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Local Review: Welsh Ambulance Service Trust

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Local Review: Welsh Ambulance Service Trust WELSH AMBULANCE SERVICE TRUST LOCAL REVIEW Local Review: Welsh Ambulance Service Trust Assessment of Patient Management Arrangements within Emergency Medical Service Clinical Contact Centres 1 WELSH AMBULANCE SERVICE TRUST LOCAL REVIEW This publication and other HIW information can be provided in alternative formats or languages on request. There will be a short delay as alternative languages and formats are produced when requested to meet individual needs. Please contact us for assistance Copies of all reports, when published, will be available on our website or by contacting us: In writing: Communications Manager Healthcare Inspectorate Wales Welsh Government Rhydycar Business Park Merthyr Tydfil CF48 1UZ Or via Phone: 0300 062 8163 Email: [email protected] Website: www.hiw.org.uk Mae’r ddogfen yma hefyd ar gael yn Gymraeg. This document is also available in Welsh. 2 WELSH AMBULANCE SERVICE TRUST LOCAL REVIEW Contents 5 Foreword 6 Summary 7 Background 8 What we did 9 What we found 9 Patient Management Arrangements 15 Workforce 23 Governance Arrangements which support Quality and Patient Safety 25 Conclusion 26 What next? 27 Appendix A – Management Response Action Plan 3 WELSH AMBULANCE SERVICE TRUST LOCAL REVIEW Healthcare Inspectorate Wales (HIW) is the independent inspectorate and regulator of healthcare in Wales Our purpose Through our work we aim to: To check that people in Wales receive good quality healthcare. Provide assurance: Provide an independent view on the quality Our values of care. We place patients at the heart of what we do. Promote improvement: Encourage improvement through reporting We are: and sharing of good practice. • Independent • Objective Influence policy and standards: • Caring Use what we find to influence policy, • Collaborative standards and practice. • Authoritative 4 WELSH AMBULANCE SERVICE TRUST LOCAL REVIEW Foreword As the independent inspectorate and regulator of healthcare arrives at the scene. The review also considered how staff in Wales, Healthcare Inspectorate Wales (HIW) has a working within the Emergency Medical Service Clinical responsibility to provide the public with independent and Contact Centres in Wales are resourced and supported to objective assurance of the quality, safety and effectiveness undertake their relevant roles. of healthcare services in Wales. Following our review This report aims to highlight key themes, good practice and inspection activity, we make judgements and issue and recommendations for improvement, in relation to the recommendations to healthcare organisations to promote patient management arrangements being used by the improvements. In our role, it is important that we maintain service. We would like to express our thanks to all of the an overview of each of the NHS Health Boards and Trusts staff from WAST who facilitated and participated in in Wales. this review. As part of the HIW local review programme for 2019/20, The fieldwork for our review was undertaken between we devised a local review of the Welsh Ambulance Service November 2019 and January 2020, prior to impact of the Trust (WAST), as a result of ongoing concerns across Wales in COVID-19 pandemic. Therefore, it should be noted that regards to ambulance waiting times. It was established that the systems and issues described within the report, were this review should explore how the risks to patients’ health, accurate at the time of our fieldwork. safety and well-being are being managed, whilst they are waiting for an ambulance. The review set out to specifically assess how patients are being managed by the Emergency Medical Service Clinical Contact Centres in Wales, once a request for an ambulance is received, to the point where the ambulance 5 WELSH AMBULANCE SERVICE TRUST LOCAL REVIEW Summary This report highlights the findings from our review of the patient management arrangements in place within the WAST Emergency Medical Service Clinical Contact Centres in Wales. The key findings highlighted during our review are outlined below. We found processes in place which aimed to provide service demands, due to limited availability of ambulance patients with safe and effective care. However, concerns resource. We feel that this issue requires a holistic review, were highlighted by staff working within the service around which should involve all relevant stakeholders, to identify, the challenges and issues they regularly encounter, which develop and implement the relevant improvements were impacting on the ability of the service to respond required. to demand. There was a clear organisational structure in place, which We found that overall, there was a very strong team depicted the lines of reporting and accountability. However, working ethos amongst staff within the Emergency Medical concerns were highlighted to us by operational staff in Service Clinical Contact Centres in Wales (EMSCCCs), relation to the lack of communication and engagement from although our findings recognised it was a stressful and senior managers across the Trust. demanding environment to work in. Staff were striving to Systems were in place to record and monitor ongoing deliver services to patients in very challenging circumstances, service and organisational risks. However, we identified often exacerbated by issues with workforce capacity some concerns with the risk assessment for EMSCCC staff and resource constraints. training. In light of the concerns highlighted by staff The Trust had made attempts to improve capacity within the during our fieldwork, and reviewing the risk assessment, workforce, however staff still felt that there were we recommend that the Trust should reassess this risk, insufficient staffing levels within EMSCCCs. This subsequently to ensure that the initial risk score is aligned to the impacts on the service delivery and also impacts on morale current establishments and work environments, and that and well-being of staff. appropriate action is implemented to mitigate the risks to service provision, as well as staff well-being. Our review highlighted that further focus was required by the Trust to ensure that staff are provided with adequate Concerns were also highlighted around the consistency of training, development and support to enable them to incident reporting within the service. This therefore, should undertake their relevant roles. Throughout our fieldwork, be addressed to ensure that the organisation is fully aware suggestions were made by staff that could help improve of the issues and risks presented at an operational level. staffs’ learning, knowledge and development of skills, as well as the patient management arrangements in place. We found that the negative impact of the delays experienced with ambulance to hospital patient handovers, was consistently raised by staff throughout our fieldwork. Handover delay was a regular occurrence for the Trust and was having a significant effect on the service. This was affecting the ability of the Trust to adequately respond to 6 WELSH AMBULANCE SERVICE TRUST LOCAL REVIEW Background The Welsh Ambulance Service Trust (WAST) is the primary frontline service delivery for ambulance transport in Wales. The Trust was formed in 1998, and serves a population of approximately three million people across the seven health boards in Wales. The Trust provides emergency medical services, advice and WAST Clinical Response Model appropriate signposting to other healthcare services. In addition to emergency transport, WAST also provides Red Non-Emergency Patient Transport Service (NEPTS)1, as well as hosting the 1112 service, which consists of the NHS Immediately life threatening calls, such as cardiac arrest or Direct Wales3 and clinical triage elements of the GP choking. These calls will be subject to both clinical indicators, out-of-hours services4. such as Return of Spontaneous Circulation (ROSC) rates and a time based standard requiring a minimum attendance at As previously highlighted, the purpose of this review was 65% of these calls within eight minutes. to assess how the EMSCCCs in Wales assess and manage patients following requests for an ambulance. There are three EMSCCCs in Wales, with each covering a designated Amber region of the country. The contact centres are located in Cwmbran (South East), Carmarthen (Central and West) Serious but not immediately life threatening. These calls and Conwy (North). They are the central hub where all will include most medical and trauma cases, such as chest emergency calls in Wales are dealt with. pain and fractures. Amber calls will receive an emergency response. A response profile has been created to ensure Within each of the EMSCCCs, there is a team of operational that the most suitable clinical resource is dispatched to each staff who are responsible for triaging calls received and amber call. This will include management via “Hear & Treat” coordinating the required response. A triage process is services over the telephone. undertaken for each call and is completed through the Medical Priority Dispatch System (MPDS)5. The MPDS is used internationally to triage calls, including half of the Green UK ambulance Trusts. The responses provided by the caller 999 calls received and categorised as green are neither allow the system to generate a priority code. These codes are serious or life threatening. Conditions, such as ear ache or matched to the WAST Clinical Response Model categories, in minor injuries are coded as green calls. Green calls are ideally order to determine the clinical response required. suited to
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