Agenda item

The South Western Ambulance Service Foundation Trust (SWASFT) has provided ambulance services in Wiltshire since February 2013, when it acquired the Great Western Ambulance Service (GWAS).

Neil Le Chevalier, Deputy Director of Delivery and Paul Burkett-Wendes, Head of Operations (North) will be in attendance to report on the performance of SWASFT in Wiltshire.  They will also describe the training they have implemented to reduce unnecessary admissions to hospitals. A copy of the report is attached to the agenda.

The Committee is asked to comment on the report.

The Committee welcomed Neil Le Chevalier, Deputy Director of Delivery and Paul Burkett-Wendes, Head of Operations (North) to present a report to the Committee on how the Ambulance Service was performing in Wiltshire and how they were trying to reduce admissions to hospitals.

The presentation highlighted the differences and difficulties in balancing performance and quality. Neil le Chevalier stated that the Ambulance Trust was meeting its contracted performance standards, but were having difficulty meeting the 8min critical response time in such a rural county.

The categories for performance were clarified, and the performance report outlined. The Committee’s attention was drawn to the comments made by Sir Bruce Keogh regarding the performance measures being fit for purpose in rural areas. It was clarified that quality outcomes for performance are measured in addition to the response and speed times.

Neil le Chevalier stated that in order to meet the future demand of the service, the Trust had essentially two options. These were to either:

a)    Control the demand for the service and the number of hospital admissions.

b)    Increase resources to better manage the increase demand.

It was stated that given current financial constraints, it was unlikely that the Trust could sustainably provide an increased service with regard to increasing the number of ambulance on call. Therefore the trust had no option but to control the demand and number of hospital admissions by better managing patients at the scene and providing structured care arrangements away from the hospital. Given that the trust is experiencing a 5% increase in demand year on year, the current arrangements are putting an ever increasing strain on resources. This was further exacerbated by a spike in the number of referrals from NHS 111.

The Committee discussed the role of community first responders and community defibrillators, to further support the front line ambulance staff tasked with reaching critical emergencies in rural parts of the county. Further discussion was also had on the number of ambulance staff and the level of investment required to meet the projected demand, currently estimated at £1.1 million. The Committee also discussed the increase in demand on the ambulance service over the weekend, with up to a 100% increase in calls over the weekend period. It was stated that an estimated 18 additional ambulances would be required to deal with the increased demand as a result of the substantial rise in the number of service users. SWASFT declined to pass comment on the performance of NHS 111, but noted that a large number of ambulance call outs received via NHS 111 were unnecessary, and placed a burden on the resources of the Ambulance Service.

The Committee then asked further questions on the operations of the Ambulance Service, in particular focussing on the control room and staff retention. The Ambulance service currently had 30 vacancies in the north division.  As paramedics are university trained, only 1 cohort is available each year in October.  The service will over recruit this year to allow for staff turnover throughout the year. The Committee then reaffirmed the importance of quality outcomes as opposed to quantitative measures, and supported the proposals for Community First Responders.

Resolved:

The Committee agreed to note the performance report from the South West Ambulance Service.