Agenda item

To receive and note the requested data, alongside responses to advance questions submitted by the Committee.

Marcus Bailey – Chief Operating Officer EEAST (COO) and Ross Collett - Associate Director of Urgent & Emergency Care NHS Norfolk & Waveney ICB (ADUE) attended the meeting remotely to brief the Committee.

The COO began by noting that response times were a known concern, particularly in areas such as North Norfolk, and confirmed that as a result Rapid Response Vehicles (RRVs) would remain in place for the remainder of the financial year, in addition to training over 100 new emergency call handlers. The ADUE stated commissioning arrangements with the ambulance service would be rolled over without change, though contract negotiations for 2023 were due to begin in Q3. He added that this allowed services to remain in place, whilst providing additional funding to help address service delays. It was noted that urgent care stacks had also been reviewed to consider what more could be done to respond differently, in ways that may not require an ambulance, thus reducing wait times for those in life threatening situations.

Questions and Discussion

       i.          Cllr N Housden referred to a press report about EEAST not having a comprehensive record of defibrillators across the region, and asked how long it would take to complete the registration process. The COO replied that the National Defibrillator Project was ongoing with the first wave of registrations complete, and an overall aim to have records complete by the end of October. Cllr N Housden noted that he understood there was also a shortage of defibrillator batteries, and asked whether this was being addressed. The COO replied that batteries had now begun to be received with over 100 distributed to local communities.

      ii.          Cllr V Holliday asked if there had been a decrease in ambulance dispatches from the Multidisciplinary Team approach, to which the ADUE replied that 48% percent of calls reviewed had been pulled away from the Ambulance Service, and evaluation data could be shared with the Committee once available.

     iii.          The ADUE stated that there was a direct correlation between ambulance response times and delays at hospitals, and concerted efforts were being made across services to address this, such as introducing Acute Hospital Liaison Officers at all Norfolk hospitals. He added that category 2 rapid release trials, which allowed for the rapid release of ambulance crews to respond to C2 calls had been successfully utilised at the NNUH, in a similar way to the C1 drop and go process. It was noted that cohorting areas had also been established to allow patients to be safely looked after whilst allowing faster release of ambulance crews.

    iv.          Cllr V Holliday stated that the NNUH had the longest ambulance wait times in the region with the QEUH in fourth, which had a significant impact on ambulance response times. She added that postcode data from earlier in the year for NR23 C1 calls showed mean response times of up to 35 minutes and 23 minutes for NR24, and asked officers for comment. The ADUE replied that none of the delays were acceptable, and patient safety remained the principal concern with all efforts being made to improve response times. He added that staffing shortages were a contributing factor, with the impact of Covid both limiting the number of staff available to work, and causing more long term issues such as staff burnout. The COO stated that response times would require a combination of actions to improve, as data showed that C2 patients were at the highest risk due to the volume of calls compared with C1 calls, accounting for approximately 75% of combined ambulance activity. He added that further measures to address the risk of harm to patients included installation of community defibrillators, enhancing cooperation with the fire and rescue services, supporting Community First Responders (CFRs) with fuel costs, and introducing a volunteer staff responder pilot scheme. It was suggested that reducing the job cycle time, from call to hand over of a patient by reducing the number of patients transported to A&E, with more local support offered would also help to improve response times.

      v.          Cllr N Housden stated that strategic long-term plans should to take into account the impact of Covid to ensure that adequate staffing arrangements remained in place. He added that volunteers were too often called upon and greater efforts were required to address major strategic issues. The COO replied that whilst many of the test to change actions were having an impact and helping evolve the service, urgent and emergency care remained crucial, and this required adequate staffing with national strategies in place to help address this. He added that the skillset, diversification, and progression opportunities were crucial to improve and retain the existing workforce. It was noted that digitalisation would also have an impact on services, with the potential for new triage software to help the service adapt to new challenges. The COO stated that further options would be explored including increased use of private ambulances, and increased use of agency staff to plug gaps in the short-term. He added that a small scale trial in Cromer granted digital access to patient records and had reduced conveyance to hospitals by between 3-5%, which equated to 30-60 minutes for every patient. The ADUE stated that the strategic approach would also look at public health data to consider how people could be kept healthier for longer, to reduce the level of need placed on the urgent and emergency care system. He added that waiting lists also had to be reduced as quickly as possible, as it was common for these individuals to require urgent and emergency care.

    vi.          The Chairman referred to meeting the needs of individuals and asked if the ICB and EEAST were conscious of meeting and managing the expectations of the public. The ADUE acknowledged that services had not always done well at meeting public expectations and communication needed to improve to address this. He added that staff were under significant pressure from increased demand, and this needed to be communicated more effectively.

   vii.          Cllr W Fredericks stated that Mundesley had two excellent CFRs and suggested that whilst fuel subsidies were appreciated, they needed retained payments similar to the Fire Service, as this would help the recruitment and retention of staff. The COO replied that the use of CFRs was helpful, but there were risks with becoming too reliant and support had to be offered incrementally. He added that he was keen to support the service and recognised its value, but noted that there had to be a balance between the support that could be offered and funding for paid staff. It was noted that several charity funds had been used to support volunteers, and further cooperation between charities and the NHS could be utilised again in the future.

  viii.          The Chairman referred to delays moving patients from hospitals into long-term care, and asked whether any measures were being taken to address this. The ADUE replied that whilst this was a known issue, it was difficult to summarise its impact. He added that there was focus on returning patients home once safe to do so, with additional support offered for domiciliary care. The Chairman said that it would be helpful to see the ICS’s strategic plan to tackle the issue.

    ix.          Cllr N Housden referred to an age profile included in the agenda, and noted that the District’s demographic was over twice the national average of residents aged 65 and over, and asked what plans were in place to account for this. The ADUE replied that the demographics were a known issue, and were taken into consideration during the planning process, alongside public health data and measures such as deprivation. He added that it was useful to understand the difference between urgent and emergency care, with over 80% of urgent care being managed in primary care. It was noted that frailty was not directly related to age and could be reversed, and focus was therefore placed on prevention.

      x.          The Chairman asked if there was anything the Council or Councillors could do to support the health and emergency services. He added that recruiting CFRs for instance, was something that may be possible to support at parish level. The ADUE replied that support for summer plans at parish level, and communication of messages at parish and district level would be helpful. He added that at a strategic level the importance of ICB place boards would be crucial as a local forum to engage with issues such as demographic data and the local footprint of services. The COO stated that promoting public health remained a key message that the health services would appreciate being shared across the District. He added that signposting residents to a range of recruitment opportunities such as CFR and paid positions would also be helpful.

    xi.          Cllr V Holliday stated that whilst the North Norfolk Ambulance Response Monitoring Group had seen reasonable success in its initiatives, these could be expanded, in addition to support that could be provided to patients leaving hospitals by their communities.

RESOLVED

1. To note the discussion

ACTIONS

1.     ICB to share evaluation data of Multidisciplinary Teams reducing the number of Ambulance Service requests once available.

2.     ICB to share plans for reducing delays in transferring patients from hospitals to long-term care.

3.     Consideration to be given as to how NNDC may help to promote key health related messages at Town and Parish level to support ICB and EEAST.