.11% 11.58% 8.50%

Survival to Discharge comparator

28.21% 38.46% 26.00%

Paper 9b

5.2.4 Stroke Quality Indicator

A stroke is a brain attack. It happens when the blood supply to part of your brain is cut off. It can be caused by a blockage in one of the blood vessels leading to the brain or a bleed in the brain. Blood carries essential nutrients and oxygen to your brain. Without blood your brain cells can be damaged or destroyed. It is essential that when an ambulance attends a patient with a suspected stroke the following is completed and documented.

Checks for facial or arm weaknesses or speech problems

Blood glucose and blood pressure measurement A patient is eligible for thrombolysis, and therefore should be taken to a Hyper-Acute Stroke Unit within 60 minutes, if they are:

1. FAST positive ie if they have face or arm weakness or their speech is slurred. 2. The Stroke has occurred within 5 hours of the incident. 3. IF their initial Blood Sugar is above 3. 4. They are conscious and are not fitting.

If the patient meets the above the ambulance crew will initiate the stroke thrombolysis care pathway and transport to the nearest Hyper-Acute Stroke Unit. During 2014-2015 there has been a re-configuration of Stroke services throughout the West Midlands. The performance shows that there has been a decrease in the number of stroke patients arriving at a Hyper-Acute within 60 minutes. The centralisation of Stroke services has been demonstrated to improve patient outcome, this does mean that patients will travel further in order to access these specialist centres and therefore the conveyance time to hospital will increase Performance shown above is from the August Scorecard Containing April - June 2015 Data. * The national data source obtained from hospital information only provides a regional performance score

WMAS YTD Staffordshire YTD National Mean

Stroke Care Bundle 96.15% 92.07% 97.10%

Stroke FAST+ Call to Door 35.29% * 59.70%

5.3. Ambulance Clinical Performance Indicators

5.3.1 Asthma Care Bundle Every ten seconds someone in the UK has a potentially life-threatening asthma attack and three people die every day (Asthma UK). The key areas for the ambulance clinicians to measure are as follows:

Measure the patient’s respiratory rate – this is recorded for a number of reasons. To acquire a baseline, monitor a patient with breathing problems, aid in diagnosis and severity of breathing problems and evaluate the response to medication that affects the respiratory system.

Measure the patient’s Peak Flow – this is a procedure in which air flowing out of the lungs is measured. This provides information about how open the airways are in the patient’s lungs. This will then show the severity of an asthma case and can also assist in the benchmarking against whether the patient has improved during treatment.

Measure the patient’s SpO2 - this is an estimation of the patient’s oxygen saturation measurement. Oxygen saturation is a term referring to the concentration of oxygen in the blood and so will help to show the severity of an asthma episode.

Administer Salbutamol – Salbutamol is administered to treat the patient’s asthma episode. Salbutamol is administered nebulised with oxygen and has a relaxant effect in the patient’s airway and so helps make the patient’s breathing easier.

Administer Oxygen - Oxygen therapy is the administration of oxygen at concentrations greater than that in ambient air, with the intent of treating or preventing the symptoms and manifestations of hypoxia. Administration of supplemental oxygen can relieve an abnormally low level of oxygen in the blood.

Performance for Asthma shown above is from the August Scorecard Containing April - June 2015 Data

5.3.2 Single Limb Fracture Care Bundle

Extremity fractures are commonly seen in pre hospital care. They demonstrate a wide variety of injury patterns which depend on the patient’s age, mechanism of injury, and pre-morbid pathology. The key areas for the ambulance clinicians to measure are as follows:

Measure the patient’s pain – the ambulance clinician should measure the patient’s pain both pre and post treatment to identify if pain management is effective.

Analgesia administered – this is to assess the proportion of eligible patients who receive pain relief prior to arrival at hospital. The analgesic options could be Entonox, Oral Codeine, IV Paracetamol, Oral Morphine or IV Morphine.

Immobilisation of limb recorded - The application of a splint is an essential aspect of the management of single limb fractures. The benefits of splintage include reducing pain, reducing blood loss, reducing pressure on skin, reducing pressure on

WMAS YTD Staffordshire YTD National Mean

Asthma Care Bundle 82.33% 82.78% 78.70%

adjacent neurovascular structures, reducing the risk of fat embolism, and reducing the risk of further damage.

Assessment of circulation distal to fracture site recorded - Ambulance clinicians should be prepared for the possibility of circulatory deterioration in patients with limb trauma. The assessment of circulatory function distal to the fracture site should be undertaken before the application of a splint and re-evaluated afterwards.

To improve the care bundle performance there needs to be improvement on the individual elements, the consistent areas that are underperforming are two pain scores recorded and immobilisation of the limb.

Articles regarding the content of the CPI and the areas that require improvement have been included in Trust publications. Work is being undertaken to ensure that all elements of the CPI are both easily inputted and reported upon.

Performance for Single Limb Fracture shown above is based on the last National CPI Submission - January 2015 Data.

5.3.3 Febrile Convulsions Care Bundle

A febrile convulsion is a seizure associated with fever occurring in a young child. Most occur between 6 months and 5 years of age, and onset is rare after 6 years of age. Fever is usually defined as having a temperature of more than 37.5°C. The key areas for the ambulance clinicians to measure are as follows:

Measure the patient’s Blood Glucose – this is to ensure the presence of hypoglycaemia is ruled out.

Measure the patient’s SPO2 - this enables the clinician to assess how much blood is in the patient’s blood and therefore how much oxygen to administer.

Administer an anticonvulsant if appropriate to the patient – if the patient has experienced repeated convulsion in close succession or one convulsion lasting over 5 minutes an anticonvulsant (such as Diazepam) should be administered.

Document if the patient has had any temperature management methods – this could be if the parent or carer of the child has removed layers of clothing prior to the ambulance crew arrival.

An appropriate discharge pathway should be completed - for example if this was the patient’s first fit it would be appropriate to transport to hospital, or if the patient has experienced these before it would be reasonable for the crew to contact the GP

Performance for Febrile Convulsions shown above is based on the last National CPI Submission – February 2015 Data.

WMAS YTD Staffordshire YTD National Mean

Single Limb Fracture Care Bundle 26.92% 25.00% 46.50%

WMAS YTD Staffordshire YTD National Mean

Febrile Convulsions Care Bundle 83.40% 64.29% 76.70%

5.4. Patient Experience

5.4.1 Complaints

From the 1 April 2015 to 30 September 2015 Staffordshire division received 25 formal complaints compared to 19 in 2014/15. The main reason for these complaints related to aspects of clinical care and treatment.

5.4.2 PALS

Staffordshire received 38 PALS contacts compared to 69 in 2014/15. The main reason being staff conduct 15, followed by lost property 9. This compares favourably with the same period in 2014/15 when the Trust received 23 concerns relating to staff conduct and 23 for lost property.

The Trust rigorously promotes learning from complaints and concerns that have been raised by members of the public in order that such incidents do not recur in the future.

Examples of Learning from Complaints and PALS during this period:

You said We did

Delay in the arrival of transport for patients leaving a hospice, resulting in the hospice cancelling and assigning to a taxi (A4938)

Hospice staff were trained in the Trust online booking system. Controllers within the Non-Emergency Operations Centre reminded to contact the hospice in the event of a problem.

A dialysis patient experiencing problems with transport.

Additional drivers employed and the journeys reorganised to improve the service.

A patient experiencing a heavy bleed advised to make his own way to hospital with family members

Following an investigation the case was referred to the NHS Pathways working group and new guidance will be issued within the next release

Lost property cases A reminder to all staff if they remove patient jewellery or assist patients in taking property to hospital that it is noted on the patient record.

5.4.3 Compliments

The Trust welcomes all feedback and is very proud that the people working for the Trust continue to receive many more compliments than complaints. During the first six months of the year the Trust received 642 written compliments and 85 of these were from patients receiving care and treatment in Staffordshire. During the same period last year the Trust received 582 compliments of which 74 were specific to Staffordshire.

5.4.4 Patient Surveys

In March 2015, 315 patients were surveyed across the region asking them about the care and treatment they received following a 999 call. 126 people returned a survey of which 15 lived in the Staffordshire area. Once the new electronic patient record is introduced it will allow the Patient Experience Team to do more targeted surveys across the Region.

Some key regional points:

67.4% of the respondents were the patients and therefore feedback is direct from the service user

70.6% of patients did not consider consulting an alternative provider prior to dialling 999.

The majority of patients were listened to carefully and reassured during the 999 call process.

The majority of the service users described the wait for the ambulance as very acceptable, acceptable and fairly acceptable

On scene – majority were asked their medical history, care was explained in an understandable way and they were involved in the decisions made about their care

The majority of patients were taken to hospital, and found the ambulance comfortable

They described the equipment and the ambulance interior as very acceptable

Ambulance crews were described as very professional in most cases and patients said felt like they were treated with dignity and respect

The majority of service users were very satisfied with the service received and would recommend to a friend or family member.

5.4.5 The Friends and Family Test (FFT) question:

The Trust piloted the FFT question from 1 October 2014 and fully implemented on 1 April 2015. The question is asked of:

999 Patients that receive an emergency response but are not conveyed to hospital

Patients that use the Non-Emergency Patient Transport

To date the responses are extremely low compared to the number of patients that received an ambulance or used Patient Transport with 56 responses received in total. No responses have been received yet from the Staffordshire area. The responses that 75% of the respondents were extremely likely/ likely to recommend the service to their friends and family. Six respondents stated they would be extremely unlikely to recommend the service. Where contact details were supplied the Patient Experience Team contacted these individuals to discuss further how improvements could be achieved,

5.4.5 Patient and Public Engagement –

The Trust recognises that people have a right to be actively involved in decisions that affect their lives and wellbeing. In order to understand people’s views the Trust has a number of strategies for engaging with its different stakeholders. The Trust has

A Membership and Engagement Strategy that explains how the Trust engages with its 9000 plus members and the people of the West Midlands.

A Quality Strategy that explains how the Trust ensures patient views are heard

A People Strategy detailing how the Trust engages with staff

Over the past year, community engagement activity undertaken by various parts of the Trust has focussed upon increasing awareness of West Midlands Ambulance Service as a Foundation Trust and on new opportunities for public involvement. The Trust actively engages with universities, schools, colleges, religious groups, communities and at public events and in order to enhance further engagement the Trust has recently introduced a Trust Mascot and Community Engagement Vehicle. Trust Mascot With sponsorship from Celesio UK the parent company of Lloyds Pharmacy PLC. The Trust ran a very successful competition amongst primary schools to ‘design a West Midlands Ambulance Service Mascot’

From the nearly 200 entries returned, the design of a local eight year old led to the creation of ‘Lloyd, the Paramedic Turtle’; Lloyd has proved hugely popular amongst local youngsters and adults alike. Now with his own Twitter page, Lloyd is play a leading role in targeted local campaigns particularly the promotion of developing lifesaving skills amongst young people.

Community Engagement Vehicle

The Trust recently acquired its first dedicated ‘Community Engagement Vehicle’ which will further enhance the public engagement carried out by the organisation. The vehicle is accessibility-friendly, has internal and external audio-visual capabilities and ample space to provide basic life support skills demonstrations and training to both children and adults. In Staffordshire the Trust Governors have introduced themselves and explained some of the engagement activities taking place in Staffordshire via a membership briefing attached as appendix 1.

6. FINANCIAL PERFORMANCE

The Trust’s Financial Plan submitted to Monitor in May 2015 identified the Trust needed to deliver a financial surplus of £0.4m in 2015/16 and that to do this the Trust needs to deliver a cost improvement programme making savings of £8.8m. Plans to achieve this are challenged by the difference between the activity agreed in the Trust’s Commissioning contract and the number of incidents actually attended. Activity is below expected levels in many areas of the Trust for the first time in many years.

At the end of August the Trust has had to repay Staffordshire commissioners £616K because activity against the 2015/16 contract has been considerably lower than would have been expected. Compared to the same period in 2014/15 patient activity is down by 7.63%. This is the first time in over 15 years that demand has dropped year to year. The Trust will break even by the year end.

7. WORKFORCE

7.1 Workforce Planning/Skill Mix

The Trust employs over c4300 staff and experienced a turnover rate of 4.3% for the period 1 April and 31 Aug 2015. This is consistent with the Trust predicted workforce planning. The Trust has recruited a large number of paramedics over the last five years to ensure a highly skilled workforce is able to provide first class care to the people of the West Midlands. The Trust aims to have a paramedic on every ambulance and rapid response vehicle.

7.2 Sickness Absence

The Trust is very proud of its Health and Well Being Strategy and its approach to sickness absence management which has resulted in a sickness absence rate of 3.44% for the period April to August 2015. This is the lowest the Trust or any other ambulance service has ever encountered and is one of the lowest rates for NHS organisations in the Region.

8. SERVICE IMPROVEMENTS AND INNOVATION

8.1 Electronic Patient Report (EPR) In recognition of the advancement in patient record keeping and the requirement to move them in a timely manner to benefit patient care, the Trust has begun the roll out programme of a new electronic patient record system. EPR will assist staff in obtaining concise data, provide an ability to take photographs at the incident that can be attached to the patient record, and also provides an ability to have a remote conversation with the clinician at a hospital or other medical establishment to gain specialist advice.

The programme was launched in Staffordshire on Tuesday 21 October 2015, and although this project is in its infancy, it is already obvious it will provide advantages to patient care going forward that the old paper system could not.