Minutes:
Attending to present on behalf of the LAS (London Ambulance Service) were Philip Powell and Darren Farmer. Mr Powell was the Stakeholder Engagement Manager for South East London; Mr Farmer was the Assistant Director of Operations for South East London.
The Committee heard that the LAS served all areas of London which included 32 CCGs and 41 NHS Trusts.
The Committee was provided with the following data:
· 1.9m calls were made to the LAS in the previous year
· There had been a 47% increase in life threatening calls since 2010
· 104 new ambulances were now in service
· 167 new frontline staff had been recruited since June 2015
· 20 specialist centres existed to deal with trauma, heart attack and stroke
· LAS treat 3500 patients over the phone every week without the need to send an ambulance
Members were appraised concerning various means by which the LAS cared for London:
• 999 emergency and urgent care response – delivered using traditional and innovative means e.g. Cycle Response Unit
• Intelligent Conveyance
• 111 Services
• Emergency Preparedness Resilience and Response
Mr Powell explained what was meant by ‘intelligent conveyancing’.
All accident and emergency departments experience peaks and troughs in pressure, often associated with the number of arrivals by ambulance. This could mean unnecessarily long waits for patients to be treated, with the possibility that they would breach the four hour target for treatment, admission or discharge, and increased pressure on staff. It could also mean that hospitals faced sudden demands for large numbers of beds for admitted patients.
Last year, London Ambulance Service and its commissioners proposed a solution that would redirect ambulances away from the hardest pressed departments to ones that were less busy.
‘Intelligent conveyancing’ involved an agreed maximum number of ambulances per hour arriving at each emergency department. Public and healthcare staff are already used to the idea that an ambulance may take patients to a more distant emergency department if it had better facilities for serious conditions, such as stroke or major trauma.
‘Intelligent conveyancing’ takes this one step further by avoiding departments that are known to be under pressure, with potential benefits for both the NHS and the patients.
Patients going to a specialist unit are excluded, along with patients receiving ongoing care from a particular hospital and those who might have an extended length of stay as a result of being taken to a distant hospital; for example, because their care package would be hard to restart.
Intelligent conveyancing involves an agreed maximum number of ambulances per hour arriving at each emergency department with any beyond this diverted to other local emergency departments that have not met their maximum and therefore have “spare” capacity.
The public and healthcare staff are already used to the idea that an ambulance may take patients to a more distant emergency department if it has better facilities for serious conditions, such as stroke or major trauma.
“Intelligent conveyancing” takes this one step further by avoiding departments that are known to be under pressure, with potential benefits for both the NHS and the patients.
Patients going to a specialist unit are excluded, along with patients receiving ongoing care from a particular hospital and those who might have an extended length of stay as a result of being taken to a distant hospital; for example, because their care package would be hard to restart.
The LAS briefed the Committee around specialist teams:
A team had been trained to respond in hostile environments such as fire arms incidents where they can treat patients 24 hours a day, seven days a week.
Additionally, London had a separate unit specially trained to give medical care in hazardous areas such as at height, in water, confined spaces or where there may be hazardous materials. LAS had additional staff trained to support responses to chemical, biological, radiological or nuclear attacks such as mass casualty decontamination and treatment. A public order team had been set up to treat patients during episodes of civil unrest.
The Committee was informed that a new method of prioritising calls had been established. Calls were now ranked in terms of ‘categories’ where category 4 was the least urgent, and category 1 was the most urgent. As part of the new system, LAS call centre staff would remain in communication with callers and ambulance crew for as long as was required.
The Committee was told that delayed handovers at hospitals had impacted upon service delivery and that the geography of Bromley was challenging. Specialist stroke facilities were located at the PRUH, but cardiac care and major trauma services were delivered by King’s.
The Chairman asked how many of the 999 calls were frivolous. Mr Powell responded that there were some calls that were vexatious and frivolous, but they were easy to identify. Some calls were received from high intensity users and it was required that plans be developed to deal with these calls and provide the callers with a different outlet, whilst still maintaining clinical safety. Some callers were not vexatious, but had problems in understanding how the system worked.
A Member asked if the LAS had enough ambulances. Mr Farmer responded that there was not a bespoke response for Bromley but on a pan-London basis there were enough ambulances available.
A Member enquired if the LAS was still in the process of co-responding with the London Fire Brigade. Mr Farmer answered that the system seemed to have been working well but had stopped—he was not sure why. The Member commented that the process had come to an end because the fire brigade unions were opposed to it.
A Member asked if the LAS were experiencing any funding issues. It was confirmed that there were challenging funding issues as savings of £20m were required.
A Member queried if the LAS were experiencing recruitment difficulties due to the high cost of housing in London. It was confirmed that this was an issue, and that many staff had to travel in from the Home Counties.
Another Member raised the issue of ambulance waiting times at hospital. He suggested that ambulances no longer wait with patients, but simply drop them off and move on to the next call. A co-opted member expressed the view that it was not appropriate for LAS staff to abandon patients on hospital trolleys. A discussion took place around the generic issue of bed availability and ambulance crew waiting to offload their patients at hospitals.
The Chairman thanked Mr Farmer and Mr Powell for a very interesting and informative presentation.