SOUTH WESTERN AMBULANCE SERVICE (NORTH AREA) JOINT … · SOUTH WESTERN AMBULANCE SERVICE (NORTH AREA) JOINT HEALTH OVERVIEW AND SCRUTINY COMMITTEE AGENDA Date & Time: Friday 11th

SOUTH WESTERN AMBULANCE SERVICE (NORTH AREA) JOINT

HEALTH OVERVIEW AND SCRUTINY COMMITTEE

AGENDA Date & Time: Friday 11th April 2014 at 11.00 am (Pre-meeting for Members and LA Officers only at 10.00 am) Venue: Wiltshire Council, Council Chamber, County Hall, Bythesea Rd, Trowbridge BA14 8JN Members of the Committee:

• Councillor Anthony Clarke, Bath & North East Somerset Council

(Chair) • Councillor Sharon Ball, Bath & North East Somerset Council • Vacant seat, Bath & North East Somerset Council • Councillor Lesley Alexander, Bristol City Council • Jenny Smith, Bristol City Council • Councillor Sylvia Townsend, Bristol City Council • Councillor Anne Kemp, North Somerset Council • Councillor Linda Knott, North Somerset Council • Councillor Nick Pennycott, North Somerset Council • Councillor Steve Lydon, Gloucestershire County Council • Councillor Colin Hay, Gloucestershire County Council • Councillor Roger Wilson, Gloucestershire County Council • Councillor Sarah Pomfret, South Gloucestershire Council • Councillor Sue Hope, South Gloucestershire Council

• Councillor Ian Scott, South Gloucestershire Council • Councillor Nicky Sewell, Swindon Borough Council • Councillor Mick Bray, Swindon Borough Council • Councillor Andrew Bennett, Swindon Borough Council • Councillor John Noeken, Wiltshire Council • Councillor Pip Ridout, Wiltshire Council

Contact Officers: Romayne de Fonseka, Bristol City Council, 0117 9222770, [email protected] or Norman Cornthwaite, Bristol City Council, 0117 9222390, [email protected] Web site addresses: Bath & North East Somerset Council - www.bathnes.gov.uk Bristol City Council – www.bristol.gov.uk Gloucestershire County Council – www.gloucestershire.gov.uk North Somerset Council – www.n-somerset.gov.uk South Gloucestershire Council -www.southglos.gov.uk Swindon Borough Council – www.swindon.gov.uk Wiltshire Council – www.wiltshire.gov.uk Access Arrangements Venues for these meetings will be provided by rotation by each council in turn and should always be wheelchair accessible. If you would wish to attend the meeting but have any special requirement to enable you to do so please contact the Scrutiny Officer for the council that is hosting the meeting as soon as possible prior to the date of the meeting. If you would like to receive any of the pages contained in this agenda in a larger print size, please contact your own council’s Scrutiny Officer. Public Question Time Up to 15 minutes will be allowed at the start of all Joint Committee meetings for questions to the Chair from members of the public about the work of the Committee. Questions must be relevant, clear and concise. Because of time constraints, Public Question Time is not an opportunity to make speeches or statements. Prior notice of a question to the Scrutiny Officers supporting the Joint Committee is desirable, particularly if detailed information is needed.

mailto:[email protected]

mailto:[email protected]

http://www.bathnes.gov.uk/

http://www.bristol-city.gov.uk/

http://www.gloucestershire.gov.uk/

http://www.southglos.gov.uk/

http://www.swindon.gov.uk/

http://www.wiltshire.gov.uk/

AGENDA

1. APOLOGIES FOR ABSENCE To receive and note any apologies from members of the Committee.

2. APPOINTMENT OF CO-OPTEES

To agree the appointment of co-optees to the Committee and to agree the role of co-opted members of the Committee.

3. DECLARATIONS OF INTEREST Members are reminded that at the start of the meeting they should declare any know interests in any matter, and also during the meeting if it becomes relevant.

4. PUBLIC QUESTION TIME See explanatory note above. Please contact the officers whose contact details appear at the top of this agenda should you need further guidance.

5. CHAIR’S UPDATE To receive any information from the Chair. There will not normally be any discussion on this item.

6. MINUTES OF THE MEETING HELD ON 31ST JANUARY 2014 To approve the minutes of the meeting for signature by the Chair.

7. MONTHLY PERFORMANCE INFORMATION COMPRISING A. Trust Activity and Performance B. National Ambulance Quality Indicators C. Hospital Handover Summary (SWAS) D. COMMISSIONERS COMMENTARY (Glos CCG) Simon Sethi, Deputy Director of Commissioning Implementation, Glos CCG For comment.

8. THE NHS 111 SYSTEM – UPDATE ON PROGRESS (Harmoni + NHS 111 Commissioners) Roshan Robati, Urgent Care Contract Performance Manager for BNSSG Patrick Mulcahy, Wiltshire CCG Simon Sethi, Deputy Director of Commissioning Implementation, Glos CCG Angie Hill, Lead Clinician, South West 111, Harmoni For comment.

9. PATIENT TRANSPORT SERVICE

(SWAS) For comment.

10. UPDATES FROM HOSCS (All) For discussion.

11. ANNUAL BUSINESS ARRANGEMENTS FOR 2014/15

To agree business arrangements for 2014/15.

12. ITEMS FOR WORK PROGRAMME AND DATE OF NEXT MEETING (verbal item) (All) To agree items for the Work Programme and the date of the next meeting.

13. URGENT BUSINESS

***PLEASE NOTE THAT LUNCH WILL NOT BE PROVIDED***

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Joint Health Overview & Scrutiny Committee Meeting 11 April 2014

Title: Performance report

Presented by: Neil Le Chevalier, Deputy Director of Service Delivery

Main aim: To update Joint HOSC members on activity and performance in the North Division

Recommendations: To note the contents of the report

1. Definitions 1.1 The Red1 category refers to those patients who are suffering an immediately life-

threatening emergency; cardiac arrest, respiratory arrest, choking. The standard for these calls is to arrive on scene within eight minutes, 75% of the time.

1.2 The Red2 category refers to those patients who are suffering a potentially life-threatening emergency; heart attack, severe breathing problems, serious bleeding. The standard for these calls is to arrive on scene within eight minutes, 75% of the time.

1.3 The Red19T standard requires the attendance of a vehicle that is suitable to convey

the patient, to arrive on scene within 19 minutes, 95% of the time.

2. Trust performance 2.1 A summary of the Trust’s performance, including details of performance across the

North Division, can be found in the attached performance report.

2.2 To date (1 April 2013 – 28 February 2014), the Trust has responded to 672,110 incidents across the South West.

2.3 The Trust is pleased to report performance above the national target levels for Red 1,

Red 2 and Red19T in February 2014.

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2.4 National targets for Red performance have been delivered for the second consecutive month. The Trust is now focused on the required actions to delivered sustained performance at and above the national performance targets for the remainder of 2013-14 leading into 2014-15.

2.5 Red 1 performance was above the national target of 75% in February 2014, but

remains below national target for the year to date. Further improvements are expected as result of the actions identified in the Red Performance Recovery Plan.

2.6 Based on data extracted from the Ambulance Clinical Quality Indicators for January

2014 the Trust delivered performance above the national targets for Red 1, Red 2 and A19 performance. Benchmarking data is only available for January 2014 and not for February 2014. Please see the separate report on national Ambulance Quality Indicators for more information.

2.7 Of concern is the number of handover delays and the associated time lost increased in

January and February 2014. Please see the hospital handover report for more detail about handover delays in the North Division.

2.8 The number and time lost to wrap up delays has reduced in 2013-14 compared to the

previous year, but further on-going improvement is expected. Wrap up is the time allocated to SWASFT to hand over a patient in an emergency department. A financial penalty is applied if wrap up exceeds 15 minutes.

3. Performance in the North Division

3.1 To date (1April2013-28February2014), the Trust has responded to 275,583 incidents across the North Division.

3.2 Of these incidents, 7,387 (or 2.68%) were classed as Red 1 calls. We attended these Red1 calls in 8 minutes 70% of the time. (The target is 75%.)

3.3 Of these incidents, a further 105,578 (or 38.31%) were classed as Red 2 calls. We

attended these Red2 calls in 8 minutes 72.3% of the time. (The target is 75%.)

3.4 Of these incidents, a further 112,844 (or 40.95%) were classed as Red 19 calls. We attended these Red19T calls in 19 minutes 94.9% of the time. (The target is 95%.)

3.5 For more details and a breakdown by CCG and District Council area, please see the

attached performance report.

3.6 The Trust is very focused on meeting the eight-minute response target and a range of initiatives have been put in place to help improve our performance in this area. These include the recruitment of Community First Responders (CFRs) and the roll out of public access defibrillators, as well as a number of internal schemes to make more

Page 3 of 5

staff available at peak times. For more information on CFRs and the roll out of defibrillators, please see the attached report.

3.7 Whilst we are seeing some improvements in our performance across the South West,

we are still finding it a challenge to meet response times in our more rural areas, including parts of Gloucestershire and Wiltshire. The attached document ‘Red1 and Red2 75th Percentile’ shows how long it takes for an ambulance resource to arrive at Red1 and Red2 calls 75% of the time. Also attached is a set of maps showing ‘hits’ and ‘misses’ for Avon, Gloucestershire and Wiltshire for January and February 2014. These maps illustrate how journey times to the wide geographical spread of incidents in rural areas, often exceeds eight minutes. A call to a patient in a rural part of the North Division can result in a two-hour round trip. It is also important to note that an ambulance resource remains on scene for an average of two hours, thus temporarily reducing the resources available on the road during the time a patient is being treated.

4. Activity in the North Division 4.1 Accident and Emergency (999) activity volumes for the month of February 2014 in

isolation were 3.45% above contract in the North Division, 3.31% below contract in the East Division and 0.85% below contract in the West Division. The table below shows the Year-to-Date position against the contract in the period 1 April 2013 to 28 February 2014.

4.2 The A&E contracts for the East/West divisions and the North Division were negotiated independently for 2013-14. The contract for the East/West Division is based on a currency of ‘activations’ (calls where a Trust resource is mobilised) and the North Division on ‘incidents with a response’ (all calls which result in a patient being treated through a treatment pathway: telephone advice only, treated at scene or treated at scene and then conveyed to a treatment centre).

Table 1: Actual versus contracted activity in the period 1 April 2013 to 28 February 2014

Actual Activity Apr 2013 – Feb

2014

Contracted Activity Apr 2013 – Feb

2014

5 Above contract

West Division A&E Activations

244,033

247,550

(1.42)%

East Division A&E Activations

191,699

194,384

(1.38)%

North Division A&E Incidents

275,583

266,514

3.40%

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4.3 Rates of activity increase across the Trust vary, with some CCG geographical areas experiencing significant year on year increases. Compared to last year, the following areas have all experienced significant activity increases:

Table 2: CCG geographical areas with relative high levels of A&E activity growth

A&E Activity Growth Apr 2013-Feb 2014 vs

Apr 2012-Feb 2013

A&E Activity (number of incidents)

Apr 2013-Feb 2014

Bristol +7.4% 58,118

North Somerset +6.8% 25,109

Gloucestershire +6.5% 70,633

South Gloucestershire

+5.1% 24,773

Wiltshire +4.6% 51,455

Swindon +1.9% 23,833

B&NES +2.0% 19,180

5. The impact of NHS111 on A&E (999) activity

5.1 Higher activity volumes during 2013-14 can be partially attributed to additional activity being received by the Trust from the new NHS111 service introduced on 19 February 2013 in the counties of Somerset, Dorset, Avon, Wiltshire and Gloucestershire. The NHS111 service was partially launched in the county of Devon on 3 September 2013 and partially launched in the county of Cornwall on 4 February 2014.

5.2 The NHS111 providers have responsibility for receiving and triaging calls previously managed by Out-of-Hours GP services.

5.3 Some of the emerging headlines since the launch of NHS111 are as follows:

The profile of activity is different to the profile of A&E activity demand, with activity surges being experienced at the weekend, particularly on Saturday mornings and early evenings during weekdays;

There are significant spikes in activity for calls transferred to the 999 service. 5.4 Please see the separate paper on NHS111 services in the North Division for more

details regarding activity.

5.5 The number of calls transferred from NHS111 to the ambulance service, their coding and appropriateness remains an issue for SWASFT, particularly since the majority of these transfers occur during periods of peak activity, such as weekends.

Page 5 of 5

5.6 On average, 15% of all 999 calls received by SWASFT in the North Division are NHS111 calls, although this figure increases at weekends to 25% on average and up to as much as 40% during peak hours.

5.7 In January 2014, 4159 calls were transferred from the NHS111 service in the North

Division (managed by Harmoni). 2,242 of these calls, or 53.91%, were transferred as category Red calls.

5.8 During the same period, 3527 calls were transferred from the NHS111 service in the

East and West Division. 1,260 of these calls, or 35.72%, were transferred as category Red calls.

5.9 The Trust is working closely with NHS111 providers and local NHS Commissioners to

manage and mitigate the impact on the ambulance service. This work includes the identification of incidents transferred which appear to be inappropriate for an ambulance/999 response and work to identify what action can be taken to manage the call volume peaks particularly at a weekend.

Page 1 of 15

Monthly activity and performance report The following pages provide information about activity and performance for response to incidents by the North Division of South Western Ambulance Service NHS Foundation Trust (the former Great Western Ambulance Service area). Information is provided to the end of February 2014, and was the latest available for submission with the agenda.

Page 2 of 15

Overall activity Total incidents with response

21000

22000

23000

24000

25000

26000

27000

Apr May June July Aug Sept Oct Nov Dec Jan Feb Mar

2013-14 actual

2013-14 contract

2012-13

Year-to-date totals %

2013-14 actual 275,583*

2013-14 contract 266,513

2012-13 actual 261,299

* +3.4% on 2013-14 contract, +5.5% on 2012-13

Conveyance rate (proportion of incidents resulting in patient being transported to hospital)

55

56

57

58

59

60

61

62


%

2013-14

2012-13

Year-to-date has seen 4,473 more patients being taken to hospital (2.8% higher) compared to 2012-13.

Page 3 of 15

The ability to manage more patients without taking them to hospital is one of the key performance measures for ambulance services – eg by treating over the phone or face-to-face (hear-and-treat, see-and-treat) or by onward referral to another healthcare provider. The above data includes all North division activity, including those calls from healthcare professionals or hospitals to request an ambulance to convey patients. Therefore, the following data excludes those calls (ie includes purely 999 calls from the public) – giving a more realistic picture of conveyance rates.

Incidents with response (excluding healthcare professional calls and hospital transfers)

16,500

17,500

18,500

19,500

20,500

21,500

22,500

23,500


2013-14

2012-13

Conveyance rate

49

50

51

52

53

54

55


%

2013-14

2012-13

Year-to-date has seen 12,272 more patients being taken to hospital (11.2% higher) than in 2012-13.

Page 4 of 15

Total incidents with response – by sector

0

2000

4000

6000

8000

10000

12000


Avon

Glos

Wiltshire

Total incidents with response – by CCG/Council

0

1000

2000

3000

4000

5000

6000

7000

8000


B&NES

Bristol

Glos

N Somerset

S Glos

Swindon

Wiltshire

Page 5 of 15

Red1 (8-minute response) activity/performance 2013-14 – by sector

Responses

100

150

200

250

300

350


Avon

Glos

Wilts

Year-to-date total North division number of Red1 calls responded to – 6,757 (inc 46 out of area)

Performance

60

62

64

66

68

70

72

74

76

78

80


%

North division

Avon

Glos

Wilts

Year-to-date Red1 (8-minute response) performance (target 75%)

North Division 70.0

Avon 71.1

Gloucestershire 69.4

Wiltshire 70.2

Page 6 of 15

Red1 (8-minute response) activity/performance 2013-14 – by CCG/Council Responses

0

20

40

60

80

100

120

140

160

180

200


B&NES

Bristol

Glos

N Somerset

S Glos

Swindon

Wiltshire

Performance

45

50

5560

65

70

75

80

8590

95

100

April May June July Aug Sept Oct Nov Dec Jan Feb Mar

%

Year-to-date Red1 (8-minute response) performance %

B&NES 70.8 Gloucestershire 69.4 South Gloucestershire 62.5 Wiltshire 59.0

Bristol 78.3 North Somerset 64.0 Swindon 88.7

Page 7 of 15

Gloucestershire is the only county in the SWASFT north division to retain a two-tier system of local government. The following data therefore shows Red1 (8-minute response) activity and performance broken down by district council areas in Gloucestershire.

Responses

0

5

10

15

20

25

30

35

40

45

50


Cheltenham

Cotswold

Forest of Dean

Gloucester

Stroud

Tewkesbury

Performance

20

30

40

50

60

70

80

90

100

110


%

Cheltenham

Cotswold

Forest of Dean

Gloucester

Stroud

Tewkesbury


Cheltenham 88.4 Forest of Dean 55.7 Stroud 55.8

Cotswold 45.6 Gloucester 87.5 Tewkesbury 56.7

Page 8 of 15

Red2 (8-minute response) activity/performance 2013-14 – by sector

Responses

1500

2000

2500

3000

3500

4000

4500

5000


Avon

Glos

Wilts

Year-to-date total North division number of Red2 calls responded to – 105,578 (inc 635 out of area)

Performance

65

67

69

71

73

75

77

79


%

North division

Avon

Glos

Wilts

Year-to-date Red2 (8-minute response) performance (target 75%)

North Division 72.3

Avon 72.6


Wiltshire 73.1

Page 9 of 15

Red2 (8-minute response) activity/performance 2013-14 – by CCG/Council Responses

0

500

1000

1500

2000

2500

3000


B&NES

Bristol

Glos

N Somerset

S Glos

Swindon

Wiltshire

Performance

50

55

60

65

70

75

80

85

90

95

100

April May June July Aug Sept Oct Nov Dec Jan Feb Mar

%

B&NES

Bristol

Glos

N Somerset

S Glos

Swindon

Wiltshire




Page 10 of 15

The following data shows Red2 (8-minute response) activity and performance broken down by district council areas in Gloucestershire.

Responses

0

100

200

300

400

500

600

700


Cheltenham

Cotswold

Forest of Dean

Gloucester

Stroud

Tewkesbury

Performance

40

50

60

70

80

90

100


%

Cheltenham

Cotswold

Forest of Dean

Gloucester

Stroud

Tewkesbury




Page 11 of 15

Red19T performance 2013-14 – by sector

90

92

94

96

98

100


%

North division

Avon

Glos

Wiltshire

Year-to-date Red19T performance (target 95%)

North Division 94.9

Avon 96.4


Wiltshire 93.7

Red 19T performance 2013-14 – by CCG/Council

88

90

92

94

96

98

100


%

B&NES

Bristol

Glos

N Somerset

S Glos

Swindon

Wiltshire

Year-to-date Red19T performance %



Page 12 of 15

Red 19T performance 2013-14 – by Glos District Councils

78

83

88

93

98


%

Cheltenham

Cotswold

Forest of Dean

Gloucester

Stroud

Tewkesbury




Page 13 of 15

Green activity/performance 2013-14 – by sector Responses

0

1000

2000

3000

4000

5000

6000

7000


Avon

Glos

Wiltshire

Year-to-date total North division number of Green calls responded to – 162,245 (inc 1,218 out of area) Performance

70

75

80

85

90

95

100


%

North division

Avon

Glos

Wiltshire

Year-to-date Green performance %

North Division 86.0

Avon 82.5


Wiltshire 88.3

Page 14 of 15

Green activity/performance 2013-14 – by CCG/Council Responses

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar

B&NES

Bristol

Glos

N Somerset

S Glos

Swindon

Wiltshire

Performance

70

75

80

85

90

95

100


B&NES

Bristol

Glos

N Somerset

S Glos

Swindon

Wiltshire

Year-to-date Green performance %



Page 15 of 15

The following data shows Green activity and performance broken down by district council areas in Gloucestershire.

Responses

0

200

400

600

800

1000

1200


Cheltenham

Cotswold

Forest of Dean

Gloucester

Stroud

Tewkesbury

Performance

75

85

95


%

Cheltenham

Cotswold

Forest of Dean

Gloucester

Stroud

Tewkesbury




Page 1 of 1

RED1 AND RED2 75TH PERCENTILE

How long it takes for an ambulance resource to arrive at Red1 and Red2 calls, 75% of the time

LOCAL AUTHORITY RED combined 75% percentile

(mm:ss) RED 1 75th percentile

(mm:ss) RED 2 75th percentile

(mm:ss)

Bath and North East Somerset 8.42 8.35 8.43

Bristol 7.9 7.73 7.9

Cheltenham 6.65 6.8 6.63

Cotswold 14.7 13.67 14.75

Forest of Dean 11.7 11.17 13.1

Gloucester 6.8 6.9 6.72

Kennet 15.1 14.17 15.12

North Somerset 10.4 9.52 10.12

North Wiltshire 11.6 10.43 11.63

Salisbury 9.42 10.38 9.33

South Gloucestershire 9.73 9.13 9.8

Stroud 10.8 7.52 10.85

Swindon 6.52 6.57 6.5

Tewkesbury 9.13 9.88 9.05

Unknown la 18.12 18.33 18.03

Vale of White Horse 12.67 8.6 12.75

West Wiltshire 9.18 9.28 9.17

South West Ambulance NHS Foundation Trust

North Division Red 1 hits and misses January and February 2014

The following maps show the hits (green) and misses (red) for RED1 calls in the North Division of SWASFT. The are displayed as follows: January 2014 • Avon • Gloucestershire • Wiltshire February 2014 • Avon • Gloucestershire • Wiltshire

Category A (Red 1) 8-

Minute Response Rate

Category A (Red 1) incidents (immediately life-threatening

conditions) should receive an emergency response within 8

minutes irrespective of location in 75% of cases.

For patients with immediately life-threatening condition,

faster response times may improve health outcomes and

the patient experience.

Avon January hits & misses

Glos January hits & misses

Wiltshire January hits & misses

Avon February hits & misses

Glos February hits & misses

Wiltshire February hits & misses

Page 1 of 2

SWASFT North Division – Community responders and defibrillators Within the North Division of SWASFT there are already a number of existing community responders. These include staff responders, fire service co-responders and community responders. All responders are trained to deliver care to patients in the critical first few minutes of a life-threatening emergency, which includes defibrillation, while the ambulance resource is en route. Early defibrillation saves lives, so in support of the community responder schemes, SWASFT is installing defibrillators and delivering training in key locations, including care homes, throughout Avon, Gloucestershire and Wiltshire. This is support by continual volunteer recruitment activity in each of the three areas. Below is a summary of the existing responder schemes which is followed by the defibrillator roll-out in Avon and Gloucestershire; the roll-out will begin in Wiltshire during April/May 2014.

Page 2 of 2

Community responders

NUMBER OF RESPONDERS AVON GLOUCESTERSHIRE WILTSHIRE NORTH

Community first responders 87 *82 36 123

St John Ambulance responders 0 *82 62 144

Static site responders 322 41 11 374

Fire co-responders 15 30 49 94

Clinical staff 6 N/A 13 19

Total number of responders 430 153 171 754

* St John Ambulance and South Western Ambulance Service NHS Foundation Trust work jointly to train and support Gloucestershire responders.

Page 1 of 5

Defibrillators Gloucestershire

Delivered:

M5 Michaelwood services

Christchurch Caravan Park and Camp Site,

Coleford

Main campus, Hartpury College

Equine stables, equestrian centre, Hartpury

College

Accommodation block, Hartpury College

Equine indoor arena, equestrian centre, Hartpury

College

Asda, Bruton Way, Gloucester

Cheltenham Racecourse

Gloucester Rugby Club, Kingsholm Road,

Gloucester

The Eastwood Park Woman’s Prison, Wotton-

under-Edge

Gloucester Quays Designer Outlet

Gloucester Railway Station Bruton Way,

Gloucester

Liquid Nightclub, Eastgate Street, Gloucester

The Milestone School, Longford Lane, Gloucester

Longlevens Rugby Club, Longford Lane,

Gloucester

Cheltenham Spa Railway Station, Queens Road,

Cheltenham

Cineworld, The Peel Centre, St Ann Way,

Gloucester

Clifton Road/Bristol Road, Gloucester

Iceland, The Oxebode, Gloucester

Hobbycraft, St Ann Way, Gloucester

Angel Chef, The Peel Centre, St Ann Way,

Gloucester

Pedalabikeaway, Cannop Valley, Gloucestershire

Puckrup Hotel, Puckrup, Tewkesbury

WTT Slimbridge, Bowditch, Slimbridge

Bentham Country Club, Gloucester

Tewkesbury Park Hotel Golf and Country Club,

Tewkesbury

Cotswold Farm Park, Bemborough Farm, Kineton

Vodka Revoltions, Clarence Parade, Cheltenham

Subtone, Promenade, Cheltenham

Badgeworth Village Hall

Shurdington

Witcombe

Temple Guiting Parish Council

Blakeney

Bredon Parish Council

Mickleton, Chipping Campden

Down Ampney

Being delivered from April/May 2014:

Fever, Regent Street, Cheltenham

Moo Moos Nightclub, Regent Street, Cheltenham

Tesco, Kings Meadow, Cirencester

Debenhams, The Oxebode, Gloucester

Tesco, St Oswald’s Road, Gloucester

Bar H2O, Eastgate Street, Gloucester

Waitrose, Honeybourne Way, Cheltenham

Broadway Golf Club, Willersley Hill, Broadway

Nauton Downs Golf Club, Nauton, Cheltenham

Page 2 of 5

Defibrillators Avon

Delivered:

High Street, Yatton

Badminton

Banwell Village

Bath Community Academy

Begbrook Primary Academy

Brislington School

Bristol Brunel Academy

Bristol City Ground X2

Bristol University

Broadlands Academy

Frome Vale Academy

Hans Price Academy

Hawkesbury Upton

Hutton

John Cabot Academy

Kings Oak Academy

Locking, Weston-super-Mare

Minerva Primary Academy

Oaktree Park, Locking

Oasis Academy

Pucklechurch

Puxton Park, Weston-super-Mare

Sainsbury’s, Whiteladies Rd, Clifton

Tesco, Brislington

Tesco, Eastville

The Beeches

Wallscourt Farm Academy


Asda, Bedminster, Bristol

Asda, Cribbs

Asda, Longwell Green

Asda, Whitchurch

South Western Ambulance Service

NHS Foundation Trust, Marybush

Lane, Bristol

Bristol Zoo, Clifton

Cabot Circus, Bristol

Cadbury Garden Centre,

Congresbury

Churchill Sports Centre, Winscombe

Clevedon Golf Club, Clevedon

Kilburn Street, Easton, Bristol

Airbus UK Ltd, Filton, Bristol

Galleries, Broadmead, Bristol

M5 Portbury services

Beaufort House, High St, Badminton

Nailsea Rugby Club

Parkway Railway Station, Stoke

Gifford

Beech Road, Kewstoke, Weston

Super Mare

SMB Automotive, Princes Street,

Bristol

Templemeads Railway Station,

Bristol

Flatholm, Weston-super-Mare

Royal Mail, Severn Beach

Old Mills, Paulton

Merlin Road, Cribbs Causeway

Security Services, Royal Fort Lodge,

Tyndall Ave, Bristol

Seafront Office, Marine Parade,

Weston-super-Mare

Grand Pier, Weston-super-Mare

Wild Place Project, Blackhorse Hill,

Easter Compton

Church Road, Yatton

Acton Turnville

AF&RS Stop and Shop

Aldwick Court Farm and Vineyard

Aldwick Teambuilding and Activities

Asda, Weston-super-Mare

Bedminster Down

Bristol Metropolitan Academy

Bristol Old Vic

Bristol Rugby Club, Almondsbury

Broadwalk Shopping Centre

Bromley Heath Primary School

Butcombe Brewery

Cadbury House X2

Charlton Mackrell

Chipping Sodbury

City Engineering

Colston Hall

Deanery House, Hambrook

Dings Crusaders, Lockleaze

Elm Park School, Winterbourne

Everything Enviromental

Folly Farm Centre

Fountain Timber Products

Frenchay local pub

Fulton Ltd

Gatepoint

Gemini Gymnastics

Integrity

John Lewis, Mall

JonMaggs Fitness

Jungle Chums Play Centre

Kerry Foods

Mcbraida

M&S, The Mall

Mendip Outdoor Pursuits

MJPatch Engineering

Nailsea Bowls Club

Portishead Town Council

Precision Profiles

QA Gordano Support

RTH Yate

Sainsbury’s, Winterstoke Rd, Ashton

Severnet

Smart Systems Ltd

Smart Aluminium Extrusions Ltd

St Brendan’s College

SunChemical

Tesco, Bradley Stoke

Tesco, Yate

The Ridings Academy

Village Hall, Frenchay

West Country Waterpark

Western Enviromental

WestoN- in-Gordano

Winford X3

Worlebury

Wrington

Page 3 of 5

Defibrillators Wiltshire

Delivered:

Westbury Railway Station

Emery Gate Shopping Centre


Southwick, Trowbridge

Catherine Wayte Primary School, Swindon

East Chisenbury/Endford

Northgate, Bath

Upavon Village

Laverstock and Ford PC

Highworth Community

Gurney Slade, Radstock

Wootton Bassett Secondary School

Further defibrillator sites (including care homes) are being identified and will be delivered from April/May 2014.

Page 4 of 5

Care homes Gloucestershire

Delivered:

Chaxhill Hall Residential Home, Chaxhill Hall, Chaxhill, Nr Westbury on Severn,

Gloucestershire

Cleeve Hill Nursing Home, Cleeve Hill, Cheltenham, Gloucestershire

Highboarder Lodge, Marsh Lane, Lenoard Stanley, Stonehouse, Gloucestershire

Lillian Faithfull Homes, Suffolk Square, Cheltenham

Northleach Court, High Street, Northleach, Cheltenham

Highfields Residential Home, Culver Street, Newent

Stinchcombe Manor Care Centre, Stinchcombe, Dursley

Ashchurch View Care Home, Ashchurch View, Ashchurch Road, Tewkesbury

Highborder Lodge Care Home, High Border Lodge, Marsh Lane, Leonard Stanley,

Stonehouse

Hunters Care Centre, Cherry Tree Lane, Cirencester

Summerfield Nursing Home, 23 Christchurch Road, Cheltenham

Elmgrove Nursing Home, 42 Somerford Road, Cirencester

Nazareth House, London Road, Charlton Kings, Cheltenham

St Faiths Nursing Home, Malvern Roa,d Cheltenham

Ashley House Nursing Home (Bupa), Ashley House, 118 Trafalgar Road, Cirencester

The Grange Care Centre, Eastington, Bristol Road, Eastington, Stonehouse

Dowty House, St Margaret’s Road, Cheltenham

Astley Care Centre, Lypiatt Lodge, Lypiatt Road, Cheltenham

Pine Tree Court Care Home, 7 Larchwood Drive, Tuffley, Gloucester

The Knoll Care Home, 335A Stroud Road, Tuffley, Gloucester

Faithfull House Residential Home, Faithfull House, Suffolk Square, Cheltenham

Amberwood Care Home, 58 Whittington Road, Cheltenham

Lilian Faithfull Homes, Northcroft House, Malvern Road, Cheltenham

Queensbridge House Residential Care Home, 63 Queens Road, Cheltenham

Astell Residential Home, Overton Park Road, Cheltenham, Gloucestershire

Church Court, Church Street, Stroud, Gloucestershire


Mill House Care Home, Sheep Street, Chipping Campden

Wickwar Nursing Home, Castle House, Sodbury Road, Wickwar, Wotton-under-Edge

Sedbury Park Nursing Home, Sedbury Park, Unnamed Road, Sedbury, Chepstow

Oak Tree Mews, Hospital Road, Moreton-in-Marsh

Redlands Acre Care Home, 35 Tewkesbury Road Longford Gloucester

The Hawthorns Residential Home, 33 Christchurch Road, Cheltenham

Bramble House Care Home, 98 Stroud Road, Gloucester

The Court, Culverhay, Wootton-under-Edge, Gloucestershire

Breadstone House, Breadstone, Gloucestershire

Broadleas, 9 Eldorado Road, Cheltenham

Penwood Lodge, Wotton Road, Kingswood, Wotton-under-Edge, Gloucestershire

The Elms, Staunton, Coleford

Page 5 of 5

Care homes Avon

Delivered:

The Willows Rest Home, Weston-super-Mare

Yatton Hall Rest Home, Yatton

Kenver House Rest Home, Kingswood

Kingfisher Lodge, Care Home, Saltford

Edgemont House, Care Home, Oldland Common

Horfield Lodge Care Home, Bristol

Kingsmead Lodge Care Home, Shirehampton, Bristol

Bishopsmead Lodge Care Home, Bishopsworth

Hartcliffe Care Home, Hartcliffe


Maesknoll Care Home, Whitchurch

Page 1 of 9

Ambulance Quality Indicator data Since April 2011, ambulance services have been measured on a range of clinical and process quality indicators, providing a more realistic picture of their performance beyond solely speed of response. The following tables show how all ambulance services are performing against these indicators. The first table, for process indicators, is for January 2014, the latest data available. The second table, for clinical indicators, covers the 2013-14 financial year to October 2013 – again, the latest data available given that reporting times for some indicators are longer as they involve patient outcomes. Following both tables are explanations of what each indicator is measuring.

Page 2 of 9

Ambulance Quality Indicator data – Process Indicator data, January 2014

Quality Indicator

Units East Midlands

East of England

Isle of Wight

London North East

North West

South Central

South East

Coast

South Western

West Midlands

Yorkshire All

Time to answer

- 50% - 95% - 99%

mm:ss

mm:ss

mm:ss

0:02

0:04

0:34

0:01

0:04

0:55

0:01

0:01

0:09

0:00

0:02

0:07

0:01

0:41

0:41

0:01

0:04

0:24

0:03

0:07

0:39

0:03

0:05

0:34

0:02

0:10

0:39

0:01

0:01

0:38

0:01

0:20

0:39

n/a

n/a

n/a

Abandoned calls

% 0.16 0.56 0.95 0.04 3.10 1.8 0.15 4.91 0.34 0.57 0.51 1.01

Cat A8

- Red 1 - Red 2

%

%

72.5

71.6

72.9

71.7

79.4

76.0

78.9

80.3

77.0

77.7

77.1

78.2

77.0

76.7

80.4

75.4

76.0

78.7

80.5

73.6

76.4

76.1

76.4

76.3

Cat A19 % 94.6 93.7 95.6 98.3 96.3 95.8 95.1 97.5 96.0 96.9 97.6 96.4

Time to treat

- 50% - 95% - 99%

mm:ss

mm:ss

mm:ss

6:19

19:24

31:57

6:19

20:06

32:35

5:01

16:28

22:20

5:36

13:36

21:48

6:06

18:30

29:42

5:22

15:12

35:14

5:54

18:48

34:09

5:34

17:00

25:32

5:30

17:18

28:36

6:09

16:25

25:53

5:27

13:31

20:10

n/a

n/a

n/a

Frequent caller % 0.07 0.13 0.95 2.02 0.00 0.00 3.08 0.00 0.00 0.00 2.37 0.76

Resolved by phone

% 4.2 8.0 13.8 7.5 4.3 2.1 4.3 11.6 6.0 5.9 3.6 5.9

Re-contact 24hrs phone

% 10.6 10.3 0.9 2.2 15.8 7.5 20.0 11.0 13.1 12.7 0.2 9.0

Non-A&E % 32.4 42.8 45.6 31.7 30.6 25.2 41.9 42.8 51.0 37.4 29.2 35.7

Re-contact 24hrs on-scene

% 6.4 5.6 1.6 7.1 5.0 5.9 7.1 4.4 5.6 5.1 4.7 5.7

Page 3 of 9

Ambulance Clinical Quality Indicators – Clinical Indicator data, 2013-14 (to October 2013)

Clinical Quality

Indicator

Units East Midlands

East of England

Isle of Wight

London North East

North West

South Central

South East

Coast

South Western

West Midlands

Yorkshire All

STEMI care % 76.0 84.6 76.0 76.7 84.5 86.4 66.0 79.9 89.3 74.9 84.8 80.5

STEMI 150 % 94.0 90.0 73.3 92.8 90.5 90.4 89.3 93.5 82.5 88.9 88.3 89.8

Stroke care % 97.3 95.7 97.4 94.5 98.0 99.3 98.2 91.5 97.2 94.1 97.8 96.3

Stroke 60 % 62.7 52.5 61.2 67.4 74.8 77.8 43.7 65.1 54.9 59.7 65.4 63.6

ROSC % 18.0 21.3 16.0 30.9 26.3 28.3 39.8 31.7 24.3 22.5 22.6 26.0

ROSC Utstein % 36.8 39.6 46.7 58.6 60.7 46.5 43.9 51.9 45.7 39.0 45.8 47.0

Cardiac STD % 6.3 6.5 5.3 9.5 7.9 9.0 20.6 8.1 9.9 7.8 10.8 9.1

Cardiac STD Utstein

% 23.9 21.3 20.0 29.7 33.3 24.7 31.9 22.3 28.2 23.6 31.2 26.7

Page 4 of 9

National Ambulance Clinical Quality Indicators

Process Indicators

Indicator Description What does this mean?

Call Answering Average time (in seconds) to answer 999 calls presented to the Trust switchboard.

The time till a call is answered represents a period of clinical risk to the patient prior to assessment from trained ambulance service staff. Many adverse events are related to initial delays in care and many emergency conditions are time sensitive. Reducing delays in treatment can improve health outcomes and the patient experience.

Call Abandonment Rate The percentage of emergency calls presented to the Trust switchboard that are abandoned before being answered.

Call abandonment rate is a marker of patient experience. A high call abandoned rate may not indicate safe practice and could reflect a high level of clinical risk for patients.

Category A (Red 1) 8-Minute Response Rate

Category A (Red 1) incidents (immediately life-threatening conditions) should receive an emergency response within 8 minutes irrespective of location in 75% of cases.

For patients with immediately life-threatening condition, faster response times may improve health outcomes and the patient experience.

Category A (Red 2) 8 Minute Response Time

Category A (Red 2) incidents (may be life-threatening conditions but less time-critical) incidents should receive an emergency response within 8 minutes irrespective of location in 75% of cases.

For patients with immediately life-threatening conditions, faster response times may improve health outcomes and the patient experience.

Category A 19 Minute Transportation Time

Category A (immediately life-threatening) incidents should receive an ambulance response at scene within 19 minutes irrespective of location in 95% of cases.

Ability to transport patients with immediately life-threatening conditions in a clinically safe manner may improve their health outcomes and patient experience.

Page 5 of 9

Time to Treatment Average time (in minutes) for a qualified health professional dispatched by the ambulance service to arrive at the scene of a Category A call.

The period of time before a patient is seen by a health professional represents a period of clinical risk and anxiety for the patient. By encouraging earlier definitive care and reducing delays in treatment this indicator will improve the health outcomes and patient experience for all patients with life-threatening conditions.

Calls Closed with Telephone Advice

Number and percentage of calls that are appropriately managed through telephone advice without the need for an ambulance resource arriving on scene.

Providing clinically appropriate pre-hospital care through clinical telephone advice may result in better outcomes for patients and a more efficient use of ambulance resources. This can include advice from Nurses within our Clinical Hubs and advice about other NHS facilities the patient could attend themselves (Minor Injury Units etc).

Re-Contact Rate Following Discharge of Care by Telephone Advice

Volume and percentage of calls where the initial call was resolved through telephone advice only, which then result in a further emergency call to the Trust within 24 hours.

Patients may re-contact the ambulance service because their condition has worsened. However in some cases there may be further contact due to an incorrect initial telephone diagnosis or poor explanation by clinical staff. Unplanned re-contact is a marker of the accuracy of the initial telephone assessment in identifying the needs of the patient and those requiring an escalation of care or who may be likely to experience deterioration. It should be noted that this Indicator also includes Frequent Callers who call the Trust many times a month because of mental health issues or clinical conditions they are unable to manage.

Calls Closed without the need for Transport to A&E (Emergency Department)

Number and percentage of calls that are appropriately managed without the need for and ambulance response at scene, or onward transport to major A&E departments.

Providing effective pre-hospital care allows for better care for the patient; such as care being delivered closer to home. A reduction in avoidable emergency patient journeys and admissions to hospitals whilst responding to and conveying those patients who would not be suitable for treatment at the scene or through clinical telephone advice.

Page 6 of 9

Re-Contact Rate Following Discharge of Care from Treatment at the Scene

Volume and percentage of calls where the initial call was resolved through treatment by a clinician on scene, which then result in a further emergency call to the Trust within 24 hours.

Ambulance staff will always use the most appropriate treatment pathways based on their clinical assessment of the patient on scene. However patients may re-contact the ambulance service because their condition has worsened or they have received a poor explanation of their condition by the staff who attended them on scene. It should be noted that this Indicator also includes Frequent Callers who call the Trust many times a month because of mental health issues or clinical conditions they are unable to manage.

Page 7 of 9

National Ambulance Clinical Quality Indicators

Clinical Indicators

Indicator Description What does this mean?

Outcome from Acute ST-Elevation Myocardial Infarction (STEMI) (Care Bundle)

Number and percentage of patients suffering a STEMI (type of heart attack) who receive an appropriate care bundle.

Early access to reperfusion (timely thrombolysis and primary angioplasty and/or delivery of the appropriate care bundle) and all components of assessment and care interventions are associated with reductions in STEMI mortality and morbidity. This is evidenced in both NSF and CHD and National Infarct Angioplasty Project Gateway 9116 (2008) and Mending Hearts and Brains (2006).

Outcome from Acute ST-Elevation Myocardial Infarction (STEMI) (Thrombolysis)

Number and percentage of patients suffering a STEMI (type of heart attack) receiving Thrombolysis within 60 minutes of the call.

Outcome from Acute ST-Elevation Myocardial Infarction (STEMI) (PPCI)

Number and percentage of patients suffering a STEMI (type of heart attack) receiving a Primary Percutaneous Coronary Intervention (PPCI), also known as primary angioplasty, within 150 minutes of the call.

Outcome from Stroke for Ambulance Patients (Care Bundle)

Number and percentage of suspected stroke patients assessed face to face who received an appropriate care bundle.

Patients should be arriving at the hyperacute stroke centre as soon as possible so they can be rapidly assessed for thrombolysis, delivered following a CT scan in a short but safe time frame. This has been demonstrated to reduce mortality and improve patient recovery. Eligibility criteria, particularly in relation to the

Outcome from Stroke for Ambulance Patients (FAST)

Number and percentage of patients who were assessed face to face and provided a FAST (Face, Arms, Speech, Time to Call 999) positive response and were potentially eligible for stroke thrombolysis who were taken to a

Page 8 of 9

hyperacute stroke centre within 60 minutes of the call. therapeutic time window, will vary between local services, depending on the availability of local expertise e.g. intra-arterial clot lysis. This indicator supports the NICE national quality standard that indicates this is an effective measure of the ambulance service’s contribution to the stroke pathway.

Outcome from Cardiac Arrest – Return of Spontaneous Circulation (Overall)

Number and percentage of resuscitated cardiac arrest patients that had a Return of Spontaneous Circulation (ROSC) at the point of handover of clinical care of the patient to the hospital.

The aim of this indicator is to reduce the proportion of patients who die from out of hospital cardiac arrest. It reviews patients who were in cardiac arrest but, following resuscitation, have a pulse on arrival at hospital. Improvement in ROSC rates informs the effectiveness of pre-hospital response and intervention. The ROSC is calculated for two patient groups:

The overall rate measures the overall effectiveness of the pre-hospital response and intervention for all out of hospital cardiac arrest patients;

The rate for the Utstein comparator group applies to a sub-set of all cardiac arrest patients and provides a more comparable measure of management of cardiac arrest for patients where timely and effective clinical care can particularly improve survival.

Outcome from Cardiac Arrest – Return of Spontaneous Circulation (Utstein)

Number and percentage of resuscitated cardiac arrest patients that had a ROSC at the point of handover of clinical care of the patient to the hospital where the arrest was witnessed and the initial rhythm was VF or VT.

Outcome from Cardiac Arrest – Survival to Discharge (Overall)

Number and percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced/continued by the ambulance service following an out-of-hospital cardiac arrest.

Survival to discharge is where a patient is able to be discharged from hospital and continue recovery after a cardiac arrest. The indicator measures the effectiveness of the

Page 9 of 9

Outcome from Cardiac Arrest – Survival to Discharge (Utstein)

Number and percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced/continued by the ambulance service following an out-of-hospital cardiac arrest of presumed cardiac origin, where the arrest was bystander or emergency medical service witnessed and the initial rhythm was VF or VT.

whole urgent and emergency care system in managing out of hospital cardiac arrest. Survival to discharge is calculated for two patient groups:

The overall survival rate measures the overall effectiveness of the urgent and emergency care system in managing care for all out of hospital cardiac arrest patients.

The Utstein survival rate applies to a sub-set of all cardiac arrest patients and provides a more comparable measure of management of cardiac arrest for patients where timely and effective clinical care can be particularly improve survival.

Page 1 of 10

Hospital handover information April 2013 – February 2014

Page 2 of 11

Hours lost summary – 1 April 2013 – 28 February 2014

Handover band

Bristol Royal

Infirmary

Cheltenham General Hospital

Frenchay Hospital

Gloucester Royal

Hospital

Great Western Hospital

Royal United

Hospital

Salisbury District Hospital

Weston General Hospital

Total

30:01-60:00 189.3 50.6 345.08 120.87 87.5 7.39 5.74 93.82 900.3

1-2 hours 386.37 41.02 527.57 100.31 84.95 13.81 2.91 214.4 1371.34

2-3 hours 186.64 3.62 130.42 10.09 20.81 5.36 0 127.28 484.22

>3 hours 114.73 0 94.76 3.71 16.92 5.15 0 109.35 344.62

Total 877.04 95.24 1097.83 234.98 210.18 31.71 8.65 544.85 3100.48

NB: Lost hours are only calculated for handovers exceeding 30 minutes.

Page 3 of 11

Handovers >15 minutes – summary

Month BRISTOL ROYAL

INFIRMARY

CHELTENHAM GENERAL HOSPITAL

FRENCHAY HOSPITAL

GLOUCESTER ROYAL

HOSPITAL

GREAT WESTERN HOSPITAL

ROYAL UNITED

HOSPITAL

SALISBURY DISTRICT HOSPITAL

WESTON GENERAL HOSPITAL

Grand Total

April 2013 547 226 928 335 430 225 70 303 3064

May 2013 359 159 580 319 288 114 28 188 2035

June 2013 327 118 626 255 187 151 40 158 1862

July 2013 373 179 643 301 166 144 43 205 2054

August 2013 277 170 678 281 261 142 51 189 2049

September 2013 252 135 709 307 311 155 43 169 2081

October 2013 362 117 814 369 361 133 38 219 2413

November 2013 316 154 875 367 359 173 50 193 2487

December 2013 452 166 869 351 454 169 38 220 2719

January 2014 389 171 928 377 344 166 62 166 2603

February 2014 500 178 994 369 433 133 58 194 2859

Page 4 of 11

0

200

400

600

800

1000

1200

HOSPITAL HANDOVERS ABOVE 15 MINUTES

BRISTOL ROYAL INFIRMARY


FRENCHAY HOSPITAL

GLOUCESTER ROYAL HOSPITAL


ROYAL UNITED HOSPITAL


WESTON GENERAL HOSPITAL

Page 5 of 11

0

100

200

300

400

500

600

April 2013 May 2013 June 2013 July 2013 August2013

September2013

October2013

November2013

December2013

January2014

February2014

BRI HOSPITAL HANDOVERS ABOVE 15 MINUTES

BRISTOL ROYAL INFIRMARY

Page 6 of 11

0

50

100

150

200

250


September2013

October2013

November2013

December2013

January2014

February2014

CHELTENHAM HOSPITAL HANDOVERS ABOVE 15 MINUTES


Page 7 of 11

0

200

400

600

800

1000

1200


September2013

October2013

November2013

December2013

January2014

February2014

FRENCHAY HOSPITAL HANDOVERS ABOVE 15 MINUTES

FRENCHAY HOSPITAL

Page 8 of 11

0

50

100

150

200

250

300

350

400


September2013

October2013

November2013

December2013

January2014

February2014

GLOUCESTER HOSPITAL HANDOVERS ABOVE 15 MINUTES

GLOUCESTER ROYAL HOSPITAL

Page 9 of 11

0

50

100

150

200

250

300

350

400

450

500


September2013

October2013

November2013

December2013

January2014

February2014

GWH HANDOVERS ABOVE 15 MINUTES


Page 10 of 11

0

50

100

150

200

250


September2013

October2013

November2013

December2013

January2014

February2014

RUH BATH HANDOVERS ABOVE 15 MINUTES

ROYAL UNITED HOSPITAL

Page 11 of 11

0

10

20

30

40

50

60

70

80


September2013

October2013

November2013

December2013

January2014

February2014

SALISBURY HOSPITAL HANDOVERS ABOVE 15 MINUTES


1

Joint Health Overview and Scrutiny Committee Meeting

CCG Briefing on Ambulance Performance

Document History

Issue No. Date Author Change (s)

1 01/04/14 S. Sethi Initial version

Agenda Item No. 7 D

2

1. Introduction

This report provides a commissioner briefing on current SWAST performance in the North Division and is intended to support the detailed overview in the SWAST commentary. This report includes:

- A summary position of performance in the North Division

- A summary of the key issues around performance and what is being done about them

- Key investments made in services to support performance delivery

- How the CCG, SWAST and other healthcare providers will work together next year to rectify the issues experienced in 2013/14

2. Current performance in the North Division

As can be seen from the chart opposite, growth in the north division in 13/14 remains similar to 12/13 at approximately 5%. It is recognised that the North Division Contract levels were set too low and so any use of variance against contract is not a useful means of understanding variation.

The key insight from growth in 13/14 are that whilst East/West Division growth has historically been higher than the North, it is significantly lower this year at 2% down from 7% last year. Commissioners from East/West and North Divisions are therefore working with SWAST on applying lessons from East/West in the North.

In Quarter 4, SWAST actions to recover performance have had a significant impact and the Trust is on target to achieve its quarter 4 target of 75%. This is a significant achievement requiring extensive service drive to deliver.

It is important to recognise that contractually, SWAST is only required to deliver performance at Trust level and not at regional or county level. However, as can be noted from the chart opposite, there is a performance differential between Divisional (and CCG level) Performance against the Red 8 target. SWAST are therefore working with commissioners in the North to recover performance in this area. Section 3 below outlines more detail about the

causes of this performance challenge and actions underway to improve it.

3

The charts opposite show 111 performance by area for England, Harmoni (the three areas including B&NES, Wiltshire, Bristol, North Somerset and South Gloucestershire), and SWAST (Dorset, Somerset, Cornwall and Devon). The top chart shows the percent of calls resulting in ambulance dispatch with the bottom one showing those leading to an A&E attendance.

Currently Harmoni perform in the mid-range of national providers when benchmarked as can be seen opposite. Generally Harmoni dispatch a similar proportion of calls to ambulances as the SWAST 111 service, but a significantly higher proportion to A&E. Given that the SWAST service has a lower rate of dispatch to A&E and red calls, joint workshops are being held to ensure best practice is shared.

Harmoni currently deliver within the 10% target for ambulance dispatch although day by day performance fluctuates as can be

seen opposite. There is a need to reduce this rate further to reduce pressure on the ambulance service.

SWAST Harmoni

SWAST Harmoni

4

3. Key performance issues and actions to improve

The issues behind performance challenges for ambulance services in the North Division are complex, the table below summarises the key three key groups of issues and the actions being taken for each.

Performance issue Action to improve

Increasing demand – historically there has been growth of approximately 5% across the South West. This increasing demand is unsustainable and work is urgently needed to control this in the future.

- 111 is recognised as a key area for improvement particularly to reduce dispatch rates. Regional workshops have been held with SWAST and 111 to identify areas for improvement. This has led to two key pilots outlined below. These pilot outcomes are being reviewed in March to decide whether to expand them.

o SWAST pilot of triaging non urgent ambulance requests identified a significant number of patients that did not need an ambulance

o 111 pilot of providing additional clinical nurse input into calls significantly reduced ambulance dispositions for those calls

- Right Care 2 is a lesson taken from East/West Division where a contractual agreement was made for several years that included a joint commitment to reduce conveyances through a number of schemes including those outlined below. This includes a significant investment from commissioners to introduce new services which will be customised for each County. Schemes include:

o GP support to the clinical hub to triage calls

o Expansion of the clinical support desk

o Increased paramedic assessment skills

Impact of organisational change – it is recognised that the scale of change required in merging SWAST and GWAS will pose challenges in ensuring continuity of performance and this was recognised at the point of merger.

- SWAST have created and are actively leading a comprehensive action plan tackling key areas of challenge particularly around staff retention, performance management and organisational change.

- Vacancy rates are being strongly managed in the North Division with vacancy rates reducing and substantive managers being moved into key roles.

Rurality - the SWAST area is highly rural compared to other ambulance services which creates challenges particularly in meeting the 8 minute target.

- An additional £0.5m of defibrillators have been purchased for use across rural areas across the patch to increase community responders to 8 minute calls. This will improve response times and ensure patients are more likely to receive very quick support for Red calls.

- SWAST have commissioned and responded to an external review of vehicle placement to ensure that vehicles are placed in the best locations to respond to patients across the region

- SWAST have recruited additional crews to improve capacity in areas of high demand particularly at peak times.

5

4. Investments made to support SWAST delivery

To support delivery of ambulance targets, specific investment was made by commissioners as part of the national investment fund to support winter this year that was funded by NHS England. The schemes funded were prioritised on the level of impact they would have both on performance and quality of care. These schemes are outlined in the table below.

Scheme Value

Additional 11 agency paramedic staff on weekends and nights and additional 20 paramedic shifts at weekends and evenings

£128,000

Additional 8 call takers to deal with peaks in call volumes £190,000

Incident Co-ordination Centre to support areas dealing with flooding or particular pressures

£29,800

9 vehicles converted to respond to Red calls

Pool cars converted to be able to respond to Red calls

£483,200

Total £831,000

5. Community-wide plans to improve performance next year

SWAST performance remains a key area of focus in 14/15 and beyond, and commissioners continue to work productively with SWAST to take forwards actions to control demand, and improve performance. The key changes going forward into 14/15 are:

- A joint SWAST and commissioner commitment to local trajectories for performance improvement and their underpinning actions by County which will be informed by the current position and the improvements possible given the local geography and demand.

- A local focus on reducing demand including local trajectories for demand reduction and plans drawn up by each CCG with their local SWAST manager. These plans are supported by significant investment to ensure services can be developed.

- Significant investment in funding the growth in activity and committing to funding increases over the next two years to provide financial stability to SWAST in recruiting and finding innovative ways to meet demand

.This page is left intentionally blank

Page 1 of 2


Title: Report on NHS111 in Avon, Gloucestershire and Wiltshire


Main aim: To update Joint HOSC members on NHS111 activity


NHS111 Avon, Gloucestershire and Wiltshire

The NHS 111 service in Avon, Gloucestershire and Wiltshire is provided by Harmoni. This area is referred to as the north division of South Western Ambulance Service NHS Foundation Trust (SWASFT). SWASFT is working closely with Harmoni to ensure that collaborative working supports a high-quality service for patients, particularly those patients transferred from NHS111 to the Trust.

When Harmoni first launched the NHS111 service in the north division of SWASFT, call volumes and call transfers to the ambulance service were higher than expected. SWASFT worked with Harmoni to assist in the management of these calls and to reduce the number of calls transferred by providing a clinical supervisor in the NHS111 call centre.

Table 1: Percentage of red calls transferred from NHS 111 in January 2014

Location Total number of calls transferred

from NHS111

Total number of red calls transferred

from NHS111

Percentage of red calls transferred

from NHS111

North Division 4,159 2,242 53.91%

East Division 2,377 872 36.68%

West Division 1,150 388 33.74%

Page 2 of 2

The number of calls transferred from NHS111 to the ambulance service, their coding and appropriateness remains an issue for SWASFT, particularly since the majority of these transfers occur during periods of peak activity, such as weekends. On average, 15% of all 999 calls received by SWASFT in the North Division are NHS 111 calls, although this figure increases at weekends to 25% on average and up to as much as 40% during peak hours.

The Trust attended a very useful meeting with Harmoni, hosted by Gloucestershire clinical commissioning group (CCG), regarding NHS111 in SWASFT’s North Division. All parties are working together to review and agree arrangements for call triage and call transfers.

Ken Wenman, Chief Executive of SWASFT, met with Edmond Yarn, Managing Director of Harmoni, on Monday 24 March 2014 to discuss the above issues.

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SWASFT north division monthly NHS111 activity – April 2013-February 2014

All incidents

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

April May June July August September October November December January February

Total incidents

Not conveyed

Page 2 of 7

Red

0

500

1000

1500

2000

2500


Total incidents

Not conveyed

Page 3 of 7

Green

0

500

1000

1500

2000

2500

3000


Total incidents

Not conveyed

Page 4 of 7

Average Calls from NHS 111 Providers by day of the week for February 2014

North East West

Total A&E Calls

Calls passed

from 111

111%

Total A&E Calls

Calls passed

from 111

111%

Total A&E Calls

Calls passed

from 111

111%

Monday 806 117 14.51% 503 60 11.97% 651 48 7.41%

Tuesday 869 128 14.67% 529 80 15.04% 712 43 5.97%

Wednesday 845 123 14.56% 538 62 11.44% 707 51 7.22%

Thursday 895 129 14.36% 560 59 10.45% 697 52 7.43%

Friday 893 107 11.96% 580 69 11.82% 737 50 6.75%

Saturday 1012 253 24.97% 581 107 18.47% 747 79 10.58%

Sunday 1004 261 26.01% 612 118 19.22% 769 85 11.00%

Please note the colour-coding is for internal reporting purposes only.

Green = <10%

Amber = 10-20%

Red = 20-30%

Purple = >30%

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Average Red Calls from NHS 111 Providers by day of the week for February 2014

North East West

Total A&E Calls

Calls passed

from 111

111%

Total A&E Calls

Calls passed

from 111

111%

Total A&E Calls

Calls passed

from 111

111%

Monday 243 49 20.19% 184 17 9.38% 243 14 5.66%

Tuesday 243 55 22.55% 193 21 11.02% 270 15 5.38%

Wednesday 247 52 20.99% 200 22 11.13% 268 19 7.20%

Thursday 264 59 22.39% 212 22 10.38% 267 18 6.65%

Friday 250 48 19.04% 198 18 9.10% 285 19 6.68%

Saturday 310 117 37.85% 220 50 22.55% 306 28 9.14%

Sunday 296 109 36.91% 227 46 20.37% 310 29 9.27%

Please note the colour-coding is for internal reporting purposes only.

Green = <10%

Amber = 10-20%

Red = 20-30%

Purple = >30%

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Percentage of calls originating from NHS 111 providers (by hour and day of the week) for February 2014

Page 7 of 7

Percentage of Red calls from NHS 111 providers (by hour and day of the week) for February 2014

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Title: Patient Transport Services


Main aim: To update Joint HOSC members on the patient transport service (PTS) provided by SWASFT within BNSSG, including criteria for use and current pressures


Patient transport service (PTS) Introduction

The Patient Transport Service (PTS) is commissioned by NHS Bristol (as lead commissioner) for patients who are registered with a GP in Bristol, North Somerset and South Gloucestershire (BNSSG). Since 1 October 2010, two PTS contracts have been in place for BNSSG patients:

Main PTS contract for patients registered to GPs in Bristol, North Somerset and South Gloucestershire

Renal PTS contract (for patients able to travel by taxi) for renal dialysis patients registered to GPs in Bristol, North Somerset, South Gloucestershire

All other patients who attend NHS facilities within the BNSSG area, but who are registered to a GP practice outside the BNSSG area, are not supported by the BNSSG PTS contracts. The service provides transport for patients in cases of medical need, for outpatient appointments, admissions, discharge, and transfers between hospitals. The service is not provided for social means, and is only made available to those who meet strict eligibility criteria, based on Department of Health guidance. For the reporting period April 2013 to February 2014, the PTS service has transported 93,609 patients. It is expected that 102,000 patients will be transported in this financial year.

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Department of Health guidance

The Department of Health describes Patient Transport Services as the non-urgent transportation of patients who have a medical need, to and from a health service provider and between health service providers. This covers a range of vehicles and levels of care:

Where the medical condition of the patient is such that they require the skills or support of PTS staff on/after the journey and/or where it would be detrimental to the patient’s condition or recovery if they were to travel by other means.

Where the patient’s medical condition impacts on their mobility to such an extent that they would be unable to access healthcare and/or it would be detrimental to the patient’s condition or recovery to travel by other means.

BNSSG guidance in amplification of the broad DH guidance is that the following patients are entitled to PTS:

Patients who require the continual support and skill of patient transport staff to enable them to travel. This typically includes the following patients, but may also include others (this is an illustrative, not an exhaustive, list): 1. Patients who have received treatment which requires the skill of patient transport staff

to ensure a safe journey home

2. Patients who require patient transport staff to administer oxygen during the journey

3. Patients with dementia or other mental health conditions who require patient transport staff to ensure a safe journey

4. Renal dialysis patients who are able to travel by car

Patients who are required to travel by stretcher

Inter-hospital transfers BNSSG provides PTS for renal dialysis patients to enable them to attend weekly dialysis and related outpatient appointments.

Authorised to decide entitlement to PTS

The Department of Health specifies that PTS must be authorised by a healthcare professional. Individual arrangements may be put in place if a healthcare professional is not regularly available to authorise transport requests. Administrative staff may authorise transport requests, but only where approved protocols are in place locally to support appropriate assessment of eligibility by a healthcare professional.

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Escorts

Escorts may be medical or non-medical. Medical escorts are to be determined by those booking PTS where the patient’s condition is such they require the constant medical attention of a medical escort (beyond the capability of the PTS crew) throughout their journey. Non-medical escorts are not expected to be routinely authorised. Department of Health guidance states that non-medical escorts (ie friends or relatives) are to be the exception. Typically non-medical escorts are only appropriate for circumstances where:

The patient is under 18 years of age

The patient requires a translator

The patient has severe communication difficulties, eg has a profound sight or hearing/speech impairment and cannot travel safely without a known carer

The patient suffers from a physical or mental health problem, eg Alzheimer’s or Dementia, which prevents them from travelling unaccompanied safely without a known carer

Assistance dogs (including guide and hearing dogs) are permitted on the service, providing this is specified in the booking.

Current pressures The current pressures impacting the service include:

A growth in activity of 4% on last year;

The number of aborted journeys (currently 16%). Aborted journeys are journeys cancelled at very short notice by patients and/or the hospital;

The number of escorts (currently 25%). When patients bring an escort who has not been booked to travel, this takes up a booked seat on the transport.

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Patient Transport Service key performance indicators April 2013-February 2014

Scorecard Year-To-Date (based on 93,609 patient journeys)

1a

Patients living up to 10 miles away from the treatment centre (Band A) should not spend more than 60 minutes on the vehicle on either an outward or return journey (Red: <80%, Amber: 80-90%, Green: >90%)

95.97% 8c

Pick-up time to be confirmed by text, email or personal phone call to the patient within a week of appointment (phone call being the preferred method) Quarter

100.00%

1b

Patients living over 10 and under 35 miles away from the treatment centre (Band B) should not spend more than 90 minutes on the vehicle on either an outward or return journey (R: <80%, A: 80-90%, G: >90%)

95.95% 9b

Commissioners to be satisfied with the level of service received. (G – no issues of concern or minor issues and resolved within 1 month; A – minor issues and not resolved within 1 month / major issues, resolved within 1 month; R – major issues not resolved within 1 month)

100.00%

1c

Patients living over 35 and less than 50 miles away from the treatment centre (Band C) should not spend more than 120 minutes on the vehicle on either an out/return journey (R: <80%, A: 80-90%, G: >90%)

98.15% 9f Telephone answering (R: <85%, A: 85-95%, G: >95%)

93.24%

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2a Patients should not arrive more than 45 mins before their booked arrival time (R: <80%, A: 80-90%, G: >90%)

83.87% 10a Agreed activity performance report received in correct format and on time within 10 working days of the start of the following month

100%

2b Patients should not arrive after their booked arrival time (R: <87%, A: 87-97%, G: >97%)

87.18% 10b Activity and finance queries are acknowledged within 3 days of receipt and resolved within 28 days from date of query

100.00%

3a

SWASFT is to arrive to collect patients from the agreed location within 45 minutes of the outwards time (R: <80%, A: 80-90%, G: >90%)

84.38% 12h

Nil Serious Untoward Incidents (SUIs). Any SUIs are to be reported and action plan put in place - in line with NHS Bristol standard and timeframes (reported immediately; investigated within 24hrs and lesson learnt shared, then closed within 60 working days of incident). (G – no SUI’s, A – SUIs reported but resolved within timeframe, R – SUIs reported but not resolved within timeframe)

100.00%

SWASFT is to arrive to collect patients from the agreed location within 75 minutes of the outwards time (R: <80%, A: 80-90%, G: >90%)

92.37% 9a

Patient satisfaction with the level of service received from the provider annual patient satisfaction survey (R: <75%, A: 75-85%, G: >85%)

97.80%

3b

A summary of reasons and actions is to be provided, for each month, for all cases where collection was outside, i.e. later than, the KPI limits. This may include case-by-case analysis as deemed necessary

12d Compliance with agreed GWAS complaints procedure –full response made in a timely manner agreed with the complainant Quarter

100.00%

Documents

SOUTH WESTERN AMBULANCE SERVICE (NORTH AREA) JOINT … · SOUTH WESTERN AMBULANCE SERVICE (NORTH AREA) JOINT HEALTH OVERVIEW AND SCRUTINY COMMITTEE AGENDA Date & Time: Friday 11th