DDES CCG AMBULANCE PATIENT REFERENCE GROUP MEETING
Draft – with track changes suggestions from JU & TF
Thursday 6 March 2014
9.30am till 12noon
Boardroom, Sedgefield Community Hospital
Unconfirmed Minutes
Present:
Joseph Chandy (JC) Director of Primary Care Development & Engagement,
DDES CCG
Mike Wilson (MW) Governor Rep, NEAS
Mark Willis (M Willis) Head of Clinical Education & Development NEAS
David Taylor-Gooby (DTG) Governing Body Lay Member, DDES CCG
Andrew Bell (AB) Duty Manager from NEAS Control
Gareth Campbell (GC) Assistant Operations Manager South Division, NEAS
Peter Docherty (PD) Team Leader NEAS
Fred Williams (FW) Easington PRG Rep
Tony Foster (TF) Easington Lay Member
Jean Heatherington (JH) Weardale Lay Member (&Durham Dales Ambulance Monitoring Team Rep)
Joy Urwin (JU) Weardale Lay Member (&Durham Dales Ambulance Monitoring Team Rep)
Margaret Dent (MD) Teesdale Lay Member (&Durham Dales Ambulance Monitoring Team Rep)
Dr Jonathan Nainby-Luxmoore (JNL) GP, Old Forge Surgery, DDES CCG
Councillor Richard Bell (RB) DCC (Barnard Castle West)
Councillor Robin Todd (RT) DCC
Stephen Gwillym (SG) Principal Overview & Scrutiny Officer, DCC
Gary Collier (G Collier) Senior Commissioning Manager –Provider Management NECS
Ali Chapman (AC) Commissioning Manager – Provider Management, NECS
Ann Lineton DDES CCG (Minute Taker)
Apologies:
Gillian Findley Director of Nursing, DDES CCG
Ben Clark Assistant Director, Clinical Strategy from NHS England, Durham, Darlington and Tees Area Team
Elaine Bennington Operations Manager Central Division NEAS
Tony Cooke Teesdale Lay Member
Nigel Mitchell Teesdale Lay Member
Item No. / Item / ActionAPRG/14/01 / Welcome and Introductions
JC welcomed the group and introductions were made.
APRG/14/02 / Declarations of Interest
Tony Foster declared an interest in Hospital Trust
Councillor Todd and Bell to reserve judgement on Contract for Skills Mix.
APRG/14/03 / Minutes of the Meeting Held on 05/12/13
Page 2 – Bishop Auckland venue had parking issues and JC confirmed when The Four Clocks Centre venue was to be used again, CCG would ensure extended parking permits would be sent via email to all members of the group.
Page 3 - typo change word from “surgeries” to “practices”
Feedback from local MPs – awaiting CCG to report back to her.
ACTION: AL/SP to make amendment to previous meeting minutes.
Page 4 – Response time reports – TF to discuss further with JC after today’s meeting
Page 6 – PRG Reimbursement Policy – for clarity JC to contact person concerned separately.
Otherwise minutes were agreed. / AL/SP
APRG/14/04 / Review of Action Log as at 5/12/13
The Action Log was reviewed and amended with the following matters arising:
· No 3 – To be discussed under agenda item
· No 6 – JC to hold further discussions – ongoing
· No 7 – Ongoing
· No 10 – JC requested this to be a permanent future agenda item. G Collier to present report including staffing level measures recorded in the Contract.
APRG/14/05 / Weardale & Teesdale Reports
MD and JH presented and referred to hand-outs showing statistics recorded under different headings. Work was ongoing regarding postcode data collection which had been fruitful.
The Teesdale figures showed a proportion of this crew covering calls to Darlington and the Weardale figures showed a proportion of this crew covering calls around North Durham. JNL requested if it was possible to have the figures split between car and patient carrying vehicles. DTG also enquired if figures were known of how many ambulances would be in the Dales area arriving from calls outside the area.
Reference was made to the winter funding initiative pilot scheme between the fire and ambulance services acting as first responders.
JU highlighted issues of lengthened time out of the Dales by all ambulances /when the new hospital in Cramlington becomes active.
NEAS were requested to provide a breakdown of clinical escalation to members of the group to enhance understanding of call out procedures.
ACTION: NEAS were requested to provide a breakdown of clinical escalation to members of the group to enhance understanding of call out procedures.
G Collier gave an update on the ambulance contract. Sub-contractor arrangements have had to be used in the past. MD looked for further confirmation that funding had been ring-fenced for Dales area.
JC identified two challenges from the data:
1. How can an improvement be made on out of area calls; and
2. How can we narrow the clinical escalation for the vehicles to leave the area less frequently?
TF suggested similar data should be collated for the whole area not just the Dales area. G Collier confirmed the Dales group had carried out excellent work but was now also looking towards having vehicle IDs included in data output which may replicate the requirement for the current data collection requirements. / NEAS
APRG/14/06 / Further Discussion on the ORH and Explain Report
JC reported when the CCG came into existence there had been the arrangement left by the PCT of the ring fencing arrangement for the Upper and Lower Dales.
The ORH report set out proposals for improving response times in DDES with or without the ring fence. JC confirmed the CCG’s intention to maintain the ring fenced funding in the next 2 year financial plan from 2014.
Joseph asked how response times could be improved across DDES.
· It was unlikely that North Durham or Darlington CCG would make the additional investment due to the fact that they are already achieving their targets
· Discussion took place around maintaining the ring fence but altering the skill mix on the vehicles to increase the resource across the Durham Darlington health system.
· Funding a DDES only ambulance service for emergency calls was cost prohibitive
Note - DTG left the meeting at 11.30am
APRG/14/07 / Discussion on the Teesdale and Weardale monitoring data
Referred to under previous agenda item.
APRG/14/08 / Introduction of CQUIN
G Collier explained this was a quality improvement scheme linked to every provider we have a contract with.
Reference was made to a new Intermediate tier system coming into place, incorporating a mixture of skill sets and providing support to patients with a lower level of clinical need.
The CQUIN scheme should allow paramedics to focus on high alerts resulting in performance indicators improving. G Collier addressed concerns of FW by confirming NEAS are working through finer detail with him before taking forward to the next North East Ambulance Service Quality Review Group meeting scheduled for Monday, 10 March. MW confirmed paramedics are undertaking training to meet the criteria.
In summary, it was agreed the potential of CQUIN should positively impact on Red 1 and 2 calls, other stakeholders asked for reassurance where this model came from. JC requested NEAS to provide the group with an update.
ACTION: JC requested NEAS to provide the group with an update on CQUIN.
Note - JNL and M Willis both left the meeting at 11.50am. RB left the meeting at 11.55am. / JC
APRG/14/09 / What are our Commissioning Options
Referred to under previous Agenda item APRG/14/06.
APRG/14/10 / Discussion on the Skill Mix of Dales Crews
There was discussion about the current staffing within the Dales. Currently double crewed vehicles are staffed by 2 paramedics in the Dales. Across the rest of the North East of England including the rural areas such as Northumberland, double crewed vehicles are staffed by a paramedic and a support worker. G Collier estimated that DDES would show a 4% performance improvement with an altered skill mix crews in the Dales. This is because paramedics separated can be reconfigured to provide additional staffed vehicles in the DDES area. The Dales area would still have the same number of vehicles funded for the same number of hours but performance would be improved as a whole because there would be more vehicles on duty overall.
PD reported the Dales vehicles were not fully staffed due to staff leaving and difficulties recruiting. Any shortfalls were being covered by putting secondments in place to improve staffing levels and maintain the double paramedic arrangements.
The discussion concluded by formulating a proposal on behalf of the workshop stakeholders. Cllrs Robin Todd, Richard Bell and Mr Stephen Gwillym from Health Overview and Scrutiny abstained from this point to allow impartiality.
JC confirmed he would put forward at a DDES CCG Executive what recommendations had been put forward by this Group proposed as:
1. To skill mix vehicles in the Teesdale and Weardale area in line with the remainder of the NEAS contract subject to metrics:
A) Reduction in out of boundary calls (To be defined) or reduction of hours the Dales is without ambulance cover
B) Reduction in Paramedic vacancies in Teesdale and Weardale
C) Increase In DDES RED 1& 2 performance
2. The ambulance PRG would support devising the metrics.
3. The skill mixing will allow paramedics to be re-deployed for the benefit of patients.
ACTION: JC to submit a proposal to DDES CCG Executive what recommendations had been put forward by this Group regarding Skill Mix of Dales Crews.
SG recommended that Health OSC should be advised of this proposal and its engagement plan. JC thanked SG for raising this point.
JC recommended that members of the Ambulance PRG including TF be involved with the commissioning team for gathering the information together for input to the matrix. / JC
APRG/14/11 / Any Other Business
JU requested that clinical escalation levels should be identified, in addition to crew shortage figures. AB confirmed he would ensure these figures would be included in the next set of reports.
ACTION: AB to identify clinical escalation levels in addition to crew shortage figures in the next set of reports.
FW requested similar sets of figures for the Peterlee and Easington areas.
ACTION: AB to produce data reports for FW for Peterlee and Easington areas.
JC finished the meeting by commenting DDES CCG were about to complete their first anniversary and wished to thank the Group for their continued support. / AB
AB
APRG/14/12 / Next Meeting
5 June 2014 at 9.30am – 11.30am – Durham Dales location – Vinovia Room, Bishop Auckland Community Fire Station, Green Lane, Bishop Auckland, Co Durham, DL14 6RS
Chair: Joseph Chandy,
Deputy Chair: Gillian Findley,
Administrator / Apologies to: Sarah Paylor,
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