Agenda item

To receive an update from Mark Docherty, Director of Nursing, Quality and Clinical Commissioning at West Midlands Ambulance Service.

The Chair introduced Mark Docherty, Director of Nursing, Quality and Clinical Commissioning at West Midlands Ambulance Service (WMAS). He in turn introduced Pippa Wall, Head of Strategic Planning and presented an information pack to the committee covering the following areas:

·       Firmographics (background on WMAS)

·       The WMAS vision and strategic objectives

·       Coventry and Warwickshire activity (incidents) comparison 2019/20 and 2020/21, across each CCG area and for the trust as a whole

·       Performance data on response times for each of four categories, by CCG area and in total for WMAS

·       Call answering time data

·       Conveyance rates

·       Hospital handover trend data for each of the three hospital trusts, including handovers in excess of one hour, with a comparative slide for WMAS as a whole

·       Daily Covid test data

·       Examples of PPE and commentary on the initial problems with the quality of some PPE supplies

·       111 service activity

·       Winter initiatives

·       COVID (including staff increase)

·       Issues identified from the beginning of the Covid-19 pandemic

·       Continued changes in working practice

·       Financial implications

·       Staff health and wellbeing, including testing arrangements

·       Covid-19 second surge and winter flu

·       New ways of working

·       Vehicle data, including the first all electric emergency ambulance in the country

·       Saving more lives – public CPR training and defibrillators

·       Maternity developments

·       Quality account priorities for both 2020/21 and 2021/22

Questions and comments were invited, with responses provided as indicated:

• A question on the WMAS staff training arrangements. WMAS employed trainee paramedics, providing in-house training and also employed graduates. A four-year masters’ degree course would launch later this year, where the qualified students could then work either as a paramedic or in primary care.
• Chris Bain reported concerns about people delaying seeking NHS support due to covid fears and then presenting in worse health. A further concern was increases in patients with mental health illness. An audit had taken place using data on stroke and heart attack patients. In the early phases of covid, there was no such evidence. More recently and through other studies evidence showed people were delaying seeking medical help. On mental health, there was evidence of more people in crisis, suicide cases were increasing, as well as domestic violence and impacts for children too. There were many contributing factors for some people currently. Chris Bain agreed that a system response was needed.
• A comment that previously WM ambulances were directed to bypass GEH and go straight to University Hospitals Coventry and Warwickshire (UHCW). The instruction to WMAS staff was to go to the nearest appropriate hospital. Some district general hospitals may not have the same range of expertise for serious paediatric issues, stroke, heart attack or major trauma and WMAS accessed the most appropriate hospital in those cases. Speed of access and logistics also affected the decision on which hospital to transport the patient to. This was supported in the meeting chat by David Eltringham confirming that GEH did not take ambulance borne children, because there were no Paediatric in-patient facilities for them.
• Hospital handover issues and questions about the protocols in place. If speedier handovers took place, it would improve ambulance response times. There was a national group looking at this issue, which had been highlighted by covid. Ambulances were not designed to be static, having no heating, ventilation or toilets. This issue had been addressed positively by the hospitals serving Warwickshire. Where ambulances were delayed at hospitals, they could not respond to other calls and patients could suffer. This was an area of continuous effort by WMAS.
• A question on cross border issues and mutual aid arrangements from neighbouring areas. Mark Docherty outlined the hub model of service provision. Ambulances were only at the hub when they were being serviced and restocked.  They were located to meet service demand and could travel many miles during a shift. There were regular reviews of resource needs. He also spoke about mutual aid arrangements and generally the help from WMAS to others was more than that received from neighbouring services. There were additional challenges for rural areas in terms of where to locate crews between calls.
• A further aspect discussed was the helicopter support run by charities, but with close involvement from WMAS. This included the collaborative approach to providing clinical staff for some areas and advantages to them being independent. In the West Midlands there was access to five helicopters. It was noted that the pandemic had impacted on fundraising for the charities.

The Chair thanked Mark Docherty and Pippa Wall for the presentation, asking that thanks be passed to all the WMAS staff for the services being provided under difficult circumstances.

Resolved

That the Committee notes the presentation.