Appendix 3

Ambulance emergency care report

Activity relating to patients in Hartlepool; Stockton on Tees; Darlington; Middlesbrough; Redcar & Cleveland

1.Introduction

1.1.This report provides an update on ambulance A&E activity to help Tees Valley joint health scrutiny committee to understand the overall current provision of emergency care services.

1.2.NEAS is commissioned to deliver emergency care and PTS ambulance services by Clinical Commissioning Group (CCG) areas and our data collection and monitoring is based at this level. This reports shows activity and response data by CCG area

  • North Tees & Hartlepool – covering Stockton on Tees and Hartlepool local authority
  • South Tees – covering Middlesbrough and Redcar & Cleveland local authority
  • Darlington

1.3.The Tees Valley OSC also requested data for each local authority area. This is not routinely collected or monitored since the abolition of Primary Care Trusts whose boundaries were coterminous with local government. However, a special data extraction has been undertaken to assist members in seeing ambulance activity by local authority area. This appears in the appendices.

1.4.National performance targets for Red calls have not been met for another consecutive month. An Emergency Care Recovery Action Plan has been developed and is being monitored

2.Ambulance activity

2.1.Potentially life-threatening calls are known as Category ARed calls. These are split into Red 1 and Red 2 incidents, depending on the nature of incident. All Red cases should receive an emergency response within 8 minutes in 75% of cases across the NEAS operational area. They should also receive a patient transport response within 19 minutes in 95% of cases.

2.2.Incident volumes continue to remain fairly static, however there remains a high proportion of 999 calls assessed as being a Red call, requiring an ambulance within eight minutes in 75% of all incidents across our service area.

2.3.The blue line indicates the number of Red incidents attended within eight minutes by NEAS. This has consistently remained at approximately 370 cases a day across the region.

2.4.The red dash-line indicates the number of Red incidents NEAS is required to attend within eight minutes to achieve the 75% performance standard. The proportion of 999 calls classified as being a Red incident has increased over the past three years.

2.5.National benchmarking for July 2016 shows that no ambulance service was meeting its performance targets for 2016/17. NEAS remained above the England average for Red 2 and Red 19. Of the eight trusts that are currently reporting performance against the three national standards, NEAS had the second highest Red 2 performance in July 2016.

2.6.Call volumes to 999 and 111 have increased, but recruitment of clinicians to the clinical hub continues to help improve hear and treat rates to avoid inappropriate ambulance dispatch. There are currently 24.5 WTE clinicians in post against the target of 34.

2.7.The 999 service continues to achieve its performance standard for call answer time. This is due in the most part to multiskilling creating resilience and efficiency. Likewise 111 is among the top five performers consistently at a national level.

2.8.Work continues to implement all actions within the recovery action plan for Emergency Care Services and the Operations Centre. Updates to key actions taken include:

  • The co-responding pilot with the four local Fire & Rescue Services continues, with FRS resources responding to over 100 incidents per week and has been extended beyond the original June 2016 deadline to February 2017, though on a voluntary basis.
  • Externally discussions with commissioners are focused on improving handover delays as well as putting processes in place to better understand the impact for NEAS resulting from changes in the wider health system. Time lost to handover delays exceeding 15 minutes has increased by 54% increase compared to 12 months ago. This also reflects an the increase seen in job cycle times, with on average each incident taking nine minutes longer to complete compared to the same period last year.
  • A task and finish group has been set up to review, monitor and manage abstraction rates to ease staffing pressures on the front line.
  • The action plan to address red volumes continues to be developed and delivery will be monitored.

3.Recruitment

3.1.Paramedic vacancy levels have fallen from 119 to 84 posts over the last 12 months.

3.2.Paramedic and Emergency Care workforce recruitment is progressing well, with 12 paramedics taking up post in September and a further 12 will start before the end of November.

3.3.Over the coming two months a further 10 Paramedics are going through the assessment process. Approximately 84 students will graduate from Teesside University between September 2016 and April 2017 which should result in full establishment successfully being achieved.

4.Quality measures and performance

4.1.NEAS has ranked above the national average for three out of eight Ambulance Quality Indicators. Those indicators ranked above the national average were:

4.1.1.STEMI full care bundle (heart attack care),

4.1.2.Arrival at a PPCI unit within 150 minutes in 96.2% of all cases (heart attack treatment) and

4.1.3.Stroke full care bundle.57.1% of 175 patients arrived at a Hyper Acute Stroke Unit (HASU) within 60 minutes which placed NEAS third nationally. An investigation into where there was a delay was carried out to determine a reason. In half of cases this was as a result of travel time to scene / hospital. The remainder was as a result of time spent on scene or waiting for

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Appendix 3

5.Hospital handover delays

Time spent in queues (in excess of 15 minute standard) outside A&E departments by hospital from July 2015 to June 2016

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Appendix 3

6.Clinical Commissioning Group (CCG) level data

Red, 8-minute response: Trustwide Annual Performance Target: 75%

CCG / Apr 16 / May 16 / Jun 16 / Jul 16 / Aug 16 / Sep 16 / Total
NHS Darlington CCG / 77.94% / 78.59% / 76.41% / 71.77% / 71.88% / 73.98% / 75.10%
NHS Hartlepool And Stockton-on-tees CCG / 72.43% / 71.58% / 63.50% / 65.26% / 70.18% / 67.45% / 68.39%
NHS South Tees CCG / 72.00% / 68.88% / 67.29% / 64.09% / 69.50% / 64.97% / 67.76%

Red, 19-minute response: Trustwide Annual Performance Target: 95%

CCG / Apr 16 / May 16 / Jun 16 / Jul 16 / Aug 16 / Sep 16 / Total
NHS Darlington CCG / 86.72% / 89.20% / 89.50% / 87.44% / 86.03% / 86.25% / 87.51%
NHS Hartlepool And Stockton-on-tees CCG / 95.27% / 94.55% / 92.82% / 90.96% / 94.25% / 91.50% / 93.20%
NHS South Tees CCG / 94.52% / 90.04% / 87.58% / 90.62% / 90.81% / 89.77% / 90.53%

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Appendix 3

7.Appendix 1:

Location and numbers of ambulances across Tees Valley local authority areas

Appendix 2:

8.Local authority level performance data

NEAS performance is commissioned and monitored at CCG level. However, the CCG boundaries do not always assist members in understanding the response times in their local authority area. This section provides NEAS responses by local authority area; however, it should be noted that NEAS is not commissioned or monitored at this level. These boundaries were last updated when Primary Care Trusts existed and so new locations may be missing from this data:

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