Scottish Ambulance Service

Argyll & Clyde Sub - Division

Remote & Rural Resources

Introduction:

The Sub – Division of Argyll has a mixed population density with the major towns being Helensburgh (18,152), Oban (10,643) and Dunoon (12,106) all other settlements on the main land have a population of 6,679 or less. There are many island locations in Argyll ranging in population form Bute (6,894) to Sanda (1).

Ambulance locations within Argyll Sub - Division provide operational cover predominately standby / on call working. The islands use a mixture of contractors, first responders and other health care professionals to respond patients.

In line with the Strategic Options Framework for Emergency and Urgent care to Remote and Rural Communities 2009, a mapping exercise was carried out to in conjunction with Territorial Health Boards to identify the Remote and Rural locations within the Division as well as existing resources and nearest response to each.

What we do

Emergency response

• As the front line of NHS services in Scotland our key role is to respond to 999 calls as quickly as possible with the most appropriate skills and equipment. • On average, our crews respond to more than 500,000 emergency incidents every year across Scotland. • We operate around 450 emergency ambulance vehicles from more than 100 stations and can also respond with helicopters, if necessary. • Every time our call takers receive a 999 call, they question the caller in detail about the nature of the emergency to ensure we respond quickly in the most appropriate way. Using sophisticated world-class software, call takers categorise calls into three types. • Category A are classed as life threatening and as the most serious calls are always prioritised above any other type of call. • Calls which are serious, but not life threatening, are prioritised as Category B and may sometimes receive a slightly slower response as life threatening calls are prioritised ahead of them. • Calls which are neither serious or life threatening are graded as Category C and in many cases do not require the skills of an emergency ambulance crew. Many of these calls are referred to the most appropriate agency, such as NHS 24. • Our call takers often give life saving medical advice over the phone while the ambulance is on its way and our highly skilled crews are trained to deal with a wide range of medical emergencies. • The Scottish Government sets targets for us to reach patients within certain timescales. The targets are: – 75% of Category A calls in eight minutes (by March 2009); 1 – 91 % of category B calls in 19 minutes, depending on population density.

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3 Table 2 overleaf outlines the current staffing levels and Skill-Mix per location in Argyll and Bute and includes the current vacancy status. The Resource levels in the table are for both Scheduled and Unscheduled Care provisions.

4 Table 2 - . SAS Workforce profile and Skill mix Argyll & Bute June 2015

Location Staff Numbers Skill Mix Live Cover On Call Vacancy Status Arrochar 4 3 Paramedics Various Shift Lengths over Yes 1Technicians 7 days Inverary 4 1 Technician Team Leader Various Shift Lengths over Yes 2 Paramedics 7 days 1 Technician Helensburgh 14 1 Paramedic Team Leader 24 hours No 2 Relief Vacanc ies 1 Technician Team Leader 6 Paramedics 5 Technicians 1ACA Dunoon 30 2 Paramedic Team Leader Varying Shift Lengths over Yes 2 Technician Vacancies 6 Paramedics 7 days 1 Driver 2 Vacancy 11 Technicians 7 Driver 2’s 4 ACA’s Rothesay 13 1 Technician Team Leader Varying Shifts Lengths Yes — 3 Paramedics over 7 days 5 Technicians 4 ACA’s Lochgilphead 11 .5 1 Technician Team Leader Varying Shift Lengths over Yes 3 Relief Vacancies 4 Paramedics 7 days 4 Technicians 2.5 ACA’s Tarbert 4 1 Paramedic Team Leader Combined Cover with Yes 1 Paramedic Vacancy 1 Paramedics Lochgilphead over 7 days 1 Technician Campbeltown 17 1 Paramedic Team Leader Varying Shift Lengths over Yes — 9 Paramedics 7 days 3 Technicians 4 ACA’s Islay 6 1 Paramedic Team Leader Varying Shift Lengths over Yes — 1 Paramedic 7 days 2 Technicians 2 Driver 2’s 5

Oban 21 1 Paramedic Team Leader Varying Shift Lengths over No 1 Vacancy 1 Technician Team Leader 7 days 7 Paramedics 2 Trainee Paramedics 7 Technicians 3 ACA’s Mull 5 1 Paramedic Varying Shift Lengths over Yes 1 Paramedic Trainee 7 days 1 Technicians 2 Driver 2’s

It should be noted that On Call working has reduced by almost one third over the past year and we are currently reviewing our resources to identify where we can reduce this further.

The table below identifies the rural assessment mapping for Argyll based on RRIG Strategic Options Framework detailing drive time & estimated SAS response time and the type of response.

Table 3 - Remote and Rural Analysis as per Argyll CHP patients register 2010, Island population as per 2001 Census

The table below identifies the mapping for Argyll;

Table 1 Remote and Rural Analysis as per Argyll CHP patients register 2010, Island population as per 2001 Census

Settlement (1) Proposed Remote Population Drive time to settlement Response time from closest Comment & Rural (3) of 10,000 (4) SAS location (if different) classification (2) Helensburgh N/A 18152 N/A <8 mins 1 or 2 x AEU Oban N/A 10643 N/A <8 mins 2 X AEU Dunoon N/A 12106 N/A <8 mins 2 X AEU (1 x on-call) Police first responder Campbeltown N/A 6505 120 mins <8 mins 2 x AEU (on-call) Lochgilphead N/A 6679 50 mins <8 mins 2 x AEU (on-call) with Tarbert Taynuilt N/A 4758 22 mins 15 mins Kilcreggan Remote Rural 2426 28 mins 25 mins FR scheme operational Garelochhead Accessible Rural 2094 15 mins 10 mins FR Scheme operational 6 Tarbert Very Remote Rural 1681 70 mins <8 mins 1 x AEU(on-call) with Lochgilphead Kilmun Remote Rural 1349 13 mins 15 mins Inveraray Remote Rural 1214 55 mins <8 mins 1 x AEU (on-call) Arrochar Accessible Rural 1068 27 mins <8 mins 1 x AEU (on-call) Tighnabruaich Accessible Rural 1002 35 mins 35 minutes Strachur Accessible Rural 895 30 mins 25 minutes Port Appin Accessible Rural 875 35 mins 20 minutes Muasdale Very Remote Rural 817 95 mins 20 minutes Carradale Very Remote Rural 630 105 mins 30 minutes Lochgoilhead Accessible Rural 468 45 mins 30 minutes FR Scheme operational Southend Very Remote Rural 444 130 mins 20 minutes Isle of Colonsay Island Community 123 145 mins Island Class Vehicle + volunteers Isle of Jura Island Community 212 240 mins GP & Volunteers + Island Class Vehicle Isle of Coll Island Community 217 180 mins Island Class Vehicle + GP Isle of Mull Island Community 3127 80 mins <8mins 1 x AEU (on-call) Community AED’s Isle of Tiree Island Community 725 240 mins Contractor & GP Isle of Islay Island Community 3441 200 mins <8mins 1 x AEU (on-call) Community AED’s Isle of Bute Island Community 6894 60 mins <8mins 1 x AEU (on-call) Police first responder Isle of Danna Island Community 5 No Ferry Isle of Davaar Island Community 2 No Ferry Isle of Easdale Island Community 58 40 mins Isle of Erraid Island Community 8 100 mins Isle of Gigha Island Community 110 120 mins Island Class Vehicle + Contractor Isle of Gometra Island Community 5 90 mins Isle of Inchtavannach Island Community 3 70 mins Isle of Innischonan Island Community 1 No Ferry Isle of Iona Island Community 125 100 mins Isle of Kerrera Island Community 42 6 mins Isle of Lismore Island Community 146 25 mins Island Class Vehicle + Volunteer Isle of Luing Island Community 212 40 mins Island Class Vehicle + Volunteer Isle of Lunga Island Community 7 30 mins Isle of Oronsay Island Community 5 140 mins 7 Isle of Sanda Island Community 1 No Ferry Isle of Seil Accessible Rural 560 20 mins Road Bridge to Mainland Isle of Shuna Island Community 1 35 mins Isle of Ulva Island Community 16 80 mins

References (1) Remote and Rural classification determined as per RRIG Strategic Options Framework:

• Very Remote Rural- Defined as settlements of less than 3,000 people and with a drive time of over 60 minutes to a settlement of 10,000 or more • Remote Rural- Defined as settlements of less than 3,000 people and with a drive time of between 30 and 60 minutes to a settlement of 10,000 or more • Accessible Rural- Defined as settlements of less than 3,000 people and within a 30 minute drive time to a settlement of 10,000 0r more • Island community

To ensure that the Division is able to meet the needs of not only these communities but also its staff, the Divisional Management Team must identify ways to redesign ambulance provision in some of these areas taking into account the recommendations from the Remote & Rural Implementation Group (Strategic Options Framework for Emergency and Urgent Response to Remote & Rural Communities, Oct 2009)

The number of first responder schemes within Argyll & Clyde Sub Division has changed over the past few years. Contained in the table below are the current schemes operating in the Sub Division. We are currently reviewing our Sub Divisional requirements to identify areas where further schemes are required.

Table 4 - Argyll & Clyde Sub Division First responder Schemes in Operation as at Nov 2013

Scheme Name \Operating Area Call Sign Number of active members

Ardfern ARDFRU 18

Braehead BHDFRU 12 Croabh Haven CRHFRU 5 Garelochhead GLHFRU 7 Glasgow Airport GLAFRU 7 Isle of Luing LUIFRU 11 Lochgoilhead LOCGFRU 9

8 Neilston and Uplawmoor - - - 14

Below outlines the key work streams which have been identified to address some of the challenges.

Key Work streams:

No. Action Points Progress to date Review Date Completion Owner Progress Date Status 1. Increase the number of 1 st The CRDO has a plan in place to identify and try to Monthly at On going CRDO Responders both community, increase 1 st responder sites DMT NHS and PTS to improve the time it takes to get help to patients 2. Increase the number and use of Quarterly meetings with BASICS Qty On going G. Fraser BASIC’s schemes Increased use by EMDC although needs improved Identified new GP’s interested in Argyll 3. Identify ways to reduce On call Shorter Working Week program addresses this July 2013 July 2015 G Fraser working partially. More work required.

4. Identify ways to undertake PTS MOU in Argyll with British Red Cross July 2013 Mar 15 G Fraser joint working initiatives 5. Put in place more sustainable In place and operational. - Aug 2011 G Fraser access to remote islands (Island air ambulance Initiative) 6. Identify ways to address Skills Clinical Governance & Quality lead/group July 2013 Mar 2015 R Lilly atrophy in particular for remote progressing this (See Clinical Action plan) and rural crews 7. HOS to set up a Remote & Rural Gap Analysis complete, vulnerable areas identified June 2013 Mar 15 G Fraser group with each NHS Board to (SE Islay, Lochgoilhead, Tighnabruaich). On going take forward recommendations in work to address vulnerabilities with workable FR RRIG strategic options schemes and BASIC responders. framework document including GAP analysis work

= good progress = steady progress = slow progress

Conclusions:

9 The challenges of providing ambulance services to remote and rural areas should not be underestimated and the Divisional Management Team shall continue to work towards re designing ambulance service provision in remote and rural areas, including where possible, working in partnership to achieve this.

It is also essential that the Division links into the Remote & Rural steering group and other rural groups particularly local NHS Public Partnership Forums and Local Authority Community Care Forums.

Wendy Quinn Head of Service Argyll & Clyde 1st June 2015

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