Presentation by Thames Ambulance Services Ltd regarding provision of non-emergency hospital transport across the district.
Minutes:
The Chairman again welcomed Andy Hill, Operational Manager from Thames Ambulance Services Ltd (TASL) and invited him to address the Committee. Members heard that there had been several concerns highlighted, most recently through a CQC report, however there had been significant steps taken to improve the service and address the concerns raised. Examples of this included amending the shift rotas to maximise the use of staff resources and also improving the computer software used to manage the daily workload.
It was explained that the control centre had been relocated from its city centre location to one on the peripheries of the city. The importance of a suitably located and resourced control centre was emphasised as this would be the point from where all other operations were managed. There had also been an increased focus on training and development with rotas arranged to help manage absence due to training requirements and it was highlighted that the service was working proactively to resolve those issues which had been identified by the CQC report.
Questions from Members had focussed on three main areas – reasons for difficulties within the service and how to improve performance, staff wellbeing including working hours and training requirements, and the concerns around cleanliness of work bases and vehicles. The Operational Manager for TASL explained that there were several pressures on the service that were out of their control, such as mis-information provided by the acute care trusts when requesting transport, the need to transport patients not only out of the area but to anywhere in the country and geographical issues whereby the area covered is mainly rural with a lack of motorway network.
The Committee heard that, as well as the rota alterations to enable staff to attend development sessions, there had been a concerted effort to provide training with regards to paediatric and bariatric transport. All staff were now trained with regards to transporting children and one in three staff were trained for bariatric patients. This was in line with CQC recommendations. It was also emphasised that, although the service did not transport patients who were subject to any Section of the Mental Health Act, all staff had received increased training in mental health awareness and were kept informed of the relevant pathways both through the induction training and regular refresher sessions.
In addition to the improved training, there had also been significant work undertaken in relation to the rota system. It was highlighted that there was not considered to be a staff shortage, however it had been necessary to re-align staff hours with fleet availability and peak transport hours, whilst also reducing overtime hours and ensuring allocated break times were adhered to as far as possible. It was explained that the updated rota system had proved a positive improvement, with breaks and driving hours being much more closely monitored and protected as far as possible. The nature of the work, although not an emergency service, was still time critical and it was acknowledged there would be times when unplanned work would take precedence. There had been a noticeable change, however, in that breaks had not previously been allocated or protected, whereas they were now scheduled into the daily work plan.
Members were also told about the updates to the computer software that were having a significant impact on service efficiency. As a result of the largely rural areas covered, crews had found that their work planner on their handheld devices was not updating correctly, due to poor or non-existent network coverage, and this had led to delays and mis-communications. By working closely with the software provider, changes had been made whereby network coverage was much more reliable, crews were receiving their work plans on a real time basis and this made the service as a whole increasingly efficient and reliable. Any devices which were not working had been replaced with new devices.
The Committee questioned the practicalities of transporting multiple patients with differing clinical needs and how several drop off points would extend the journey and make it increasingly uncomfortable for those patients in poor health. The Operational Manager agreed that there would be situations where it was not prudent to transport a patient in such a way, for example late at night or when arrival time would be significantly later, however, there was an expectation on the acute care providers to adequately assess the clinical needs of the patient and request transport that was appropriate to their needs. For example, it was not uncommon for a vehicle designated for a stretcher-bound patient to arrive and find the patient walking unaided. It was acknowledged that the pressure on acute care providers to discharge patients then created a pressure on non-emergency transport providers to move the patient and it had been key for TASL to open up communications with the acute care providers in order for all points of contact to be as efficient and accurate as possible.
Members enquired as to what was in place to ensure patients arrived for their appointments on time or did not miss appointments, as had been happening previously. It was explained that when needed, TASL would make use of third party transport providers to ensure that patients were not disadvantaged in any way. The cost of using other parties was borne by TASL. The issue of vehicle breakdown was also addressed, with the Operational Manager confirming that all vehicles were well maintained but there was prompt access to spare vehicles as well as a nationwide recovery/repair agreement in place. Members were assured that contingency plans were in place for all possibilities.
The final area of concern had been the hygiene and cleanliness of the vehicles and the transport hub locations. The Committee heard that these problems had been addressed and, on the advice of the CQC, TASL had undertaken a cleaning contract with a company with significant experience of cleaning and maintaining healthcare related premises. There had also been work undertaken with the landlords of the relevant properties and the issues had been resolved. It was emphasised that TASL had worked closely with the CQC in terms of addressing the concerns raised in their report and there was dedication across the organisation to rectify and improve their performance.
At the conclusion of the presentation and questions, the Chairman thanked Mr Hill for his time, his clear explanation of the issues faced by the organisation and the steps they were taking to address it. The Committee heard that there was due to be a further CQC inspection within the next three months and they expressed their interest in hearing from Mr Hill again with the results of the second inspection. It was agreed this could be considered for the work plan in the next Civic Year.
On behalf of the Committee, the Chairman again thanked Mr Hill for his time.
Note: The meeting adjourned at 7.19pm for Mr Hill to leave the meeting and was reconvened at 7.21pm.