STAFFORDSHIRE HEALTH OVERVIEW SCRUTINY MEETING 8 April 2015 The last year as proved to be a very challenging year for the West Midlands Ambulance Service both regionally and within Staffordshire. Challenges specific to Staffordshire have been seen in: a. The ongoing transformational issues surrounding the County hospital have dominated the local health landscape. b. Increased focus on the health economy as a whole due to other performance issues that have affected stakeholders. c. Increased ambulance activity in the first part of this year with increases above the contracted activity up to 12%. d. Industrial action taken by ambulance staff during the year in support of their National pay claims. Whilst the WMAS have supported the health economy with their challenges through ambulance diverts and subscribing to alternative care pathways, this has only served to place more pressure on the local service and as resulted in a dilution of operational performance. Locally the ambulance service are striving to make the balance in supporting the wider health economy whilst also returning performance to the standards required. RESOURCES Across the County WMAS operate from three stations Stoke on Trent hub is situated on Hilton Road, Tollgate in Stafford situated at Beacon side, and the newly opened Lichfield Hub on Eastern Avenue. The hubs are supported by a network of response posts strategically situated across the County. The hubs are further supported by Community Ambulance Stations mainly situated in the market towns in the North of the County and in the centres of Cannock, Tamworth and Burton in the South of the County. There is a plan to redevelop the current Stoke on Trent hub which is old and not of the design or capacity required. Currently the Local management team in conjunction with the Estates department are seeking appropriate development sites of sufficient size in a preferred location to meet operational requirements for the area. There are currently 426 operational ambulance staff within Staffordshire across the three Hubs and Community Ambulance Stations and there is a fleet of 62 ambulances and 31 response cars in total.
PERFORMANCE Ambulance performance standards are categorised as:- The West Midlands Ambulance Service performance by Quarter is detailed in the following table, it is acknowledged that the Red 2 performance dropped during QTR3 mainly due to the pressures felt through numerous transformational programmes relating to hospitals, and the series of disruptions caused through the industrial action, and very high increased demand running at double the average annual increase, recovery is noted in QTR4. WMAS do however remain the best performing ambulance service in the country with the performance table for this year as follows. PERFORMANCE TARGET 2013/14 QTR 1 QTR 2 QTR 3 QTR 4 Red 1 Red 2 Red 19 GREEN 2 GREEN 4 75% In 8 75% In 8 95% In 19 90% In 30 90.0% Triage in 60 80.0% 81.7% 80.87% 75.87% 76.73% 73.6% 76.63% 75.20% 71.37% 73.23% 97.0% 97.17% 97.07% 96.40% 96.83% 88.7% 90.10% 88.97% 85.10% 88.43% 99.6% 99.30% 99.30% 99.40% 99.70%
Referrals 90% 91.1% 92.37% 90.77% 90.07% 92.50% Staffordshire performance is presented in the table below:- PERFORMANCEPERFORMANCE PERFORMANCE TARGET YEAR TO DATE Red A8 75.0% Red A19 95.0% Green 2 90.0% Green 4 90.0% 71.8% 95.2% 89.6% 99.5% Effects on Performance Operational performance can be effected by a multitude of issues such as weather other environmental factors patient demand etc but this last year has been even more challenging. a. Industrial action by health service staff. b. The nervousness surrounding the potential spread of Ebola led to all ambulance staff having to be trained to wear and use the appropriate protective clothing. c. Increased patient activity creating spikes in demand over a number of months. d. The Reconfiguration of health services in Staffordshire a. A special agreement surrounding the County hospital during the day b. The overnight closure of the County Hospital c. Movement of specialist services to Stoke and Wolverhampton e. The increased pressures endured by the acute Trust during winter which as been documented through the media placed increased pressure on ambulance services through delayed ambulance handovers. Recruitment and Development of Staff During the year WMAS have continued to expand the workforce in order to meet the forecasted contract activity and also have provided development opportunities to continue to develop the existing workforce in order to ensure that the most skilled and appropriate ambulance staff are responding to the calls entering the Emergency operations Centres based at Tollgate Stafford and Dudley. This expansion in recruitment is continuing forward into financial year 2015/16 as indicated in the following table:-
RECRUITMENT March 2015 April 2015 May 2015 June2015 July2015 Birmingham 526 532 530 544 559 Black Country 462 463 461 464 481 Cov & War 318 318 317 322 332 Staffs 428 430 428 437 463 West Mercia 550 550 548 563 576 2284 2293 2284 2330 2411 The recruitment of Staff is mainly through the university programmes at Staffordshire, Coventry and Worcester Universities. However the trust still continue to develop current employees offering Technician to Paramedic Conversion course. Clinical Performance Staff Development Technicians trained to Paramedics 14 Student Paramedics Into Staffordshire 26 Paramedic to Advanced Paramedic 6 Performance Indicator WMAS National Mean STEMI Patients to Treatment PPCI - 150 87.21% 89.00% Stroke FAST+ patients transported to a Hyper Acute Centre within 60 46.95% 62.00% STEMI Care Bundle 75.05% 80.50% Stroke Care Bundle 93.73% 97.10% FAST+ Patients to Hyper-acute center in 60 46.95% 62.00% ROSC At Hospital 28.48% 26.90% Cardiac Arrest Patient Discharged 8.40% 8.20% The Trust clinical performance is monitored and recorded accordingly, there are areas for clinical development and these areas are covered in the annual training of staff From the report presented to the committee today it can be noted that the trust as performed well against the challenges it has had to face and meet during the year. However going forward the Trust are learning the lessons from the changing climate in health and putting into place a plan a series of actions to improve performance based on the experience. Current Actions to improve Performance in Staffordshire Locally in Staffordshire it is recognised that there is an issue with performance however it should be acknowledged that WMAS cannot support the health economy and maintain performance without the appropriate funding to support this, and this is highlighted through the current situation. Locally the management team are now focusing hard on returning ambulance performance to the national standard, where as in past months there have been many external
distractions relating to priorities of the wider health economy. There is an action plan in place to address a range of operational issues which will ultimately increase the number of resources available each day. The operational plan that geographically details where ambulances should be placed, is being reviewed based on the profile of demand through the year. This will identify where ambulances need to be positioned and thus any changes to the current estate. Revision of work rosters, is being undertaken as the impact of patient s behavioural changes such as the use of the 111 system needs to be accounted, and the patients demand by hour of the day for services impact on the daily service. Additional recruitment as the Trust expands its workforce to meet the contractual activity that is being experienced and also forecast in the coming year. Ambulance input into the reconfiguration of the health system locally so the impact of reforms are resourced appropriately to reduce any risks in moving patients between sites or extended distances to other sites. The Trust has invested considerably in deployment of a further 134 automated external defibrillator sites throughout the County to improve the survival from cardiac arrest. Continued training of the general public in Staffordshire in Basic Life Support an initiative started with a pilot project called Heartstart Staffordshire that has reaped huge rewards in the County. Lee Washington General Manager Staffordshire March 2015