Agenda item

Report of NHS Devon,  attached 

The Committee considered a report of the County Commander for North and East Devon of the South Western Ambulance Service Foundation Trust.

The Report provided an update on the progress towards the recommendations made by this Committee’s Spotlight Review into South Western Ambulance Service Trust in June 2022. A series of recommendations had been made to the health care system in recognition of the overlap on many of the recommendations between Devon County Council, NHS Devon and South Western Ambulance Service NHS Foundation Trust (SWAST). The recommendations had been directed to relevant lead organisations, but it was for the system as a whole to ensure these were effectively implemented.

The progress against the recommendation were detailed in the Report with an overview of the current system pressures and mitigations in place where the system was unable to progress on actions due to pressures locally, regionally and nationally.

Members’ questions and discussion points with the SWAST Executive Director of Operations and the County Commander and the NHS Devon Director of Delivery covered:

• Overtime and putting extra stress on staff. This was being addressed by using private resources which helped to cover the gaps.
• Rapid assessment model for triage which had been adopted in Exeter and North Devon hospitals but not in Plymouth. Derriford Hospital would soon have a rapid assessment centre which would enable them to run a similar model to the Royal Devon and Exeter Hospital. Completed works for this was due by the end of January. In the meantime, a triage system was being used by senior nurses.
• Extra hours undertaken by staff through shift overruns which happened when there were handover delays.
• An incredibly challenged period recently, in December a critical incident was called due to the pressures on the service. However, there had been a marked improvement in the last two weeks. Activity in December was 22,000 incidents a week and last year it was about 18 to 19,000. In the last couple of weeks this has dropped to between 15,000 and 17,000 incidents. The handover delays had significantly improved  and response times were much better.
• Minor Injury Units (MIUs) plans. SWAST looked after the Urgent Care centre in Tiverton. A review was being commissioned to establish equity in the system and understand what the current offer was and what improvements could be made in the short term. The findings of this could be brought back to a future meeting.
• Problems were experienced when there was an inconsistency of service from MIUs and pathways across the system. In rural communities there was a benefit to having an MIU where people could be treated instead of needing the service of a paramedic. The Urgent Care centre in Tiverton was the highest level of offering with a multi skilled workforce and offered a far greater scope including x rays.
• Improvements in service was felt to be multifactorial – a combination of lower activity volumes and lower handover delays and improved resourcing levels from SWAST. Patient flows were improving. It was important that discharge levels were maintained.
• The current position remained fragile due to entering a period of industrial action which may or may not be prolonged and operational challenges could come into a system quickly.
• A request had been made for information with descriptions of all the minor injury units and urgent care centres in the County to be sent to the Committee and for confirmation and a date for the re-opening of the Dawlish MIU.
• Internal processing changes had helped release beds; a significant factor in delays had been staff sickness which had a huge impact on the service. In December there had been 800 staff sick across 3 acute trusts which had caused massive delays, but this had now rescinded.
• The robustness of ICT systems. SWAST had many systems such as triage platform and mobile terminals in the vehicles and there was an infrastructure which supported that. The service relied on this heavily and those systems was continually being monitored to ensure they were modernised and remained fit for purpose.
• Future staffing requirements were looked at by the Strategic Resourcing Group which had multi-disciplinary members on it and took a long-term approach for both clinical and non-clinical staff. It was felt SWAST were in a good position with this going forwards. 
• Driving improvements in the system around the process for emergency care. A national team has been in to support this which would be fed into an improvement plan for all 3 trusts.
• Lack of building space at Derriford had created some of the performance problems. There were plans to help improve the situation, but it was recognised as being a very constrained site.
• The importance of patients being assessed so that the most suitable care response can be made for all including those with mental health needs. 

The Chair thanked SWAST and NHS Devon officers for their time and responses and highlighted the importance of this area and that the Committee would be keen to have a report about the NHS 111 service in due course now that there was a new operator in place and the impact on SWAST and the hospitals.

RESOLVED that the Report and information presented be noted.