Scrutiny at Eden 999 - Ambulance Service! A Scrutiny Review into the North West Ambulance Service Coverage and Emergency Response Times in Eden District Contents 1. Summary 3 1.1 What we wanted to do 3 1.2 How we did it 3 1.3 What we found out 3 1.4 Where we go from here 4 1.5 Summary of recommendations 5 2. Background 7 2.1 Membership and Terms of Reference 7 2.2 Background to North West Ambulance Service 7 2.3 Background to the Ambulance Service in Cumbria 8 2.4 Background to the Ambulance Service in Eden District 10 2.5 Background to Eden District 11 2.6 Automated External Defibrillators 11 3. Methodology 12 3.1 Desktop Research 12 3.2 Summary of Review Meetings 12 3.3 Surveys 14 3.4 Letters 14 3.5 Media Releases 14 4. Addressing the Scope: Evidence Gathered 15 4.1 To review the Emergency Ambulance Service within 15 Eden District and in the wider context of Cumbria 4.2 Emergency Ambulance Coverage in Eden District 15 4.3 Response Times 16 4.4 Developing a Rural Response Time Target 18 4.5 Community First Responders in Eden District 19 4.6 Alston Ambulance Agency 20 4.7 Automated External Defibrillator (AED) Towns 21 4.8 Raising Awareness 22 4.9 BEEP Fund/Doctors 23 5. Conclusions 24 5.1 Emergency Vehicle Coverage in Eden District 24 5.2 National Response Targets 24 5.3 Community First Responders 25 5.4 Automated External Defibrillators (AED’s) 26 5.5 Raising Awareness 26 5.6 Alston Moor 26 5.7 The Scrutiny Review in the Wider Context 26 6. Recommendations 28 Scrutiny Study of North West Ambulance Emergency Service in Eden District Coverage and Response Times 1. Summary 1.1 What we wanted to do Whilst Cumbria County Council has the statutory duty to scrutinise health services we are aware that, because of the size of the county it cannot usually look at detailed local issues. It was therefore decided, and agreed with the county, that Eden would look at health services in the district to make sure we are happy with the services provided. Following requests from residents and other factors it was decided to begin by investigating the emergency ambulance service in the district. 1.2 How we did it We began by holding four pre-scoping meetings to get up to speed with the current service We met and/or spoke with staff, users of the service and contacted all the parish councils in the district We also met with representatives of North West Ambulance Service, Cumbria Clinical Commissioning Group and Alston Ambulance Service We talked to representatives of Mountain Rescue, Community First Responders and the BEEP (Birbeck Emergency Equipment for Patients) service 1.3 What we found out There was a discussion in the House of Commons on 21 January 2013 when the Secretary of State, Anna Soubry, called for an urgent review of the Ambulance Services That everyone who contacted us or we spoke to said this was not about the ambulance crews, who were in their opinions, professional, caring and competent and wished their sentiments to be reflected in this report The current ambulance service data is designed to meet national response times rather that patient outcomes Response times in Eden district (and the rest of rural Cumbria) is significantly lower than urban areas and therefore affect outcomes The current national commissioning arrangements do not suit rural areas such as Eden district (nor the rest of rural Cumbria) That NWAS propose to make changes to the night time emergency ambulance cover in Cumbria. This will mean the loss of Penrith’s Rapid Response Vehicle (RRV) for 5 hours per night. There are a number of issues in the wider health organisation that impact on the ambulance service such as hospital turnaround times, patients requiring specialist treatment at hospitals outside of the county and emergency calls made when patients cannot see their GP’s or ‘Cumbria Health on Call - CHOCdocs’ (out of hours GP service) quickly. Community First Responders are a key part of the Ambulance Service in Cumbria and especially in Eden district and should be treated in a similar fashion to the Mountain Rescue Service in terms of VAT exemption/compensation. That Eden district needs to keep its ambulance vehicles and staff within the area 1.4 Where we go from here We are asking our MP to take four of our recommendations to the Health Minister to request that the Government investigate the national policies. We are asking the County Council Health Scrutiny to monitor NWAS and the recommendations the Eden Review Group has made. We have asked NWAS to consider some recommendations made and return their comments to us. We will consider progress with our recommendations in November 2014 and April 2015. 1.5 Summary of Recommendations Recommendation Responsible Body Financial Implications Delivery Risks to Timescale Delivery/Officer Comment 1. That the Government investigate the Government None March 2015 consistent failure to achieve the national target times in rural areas 2. That more emphasis should be placed on Government None March 2015 nationally reporting patient outcomes CCG rather than response times 3. A holistic approach to healthcare is Government None March 2015 required as there are pressures on CCG NWAS which are beyond their control such as queuing at A&E departments and problems with the Out of Hours GP service 4. Community First Responders are a key Government None March 2015 part of the Ambulance Service in Cumbria and especially in Eden district and should be treated in a similar fashion to the Mountain Rescue Service in terms of VAT exemption/compensation. 5. NWAS should report the contribution NWAS None March 2015 made by CFR’s to their national response targets and their contribution to patient outcomes 6. A limited extension of the CFR’s remit NWAS None March 2015 should be considered to include attending fall patients where there is low risk to the Recommendation Responsible Body Financial Implications Delivery Risks to Timescale Delivery/Officer Comment responders 7. Re-advertising the ‘Point Taken’ initiative NWAS None December and offering it in different formats to 2014 enable more remote rural residents the chance to register their properties in case of emergency 8. Using parish/community newsletters to EDC Some newsletters December inform residents of what to expect from Organisation and require purchase of 2014 NWAS when calling in an emergency and External Relations PH space in their magazine. what NWAS expects from the caller Costs would be minimal. 9. The key service centres in Eden to be EDC Finance for AED’s could March 2015 promoted as AED Towns and Heartstart Organisation and be grant financed. training to be offered to as many External Relations PH Heartstart training is residents including school pupils and free. businesses as possible 10 To monitor the RRV situation should the CCC Health Scrutiny None March 2015 proposals be brought up again next year 11 Councillor Libby Bateman be supported in CCC Health Scrutiny None her bid to have a mobile ‘app’ for public AED locations to be rolled out nationally 2. Background 2.1 Membership and Terms of Reference 2.1.1 Six members were nominated to the Task and Finish Group. They were: Councillors: Patricia Godwin Neil Hughes Keith Morgan Sheila Orchard Joan Raine (Chairman); and Malcolm Temple 2.1.2 Although Cumbria County Council has the statutory duty for health issues, this topic affects all residents in and visitors to Eden district and was a topic raised by the public during consultations for the 2013/14 Scrutiny Work Programme. 2.1.3 The Group agreed the following Terms of Reference: a) To examine the current performance of the North West Ambulance Service (NWAS) against Category R1 (immediate life threatening calls) and Category R2 (less critical but still urgent) calls. b) To understand the limitations/obstacles that prevent achievement of targets and consider if/how these can be overcome. c) To examine the pattern of Community First Responders (CFR’s) in the district and if/how to develop the scheme. d) To monitor the new approved proposals for the Alston Ambulance Service during the review period. 2.2 Background to North West Ambulance Service 2.2.1 The North West Ambulance Service NHS Trust (NWAS) was established on 1 July 2006 following the merger of the Cumbria, Greater Manchester, Lancashire and Mersey Regional ambulance trusts. 2.2.2 NWAS provides services to a population of around seven million people across a geographical area of approximately 5,400 square miles. The Trust handles in the region of one million emergency calls each year and undertakes approximately 1.2 million patient journeys. 2.2.3 The Trust employs just under 5,000 staff who operates from 109 sites across the region and provides services for patients in a combination of rural and urban communities, in coastal resorts, affluent areas and in some of the most deprived inner city areas in the country. NWAS also provide services to a significant transient population of tourists, students and commuters. 2.2.4 Ambulance services nationally are required to achieve 75% attendance in 8 minutes from the call connect point for immediate life threatening conditions classed as Red 1 (R1) and 75% in 8 minutes attendance from point of triage for all other Red 2 (R2) emergencies. There are no national targets for Green (G1 and G2) categorised calls. 2.2.5 Red 1 - known as immediate threat to life are conditions which may require defibrillation (ie cardiac arrests and respiratory problems).