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North East Ambulance Service NHS Foundation Oundation Trust North East Ambulance Service NHS Foundation Trust North East Ambulance Service NHS Foundation Trust Quality Report Bernicia House, Goldcrest Way, Newburn Riverside, Newcastle upon Tyne NE15 8NY Tel: 0191 430 2000 Date of inspection visit: 18-22 April, 4 May 2016 Website: www.NEAS.nhs.uk Date of publication: 01/11/2016 This report describes our judgement of the quality of care at this provider. It is based on a combination of what we found when we inspected, other information know to CQC and information given to us from patients, the public and other organisations. Ratings Overall rating for this Good ambulance location ––– Emergency and urgent care services Good ––– Patient transport services (PTS) Good ––– Emergency operations centre Requires improvement ––– Resilience planning Good ––– Are acute services at this trust safe? Good ––– 1 North East Ambulance Service NHS Foundation Trust Quality Report 01/11/2016 Summary of findings Are acute services at this trust effective? Good ––– Are acute services at this trust caring? Good ––– Are acute services at this trust responsive? Good ––– Are acute services at this trust well-led? Good ––– Letter from the Chief Inspector of Hospitals North East Ambulance Service NHS Foundation Trust • There was generally a culture of passion and (NEAS) covers the areas of County Durham, enthusiasm with a focus on the patient. However, Northumberland, and Tyne and Wear, along with the there were differences in culture across the different boroughs of Darlington, Hartlepool, Middlesbrough, geographical patches. The trust had recently Redcar and Cleveland and Stockton-On-Tees covering undertaken a cultural survey which had identified almost 3,230 square miles. The trust employs over 2,700 some concerns regarding management support. staff and provides 24-hour emergency and healthcare Actions had been identified and were being services to a population of 2.71 million people. implemented to address this; an example was the management essentials programme. The trust provides an accident and emergency (A&E) • Most staff confirmed there had been a real shift in service to respond to 999 calls, a 111 service for when emphasis toward patient engagement and staff medical help is needed fast but it is not a 999 emergency, wellbeing. This was reinforced by the NHS Staff Survey patient transport services (PTS) and Emergency operation 2015 where it was reported trust management had a centres (EOC) where 999 and NHS 111 calls are received, real interest in staff health and wellbeing which was clinical advice is provided and from where emergency better than the England average. vehicles are dispatched if needed. There is also a • The relationship between the executive team and Resilience and Hazardous Area Response Team (HART). union representatives had improved and we were told The comprehensive inspection of the ambulance service by both sides that there was now a more open took place from 18 to 22 April 2016 with an unannounced dialogue and discussion regarding meeting the needs inspection on 4 May 2016. We carried out this inspection of staff and the service. as part of the CQC’s comprehensive inspection • The emergency care clinical managers were front line programme. leaders who supported staff and supervised operations. This recently established role was to We inspected five core services: ensure staff received appropriate clinical leadership, • Emergency Operations Centres which was documented and evidenced via quarterly • Urgent and Emergency Care one to one meetings. However this had only been • Patient Transport Services implemented in the urgent and emergency care • Resilience Services including the Hazardous Area service. Response Team • Throughout the inspection and across services we • 111 services. found that patients received care in a clean, hygienic and suitably maintained environment. Overall, we rated all of the five key domains as good • Patients on the whole told us they were happy with the which meant the overall rating for the trust was also care they received and the attitude of staff. We good. observed staff engaging with patients in a caring and Our key findings were as follows: respectful manner. 2 North East Ambulance Service NHS Foundation Trust Quality Report 01/11/2016 Summary of findings • The trust was experiencing difficulties recruiting to motorcyclist had had an accident, and sent location paramedic vacancies and information provided by the data to the NEAS EOC, allowing staff to contact the trust before the inspection indicated there was a nearest appropriate ambulance service to arrange an vacancy of 102.49 wte paramedic posts which equated emergency response. The trust had been recognised to vacancy rate of 16%. at a national level for this. • There were concerns identified during the inspection • The resilience service developed strong working regarding the emergency operations centre in relation relationships with the Sports Ground Safety Authority to the management of clinical risks when the ‘stack’ of (SGSA) following innovative approaches to improving calls was increasing. medical safety standards at stadia events such as • Concerns were raised regarding the business premier league football matches and music concerts. continuity plans for the emergency operations centre • The advanced paramedic programme was an area of in the event of a major disruption of services. There work that would benefit patient care and improve would be a delay in the setting up of the dispatch treatment pathways for patients. function of this service. • The trust research and development team were • Data showed that between April 2015 to March 2016 involved in a number of trials which were underway at out of the eleven national ambulance trusts NEAS was the time of the inspection. These included for example the joint worst performing ambulance service in NHS trailing a device that regulated intrathoracic pressure with responses within the target for Red 1 during resuscitation and the PASTA trial which was a performance. There was a downward trend in the multi-centre randomised controlled trial to determine proportion of Red 1 calls responded to within 8 whether a Paramedic Acute Stroke Treatment minutes between June 2015 and March 2016. Assessment (PASTA) pathway could speed up access to • Patient Transport Services (PTS) provided resilience to stroke patients. support the emergency and urgent care service, both • The Trust had pioneered a Flight Deck methodology operationally and within the Emergency operations for the North East. This was a capacity management centre. The trust was in the process of implementing a system intended to support improved whole system project to integrate PTS with emergency care to create awareness of capacity, quicker and safer diverting of an integrated care and transport service. This meant patients to appropriate receiving care locations, and additional capacity would be created to support the enhanced whole system learning. transportation of urgent care patients. • The trust had been nominated for a national • The trust took into account local events which innovation award for the development and use of the increased demands on the service. Information electronic communication system. provided by the trust highlighted that staffing However, there were also areas of poor practice where demands for local events were planned in advance the trust needs to make improvements. and staffing rotas were adjusted as required. • There was a lack of clarity in the line management and Importantly, the trust must: governance arrangements for the community first • The trust must review and ensure there are responders they told us that there had been many appropriate arrangements in place to provide dispatch changes recently, which had left them unclear about in the event that Bernicia House was unavailable to who managed them. operate as a dispatch centre. We saw several areas of outstanding practice including: • The trust must ensure at all times there are sufficient numbers of suitably skilled, qualified and experienced • The trust had enrolled in the Mind blue light mental staff. health programme and had encouraged staff to take • The trust must ensure all staff have completed on training to support colleagues with their mental mandatory and role specific training relevant to their health. role. • The trust provided national support for a motorcycle application; this was a mobile phone application, that used smart phone technology to identify if a 3 North East Ambulance Service NHS Foundation Trust Quality Report 01/11/2016 Summary of findings • The trust must ensure all staff receive an appraisal and Chief Inspector of Hospitals are supported with their professional development. This must include support to maintain the skills and knowledge required for their job role. • The trust must continue to address the complaint and incident backlog and ensure systems and processes are put in place to prevent a re-occurrence. • The trust must ensure that clinical records are stored securely. In addition the trust should: • The trust should ensure all relevant staff have received appropriate major incident training. • The trust should ensure staff within the emergency operations centres are involved in the development of the strategy and vision of the service. • The trust should ensure staff are supported and encouraged to report incidents and feedback is provided to staff on the outcomes of the incident investigation. • The trust should review the training requirements for operational staff for vulnerable groups such as patients living with dementia and patients experiencing mental health concerns. • The trust should ensure there is a robust system in PTS to monitor the daily cleanliness of vehicles and ensure deep cleans are carried out to planned levels. Professor Sir Mike Richards 4 North East Ambulance Service NHS Foundation Trust Quality Report 01/11/2016 Summar y of findings Summary of findings Our judgements about each of the main services Service Rating Why have we given this rating? Good ––– Overall we rated emergency and urgent care services as good because: • There was an open and transparent culture with regard to the management of risk.
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