East Midlands Ambulance Service Quality Account 2017/18

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1 East Midlands Ambulance Service Quality Account 2017/18 Caring Patience Friendly Professional Compassionate Fantastic HELPFUL AMAZING CALM Respectful Reassuring KIND EXCELLENT WONDERFUL BRILLIANT EFFICIENT 1

2 Contents Introduction... 4 Declaration of accuracy... 5 About us... 6 EMAS vision and values... 6 People we serve... 6 The area we cover... 7 Our service... 7 Review of quality improvements for 2017/ Our 2017/18 priorities... 9 Commissioning for Quality and Innovation (CQUIN) New services and innovation Enhancing quality improvements and assurance What we want to do better in 2018/ Evidence of quality improvements for 2017/ What have we done to improve patient safety? Learning from incidents, experiences and feedback Duty of Candour EMAS Patient Voice Quality visits Assurance rather than improvement What we have done to improve patient experience Compliments Continuing improvements to the EMAS complaints system Formal Complaints (FC) Ombudsmen requests Patient stories Extracts from messages of thanks during 2017/ Community engagement Staff engagement Communications and social media Equality and diversity Improving the care environment Appendix 1 Workforce Appendix 2 IG Toolkit

3 Appendix 3 Research and Development Appendix 4 CQC registration Appendix 5 Third Party Statements Appendix 6 EMAS Trust Board Director s responsibilities in respect of the Quality Account Glossary Contact details

4 Introduction Welcome to the Quality Account for 2017/18 for East Midlands Ambulance Service NHS Trust (EMAS). Over the last year EMAS has faced many challenges; including unprecedented levels of demand, changes to the way we respond to patients and cyber-attacks. With the hard work and commitment of our staff we have still managed to make significant improvements. Following the largest clinical ambulance trials in the world, NHS England implemented the new Ambulance Response Programme (ARP) standards across all ambulance trusts in The changes focus on making sure the best, high quality, most appropriate response is provided for each patient first time. In order to deliver our service through ARP and for patients to benefit fully from it, we consulted with our staff and trade unions on a proposed new operating model. The consultation was not about reducing the overall number of staff available across the region. It was about increasing the number of ambulances available to take patients to hospital and reducing the number of cars. Our new operating model was launched in April Alongside this change, we have attracted and recruited more people to our frontline, and have improved our retention rate through schemes that have improved the staff support we provide. We have also launched a new service to support patients with an urgent healthcare need. On average we get 130 calls a day from healthcare professionals (HCP) making bookings for the provision of care and transport for people with an urgent healthcare need. The journeys are provided by our ambulance crews when they are not required to respond to higher priority 999 calls. From April 2018 we have introduced the Urgent Care Transport Service (UCTS) starting with 20 additional ambulance resources during the day to provide care to patients categorised as urgent. This then allows other ambulance crews to focus on 999 emergency calls. In addition, our financial position has significantly improved and is more stable, and we ve invested in new ambulances and equipment. These improvements, to name a few, have resulted in our commissioners and regulators having improved confidence in our ability to continue to develop services and create organisational strength, as evidenced in the latest Care Quality Commission inspection report. At the heart of the changes we have made has been the Plan, Do, Study and Act methodology which we have adopted. It ensures there is a robust mechanism to drive quality improvement and challenge the process, and to check that systems are working and constantly adapting to change. 4

5 In this report you will find a review of how we did against our quality and safety targets and updates on innovation, and research and development work at EMAS. To the best of our knowledge the information contained within this Quality Account is accurate and reflects a balanced view of EMAS future ambitions. Finally, we would like to say thank you to all our colleagues, volunteers and partner agencies for their continued hard work and commitment to providing the best services possible for patients. It hasn t been easy this year, but as evidenced in this report, we are making progress and heading in the right direction on our improvement journey. Richard Henderson Chief Executive Declaration of accuracy I confirm that to the best of my knowledge the information presented in our Quality Account is accurate. Richard Henderson Chief Executive 5

6 About us East Midlands Ambulance Service (EMAS) provides emergency and urgent healthcare on the move and in the community. EMAS vision and values It is our vision to deliver outstanding sustainable emergency and urgent care services across the communities of the East Midlands. We are transforming from a mainly emergencyfocussed service, reliant on a single Accident and Emergency contract (eg providing blue light responses to 999 calls), to an organisation that provides the most appropriate and effective response for patients. This will involve providing care directly, signposting or referring patients to the best service that can support them in their homes and the community and reducing admission to hospitals, where appropriate. We will do this by working closely with primary, community, social care, mental health and secondary care services. Our values support everything we do. They are: Respect: Respect for our patients and each other Integrity: Acting with integrity by doing the right thing for the right reasons Contribution: Respecting and valuing the contribution of every member of staff Teamwork: Working together and supporting each other Competence: Continually developing and improving our individual competence Our values help us provide our patients with access to high quality clinical care and services to ensure the best experience and clinical outcome. People we serve The East Midlands is undergoing similar demographic changes to the rest of the country; as our growing and aging population has ethnicity and health diversities. There are specific local area differences and challenges, such as student populations and areas with concentrations of young families or retirees, with significant variations in population densities. Historically the region s population has been growing fast and this looks set to continue over the next decade, putting pressure on our new and existing services. Health 6

7 inequalities are marked across the region, with generally poorer levels of health in the urban centres, as evidenced through Public Health England s data. It must be our priority, together with our commissioners, to ensure equality of service provision to all patients. The area we cover We provide emergency 999 and urgent care services for a population of approximately 4.8 million people within the East Midlands region. This region covers approximately 6,425 square miles and includes the counties of Derbyshire, Leicestershire, Lincolnshire, Northamptonshire, Nottinghamshire and Rutland. There are large differences in population density across the East Midlands from the highly concentrated urban areas and more dense population corridor along the M1, to the low density rural areas in the east. There are several airports within our region, with the largest being East Midlands Airport serving over four million passengers a year. Two of the UK s mainline railways serve the region, providing regular high speed services. The East Midlands is home to numerous entertainment venues including major sporting venues, national parks and forests, the East Coast, music festivals, the National Space Centre, and holiday and caravan parks. Our service Our annual turnover is million (2017/18) and we are paid to provide services by 22 clinical commissioning groups (CCGs) based across the East Midlands. We deal directly with the A&E contract lead in NHS Hardwick CCG, which represents the other CCGs in the region. We employ over 3,000 colleagues, the majority being frontline accident and emergency ambulance personnel. Patient Transport Services (PTS) are currently provided for people who have routine (nonurgent and scheduled) clinic appointments across Derbyshire. 7

8 We operate from over 90 facilities including ambulance stations, community ambulance stations (smaller facilities which are often shared buildings with other organisations, and are used as standby points for our crews), two emergency operations centres (Nottingham and Lincoln), training and support team offices and fleet workshops. Every day we receive around 2,500 calls from people dialling 999 and other healthcare professionals making urgent transport requests. During 2017/18 we received 989,486 emergency and urgent calls to our emergency operations centres, and dispatched ambulance clinicians to 651,875 incidents, using a fleet of over 580 vehicles, including emergency ambulances, fast response cars, specialised vehicles. In addition to our core services, we provide a range of other key services including: Specialist transfers: inter-hospital transfers that include adult critical care for specialised surgery, paediatric and neonatal care. Hazardous Area Response Team (HART): a dedicated team providing specialised cover for civil contingencies, major incidents and chemical, biological, radiological and nuclear (CBRN) incidents. Emergency Preparedness and Business Continuity (regional resilience): a service that ensures we are prepared to deal with a range of civil contingencies and major incidents. It works closely with the six local resilience forums across the region, each of which includes local authorities, police and fire services. This also ensures business continuity in the event of a civil contingency or other adverse event that affects normal operations. Bariatric transfers: specialist services and equipment to transport bariatric patients (our bariatric ambulances can transport patients with a weight of up to 50 stone). Cycle Response Unit: these individuals carry the same essential life-saving equipment as a fast response car and can reach patients even faster in congested areas. Patients can often be treated on the scene by the Cycle Response Units meaning our ambulance vehicles can be deployed to other life threatening emergency calls. Community Public Access Defibrillators (CPAD): we have placed life-saving equipment in local communities across the East Midlands. Defibrillators are used when someone has gone into cardiac arrest (ie when the heart stops pumping blood around the body), to give the heart an electric shock to allow effective 8

9 cardiac rhythm to be re-established. Events support: a commercially available team that provides professional emergency medical support to special events such as sporting, musical and athletic showcases across the region. Admission avoidance schemes: provided through a number of schemes across the East Midlands including Falls Partnership Services and mental health nurse with an EMAS paramedic responding to related calls in a fast response car. Review of quality improvements for 2017/18 This Quality Account demonstrates our achievements for the year 2017/18 and what we are aiming to achieve in the coming year. We are required to achieve a range of performance outcomes specific to the nature of the services we provide to the public. In addition, we are required to achieve many other organisational responsibilities as laid down by the Department of Health. Our 2017/18 priorities We identified the following quality improvement priorities against the three domains of quality these being: Clinical effectiveness Patient safety Patient experience Priority 1: Cardiac arrest return of spontaneous circulation (ROSC) and survival outcomes. EMAS has continued to focus its attention upon the improvement of successful ROSC rates in cardiac arrest. Priority 2: Sepsis is a worldwide public health issue. In developing nations, sepsis accounts for nearly 80 percent of deaths. Sepsis kills far more citizens than AIDS, prostate cancer and breast cancer combined. It is the leading cause of death and has a high mortality in the developed world. Priority 3: To identify the common themes of all maternity related incidents, and to reduce patient related incidents. Priority 4: To explore the use of alternative pathways in each division by using the pathfinder leads to develop the pathways in EMAS in each commissioning area. Priority 5: To improve performance and reduce prolonged waits across all call categories. In the Quality Account we evidence how these priorities have been met and are progressing. 9

10 Commissioning for Quality and Innovation (CQUIN) CQUIN schemes are an opportunity for EMAS to provide a key focus on quality improvement. The outcomes from these schemes can be significant and impact directly on patient care. We have focused on delivering schemes in the below areas that make significant changes to the lives of patients and their outcomes. Workforce Wellbeing Electronic Patient Record During 2018/19 we will continue to focus on sepsis treatment. This will include: Identifying and treating Sepsis within our patients. Ensuring the formalisation of an EMAS Sepsis Lead, including documented objectives and performance measures. Appointing divisional Sepsis champions (one per division) on a volunteer basis. Developing a robust action plan to ensure the availability of waveform capnography on a minimum of 95% of frontline operational resources (double crewed ambulance and fast response vehicle). Working with a partner acute trust to explore the increased pre-hospital use of IV antibiotics in the treatment of Sepsis. New services and innovation Sepsis Following an EMAS wide review of Sepsis care within untoward incidents raised from both within the organisation and externally, common themes were identified, and measures were adopted to minimise risk of reoccurrence and improve patient care across the region. In summary the main actions have been as follows: Review and re-launch of the Sepsis Triage Tool, which is used by clinicians during patient consultations. The triage tool aligns to NICE guidance NG51 Sepsis: recognition, diagnosis and early management. The launch was supported by EMAS clinical leadership teams and internal communications. Launch of a telephone Sepsis triage tool for the Clinical Assessment Team (CAT). Recognising the potential difficulty in recognising Sepsis using telephone triage, we produced guidance aligned to the face-to-face Sepsis Triage Tool that gave indicators to telephone clinicians to recognise severity and physical deterioration of a sepsis patient and the appropriate level of response required for that patient. 10

11 Additionally, we distributed, through commissioner colleagues, guidance on calling 999 to oncology departments across the region, for patients at potential risk of neutropenic sepsis. This guidance enabled patients at risk to access a CAT clinician who would then use the telephone triage tool to ensure the appropriate level of response. Throughout this review process it was evident that a growing body of guidance recommended treatment for a red flag or high risk sepsis patient within the hour of recognition. The recommended treatment for these patients was for use of oxygen, fluid resuscitation and early empiric antibiotic therapy. Within ambulance services only the fluid and oxygen elements of this treatment were given, leaving the antibiotic treatment until arrival at an emergency department. Given the benefits for sepsis patients in terms of the reduction in mortality with early antibiotic therapy, EMAS worked with key stakeholders within North Lincolnshire to conduct a service evaluation; assessing the feasibility of a paramedic delivering antimicrobial therapy in the pre-hospital environment. Through close collaboration between EMAS, North Lincolnshire and Goole NHS Hospital Trust (NLAG), Lincolnshire Clinical Commissioning Groups (CCG) and Path Links Microbiology Service we were able to conduct a six month evaluation where 20 paramedics, who volunteered for the trial and attended training in their own time, carried an antibiotic therapy during operational shifts. Over the six month period we treated 90 patients for a red flag sepsis, with results showing an accuracy of diagnosis for identifying an infectious source of over 94%. Our paramedics were also able to demonstrate effectiveness in obtaining blood culture samples, which should be harvested prior to antibiotic medication, returning a contamination rate slightly lower than those of the receiving emergency departments over the same period. Through retrospective analysis of the results it was shown that where a paramedic delivers the antibiotic therapy, the patient receives this vital medication over 70 minutes sooner than for patients transported to emergency departments for treatment. We have presented our findings on a national level and were honoured to receive the Research most likely to affect practice award at the 999EMS Research Conference in March 2017 in addition to a highly commended award from the East Midlands Critical Care Network in November With a view to standardising this treatment across the region, work has started within Lincolnshire division with support from both NLAG and United Lincolnshire Hospitals (ULHT). Both hospital groups are in the process of aligning emergency department treatment for these patients to complement the medication EMAS will deliver and provide a unified treatment pathway across the county. Within EMAS work has also started on an electronic training package for all paramedic staff in Lincolnshire and Leicestershire to access prior to the therapy being rolled out. 11

12 The evaluation has generated national interest and we have received invitations from representatives within the hospital groups in Derbyshire and Nottinghamshire to discuss subsequent cascade to these divisions. Urgent Care Transport Service We have launched a new service to support patients with an urgent healthcare need. On average we get 130 calls a day from healthcare professionals (HCP) making bookings for the provision of care and transport for people with an urgent healthcare need. The journeys are provided by our ambulance crews when they are not required to respond to higher priority 999 calls. Most HCP bookings are received during the afternoon when we also experience an increase in emergency 999 calls. This means patients can experience delays of several hours, putting additional pressure on the patient, our control centre staff and ambulance crews. To address this and improve services, we have introduced the Urgent Care Transport Service (UCTS). From April 2018 we had 20 additional ambulance resources during the day to provide care to patients categorised as urgent. The team manning the UCTS vehicles are not being trained to drive on blue-lights and the vehicles they use do not allow them to travel with lights and sirens on; therefore, these crews won t be dispatched to 999 emergency calls. Instead they will focus on HCP referrals, allowing other ambulance crews to focus on 999 emergency calls. Enhancing quality improvements and assurance Quality Everyday was introduced in 2015 as a programme to ensure we are focused on quality at every opportunity, and that everyone at EMAS understands their responsibility and contribution to deliver a high-quality service. It has now evolved into a robust programme of engagement with senior managers and staff, who embark on a quality assurance process, which identifies issues locally and through active challenges aims to ensure all key lines of enquiry are acted upon. Quality Everyday provides ambulance crews with a comprehensive up-to-date range of standards which can be measured allowing for timely and accurate feedback. Four strands are included in Quality Everyday: Central inspections (audits). Trust Board quality visits. Articles in the weekly electronic staff newsletter Enews. Quality Everyday station/base noticeboards. The Quality Everyday noticeboards and updates help improve communication with colleagues via the sharing of key messages, patient feedback, lessons learned from incidents and discussions at our Lessons Learned Group (protecting the identity of people involved), as well as local clinical updates and performance standards data. 12

13 The Quality Everyday programme has improved standards across stations and vehicles, embedding changes into everyday practice. The divisional Quality Everyday audits have provided divisional management teams with ownership of the process within their areas, empowering them to pursue the changes. Recent Quality Everyday inspections have also been undertaken with representatives from the Care Quality Commission and Patient Voice groups. The Trust Board have undertaken three visits throughout the year utilising the Quality Everyday methodology to ensure a Board to Floor overview. Improvements include: De-cluttering of station and minimizing stock held on stations Removal of all old and out of date information from stations Enhanced communication methods through our quality everyday feedback noticeboards Introduction of the Class Publishing Application Care Quality Commission EMAS continues to make good progress against the Quality Improvement Plan identified by the Trust following the latest inspection from the Care Quality Commission (CQC). The Trusts Quality Improvement Plan has adopted the Plan Do Study Act (PDSA) Quality Improvement Methodology which is at the centre of all the strategies and action plans. There are several key work streams that have been identified to enhance the Trust s preparation for the next inspection that will have a positive impact. These are as follows. Wider CQC outcomes report Class Publishing Application PDSA implementation plan Equality, Diversity and Inclusion Well led framework Carter Programme Increased patient experience and stakeholder engagement Bright Sparks Initiative CQC Engagement with Staff Work Plan Estates improvement including Blue Light Collaboration Clinical Improvement Group work plan Mental Health The implementation of the plan will be overseen by the Transformation and Improvement Programme Board which will seek assurance at its monthly meetings that progress is being made in implementing the action plan and that the actions have the desired outcome. In addition, EMAS has enrolled onto the Requires Improvement to Good Programme undertaken by NHS Improvement which supports the Trusts aspirations of a good or outstanding rating. 13

14 What we want to do better in 2018/19 At EMAS we are working hard to bring about significant improvements to the services we provide. We actively listen to our colleagues, patients and stakeholders to act on things that did not go well, and also those that had a good outcome, to learn from and reflect on the services we provide. As in 2017/18, we have identified three domains of quality: Clinical effectiveness Patient safety Patient experience 14

15 Priority 1: Staff health and wellbeing The quality priority area for staff health and wellbeing focuses on improving staff member s health and wellbeing at work. EMAS will continue to develop staff support mechanisms that ensure the health and wellbeing of our staff. Clinical effectiveness Lead: Director of Human Resources and Organisational Development Priority 2: Improving Sepsis care Red Flag Sepsis is the Sepsis Trust's definition of a patient who is presenting with clinical signs that suggest the patient is either suffering or approaching septic shock. EMAS will continue the work from last year that will focus on delivering antibiotics to Red Flag Sepsis patients. Lead: Medical Director Priority 3: Cardiac arrest return of spontaneous circulation (ROSC) and survival outcomes. Aligned with Category 1 performance. During 2018/19 we will: Clinical effectiveness continue to develop and improve our cardiac arrest outcomes continue to see our Ambulance Quality Indicators and outcomes around stroke, chronic obstructive pulmonary disease (COPD) and asthma improve see an increase in the presence of frontline clinical supervision to all active resuscitation attempts. Lead: Medical Director 15

16 Priority 4: Continue to reduce conveyance by the utilisation of alternative care facilities. During 2018/19 we will: Patient safety maintain and improve hear and treat maintain and improve see and treat reduce conveyance by accessing alternative pathways that are available and have robust patient safety plans in place that support non- conveyance. Lead: Medical Director Priority 5: To reduce prolonged waits across all call categories by delivering the national Ambulance Response Standards. During 2018/19 we will: Patient safety deliver agreed workforce plan deliver the agreed performance improvement trajectories improve efficiency and productivity through better utilisation of our resources. improve fleet availability through the delivery of the new vehicles. Lead: Director of Operations 16

17 Evidence of quality improvements for 2017/18 Priority 1: To improve staff members health and wellbeing at work and to develop staff support mechanisms to ensure the health and wellbeing of our staff. Aim What we did What we have achieved Quality Indicators Looking after our staff in the following areas, Health and wellbeing Health and Wellbeing initiatives completed April Relaunched One You campaign May Mental Health Awareness, Equality, Diversity and Human Rights and Mental Health including types of mental health problems, Understanding Anxiety Stress and Depression (ASD) June Focus on; Trauma, Depression, Anxiety, Stress The wellbeing clinics have been delivered and due to the successes of My Resilience Matters workshops the priority will be continued in 2018/19 and has been added to the contract for the next year. The flu vaccination is the highest achieved in the Trust at 73.5%. 73.5% flu vaccination. July Looking after our backs, back care, musculoskeletal issues August being more active September Suicide Prevention (link to Suicide Prevention Day 10 th Sept), Women s health 17

18 October Winter health (link to flu campaign launch) November Men s health, financial wellbeing, flu campaign December Festive season wellbeing, alcohol awareness, flu campaign January Dry January, Stop Smoking, diet awareness, flu campaign February Keeping fit and healthy, focus on nutrition, Time to Talk day March Healthy You One You, supporting smoking cessation Wellbeing and Resilience workshops in our Emergency Operations Centres continue to be a success and feedback to date has been that the workshops have been thought provoking and useful for understanding stress, resilience, coping mechanisms and support available. The Staff Opinion Survey was launched in October 2017 and closed in early December, with initial reports published in March 2018, see appendix 1. 18

19 A Health and Wellbeing toolkit is being created for staff and managers to access. A task and finish group has been set up to take this work forward. Age Management A working group met in September to consider the organisational processes, structures, systems and culture surrounding an aging workforce. This work encompasses looking into the new era of working; including flexible working, alternative working patterns, aging and wellbeing, cultural changes and working longer. The Health and Wellbeing leads attended an event held by the Advisory, Conciliation and Arbitration Service (ACAS) about the aging workforce and will take learning back to the group for progress. Staff engagement the Conversation Café staff engagement pilot which was trialled during October across the EMAS has been well received with staff and managers reporting that they welcomed the engagement. The project team met to evaluate the approach and this feedback went to the Executive team in November. A second Conversation Café was held in January and February

20 The flu campaign launched on 1 October and the results were the best EMAS has ever had. The national target is 75% of eligible staff vaccinated year. 20

21 Priority 2: Sepsis is a worldwide public health issue. In developing nations, sepsis accounts for nearly 80 percent of deaths. Sepsis kills far more citizens than AIDS, prostate cancer and breast cancer combined. It is the leading cause of deaths and has a high mortality in the developed world. Aim What we did What we have achieved Quality Indicators During 2017/18 particular focus will be: To identify sepsis within our patients. Ensure the formalisation of the EMAS sepsis lead, including documented objectives and performance measures. Appoint divisional sepsis champions (one per division) on a volunteer basis. Our sepsis lead was appointed, and a pilot scheme introduced into north Lincolnshire and Goole for the treatment and management of sepsis. We identified a number of staff and gave them specific awareness and training in the administration of antibiotics. Working collaboratively with the acute trusts and microbiologists, we have completed our pilot study. The results have been significant in patient outcomes. We have achieved the National Institute of Clinical Excellence (NICE) guidance recommendations that in positive septic patients, we have delivered antibiotics within the nationally recognised one hour window. Currently no other ambulance trust in the UK is administering antibiotics to patients in the prehospital environment. Our results have significantly changed the lives of so many patients that we will work with other hospital trusts to ensure patient care is at the centre of all that we do. Lincolnshire and Leicestershire are now administering antibiotics to patients with RED Flag sepsis. Ongoing work with the microbiologists has continued and The results of the trial have been monitored through Quality Governance Committee through the clinical effectiveness reports. 21

22 Develop a robust action plan to ensure the availability of waveform capnography on a minimum of 95% of front line operational resources (DCA & FRV). the other divisions are waiting for the results of the roll out first. Work with a partner acute trust to explore the increased prehospital use of IV antibiotics in the treatment of sepsis. 22

23 Priority 3: Cardiac arrest return of spontaneous circulation (ROSC) and survival outcomes. EMAS has continued to focus its attention upon the improvement of successful ROSC rates in cardiac arrest. Aim What we did What we have achieved Quality Indicators Improving focus on Red 1 performance and ROSC rates EMAS joined the national Ambulance Response Programme (ARP) on 19 July The previous Red 1, 2 and the 4 green performance categories were replaced by new classification of Category 1, 2, 3 and 4. EMAS consulted with all operational staff on a new operating model and rotas to help deliver the ARP standards. The new model and rotas went live during April Further work is planned with Organisational Research for Health (ORH) to determine the required staffing levels needed to deliver the new standards in full. The newly formed Clinical Improvement Group have drafted the Cardiac Arrest Strategy which will detail how EMAS focuses its approach on survival to discharge for the patients. The key aims of the strategy are around the following areas: operational modelling clinical leadership patient care definitive pathways ROSC rate has improved overall, and further specialist training will be given to ensure EMAS improves survival to discharge. The new operational rotas went live in April 2018 along with the urgent tier which will support delivery to front line resources. The Clinical Improvement Leads will be focussing on ensuring new pathways are identified for additional signposting in 2018/19. There will be an additional focus on cardiac arrest survival and survival to discharge with the new Ambulance Clinical Quality Indicators (ACQI). 23

24 Priority 4: To explore the use of alternative pathways in each division by using the pathfinder leads to develop internal pathways in each commissioning area to improve non-conveyance and utilisation of pathways at EMAS. Aim What we did What we have achieved Quality Indicators Continue to reduce conveyance by the utilisation of alternative care facilities. We reduced conveyance to accident and emergency departments through appropriate use of alternative care facilities, including our own Clinical Assessment Team providing Hear and Treat support to patients. The Paramedic Pathfinder leads have now received an amended job description that aligns them to a division. This ensures they focus on Pathway design that identifies gaps with commissioners at local commissioning meetings. This will formulate the locally required pathways. Overall reduction in none conveyance through increased See and Treat and Hear and Treat. Increase in our Clinical Assessment Team to ensure appropriate signposting and safety netting of patients. Falls services have been designed to ensure the most vulnerable of patients are cared for in the safest way. Ongoing work with commissioners will enable EMAS to work with the Sustainability and Transformation Plans (STPs) in identifying and developing the most suitable pathway for all patient groups. 24

25 What have we done to improve patient safety? Learning from incidents, experiences and feedback At EMAS we have an open and honest approach that we promote to our staff; encouraging them to report excellence or poor practice. EMAS has a robust reporting system in place where staff can report issues and be confident that they will be taken seriously. This method of reporting helps us to identify learning opportunities ensuring that we learn from mistakes to reduce the risk of it occurring again or replicate best practice into other areas. Learning is also identified through investigating untoward incidents, serious incidents and complaints. Other sources are patient surveys, compliments, community events and patient focus groups. We share learning across the organisation through our established Lessons Learned Groups which include senior representatives from all divisions and teams within EMAS who review the feedback to learn, and promote the learning outcomes across the service. Duty of Candour EMAS priority is to deliver safe, prompt care to our patients. We are committed to openness and will always tell patients if something has gone wrong during their care. We encourage a culture which involves acknowledging, apologising and explaining when things go wrong, conducting thorough investigations and ensuring that lessons learned assist in future incident prevention and providing support for those involved. All frontline staff will continue to receive Duty of Candour training to embed our commitment to openness. EMAS Patient Voice EMAS Patient Voice is a group of volunteers chaired by Director of Quality and Nursing Judith Douglas; supported by patient representative and Vice-Chair John Crouch. The group meets every two months in Nottingham, with two sub-groups set up to look at more local issues. EMAS held an event in March 2018, to help recruit volunteer members to the Counties that it serves. The event was also an opportunity for all the EMAS Patient Voice Groups to come together and discuss the work they have been carrying out, including visits and recruitment. East of 25

26 East of England Ambulance Service attended and provided a presentation about the community engagement work that they carry out whilst being Ambassadors for the Trust. Yorkshire Ambulance Service also attended. Throughout 2018/2019, the Patient Experience Team will be building on the relationships that were developed from this day to create sub groups across Lincolnshire, Leicestershire and Northamptonshire. Members of the group act as the link between patients and the Board, helping to keep the conversations going and development work progressing. They give the patient perspective on the way we operate, and help us to develop services and ensure they are patient friendly. Throughout the year the group have visited various parts of our service including ambulance stations and our Nottingham Emergency Operations Centre, Patient Transport Service and Fleet Workshops. All members of the EMAS Patient Voice Groups in 2017/2018 were invited to attend events that were held within the Patient Experience and Health & Safety Work Plans. These included, taking part in the Royal Society of the Prevention of Accidents (ROSPA) National Family Safety Week, in May 2017, which saw the teams attend three different primary schools, talking to the children about being aware of the dangers in their own home. The sessions also included teaching the children how to make a 999 call and the reasons that they might do this. Our Community First Responder (CFR) Team helped support the week with equipment and an ambulance for the children to visit, along with teaching the children hands only Cardiopulmonary resuscitation (CPR). The members supported the Safety Week in both June and September that were hosted by the CFR Team, as well as National Restart a Heart Day in October You can find out further information about joining the EMAS Patient Voice team on our website. 26

27 Quality visits Quality visits give Trust Board members the opportunity to see what goes on at EMAS by observing patient safety experience and effectiveness. All the executive directors and non-executive directors also undertake quality visits utilising the Quality Everyday methodology. The following areas are visited as part of our quality visits: Hospital emergency departments. Emergency Operations Centres - Clinical Assessment Team/call takers/emergency medical dispatchers Patient Transport Service Ambulance stations and ambulance support teams Operational shifts with frontline staff Air ambulance providers. The purpose of the quality visits is to: show meaningful visible leadership engage with colleagues and, if possible, patients and their carers triangulate information obtain assurance identify issues/barriers and ideas for solutions communicate key messages. In 2017/18 a total of three visits have been undertaken. These visits have proven successful in engaging frontline staff and providing a board to floor approach where the senior leaders at EMAS engage with operational staff and listen to their concerns. In addition to this, the EMAS Patient Voice group also undertake quality visits to obtain feedback from the operational staff, which also gives the Trust Board assurance and the operational staff another voice. A template is completed by the Board member to record feedback which is collated into a report and the actions are addressed. The information collated during 2017/18 told us the following: What s good? Comments from the quality visits included: exemplary patient care was shown patients were respected by the crews and they had their dignity protected always electronic patient record form being utilised patients on the phone were given professional and courteous advice 27

28 crews were observed to be caring and compassionate to patients and family members appraisal and statutory and mandatory education was up to date deep cleaning was up to date team leader protected time was working well noticeboards are up to date, in particular Quality Everyday noticeboards ambulances were observed as being clean and vehicle checklists had been completed some staff reported having access via to the clinical bulletins and finding them useful. Enews was seen as a positive step forward and communications had improved equipment was seen to be replaced diligently and staff were aware of policies and procedures patients had their individual needs taken into account, they observed special attention being given to patient with dementia good communication skills and interactions were shown between the fast response vehicle paramedic and the crew in a double crewed ambulance with full involvement of the patients and their families dignity and compassion shown and full explanations of the course of treatment and the rationale for transfer to hospital were given good documentation and understanding of individual patient needs. Extra care and consideration was given a patient being transferred whilst very breathless and anxious to ensure that they felt safe and treatment continued throughout the transfer process What could be improved? Comments from the quality visits included: meal breaks being taken away from stations, eg in a different location, caused concerns discussions identified board to floor communication needs to improve staff were feeling pressurised with the current workloads and the intensity during their shifts discussions with staff through the shift identified challenges regarding work life balance and flexibility in rotas, particularly staff on relief staff don t seem to be able to access time off in lieu when they need to clinical risk in the community due to hospital handover delays concerns raised around the new divisional structure and roles discussions in relation to the supplies of available equipment on vehicles 28

29 Assurance rather than improvement Serious incidents (SI) Our transparent approach sees us proactively encourage colleagues to report patient safety incidents in line with a mature safety culture. Reporting allows us to analyse what happened to identify and put in place actions to reduce the risk of recurrence. During the year, EMAS identified 40 serious incidents requiring investigation. The general themes are: 1. delayed response 2. quality of care 3. call handling The EMAS Trust Board regularly receives an update on the number and type of serious incidents reported. Again, supporting our open approach, the Board meeting papers are made available to the public approximately a week before each bi-monthly meeting via Mortality reports The Secretary of State for Health has accepted the recommendations from the Learning from Deaths review, which was undertaken by the Care Quality Commission. This review in summary ensures that NHS providers are committed to improving the care for patients who die. A letter has been sent to all NHS provider trusts stating that new requirements will come into effect from 1 April 2017 that they will start collecting and producing mortality reports on a quarterly basis. The outcomes of mortality reports are also mandated to be reflected in the 2018 Quality Account. There are therefore several commitments that East Midlands Ambulance Service is required to undertake. These are as follows. Strengthened governance on reporting mortality Increased transparency of investigation of deaths Improved data collection and reporting Better engagement with families and carers An executive director should take responsibility for this process, and a non-executive director should be assigned to ensure transparency of reporting and recording of data. Although not identified directly for ambulance trusts, mortality reviews are highly likely to factor on the Care Quality Commission s inspection regime for an ambulance provider. 29

30 EMAS will therefore, collect and publish data on a quarterly basis, including serious incidents and evidence of learning from what has happened as a consequence of this incident and specific information on looking into deaths. The monitoring requirements also include: The total number of the provider s in-patient deaths, the subset of these that the provider has subjected to case review and, following application of the Structured Judgement Review methodology, estimates of how many deaths were thought more likely than not to have been related to problems in care. A full version of the Structured Judgement Review methodology under development by the Royal College of Physicians will be provided to trusts as part of more detailed guidance, for imminent publication. This will be accompanied by a suggested dashboard. The data in the dashboard should be collected and published on a quarterly basis together with relevant qualitative information, interpretation of the data, and what learning and related actions your organisation has derived from it. This data should be collected from April 2018 for an initial quarterly publication in June. We have defined the criteria of the cases we will review. These will be: deaths from serious or high level incidents all care records where a Cardiac Arrest Resuscitation attempt has taken place all deaths with clinical interventions, not patients with a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) in place all Category 1 deaths triangulation of incidents from PALs, which are death related deaths where learning will inform the organisations existing planned improvement work, for example Sepsis patients all deaths that arise from a patient safety incident all patient deaths that we have responded to within 24 hours from hospital and on EMAS databases Governance processes A report will be submitted to the Quality and Governance Committee on a quarterly basis that identifies deaths that meet the indicators above. The report will be shared with the EMAS Lessons Learned Group to identify any areas of improvement or recommendations. The Coroners Service Manager will produce the report and share with the relevant groups and committees for assurance purposes. 30

31 As part of the Serious Incident Investigation process a Root Cause Analysis (RCA) meeting takes place at which the root cause, contributory factors and learning for both individuals and the organisation are established; recommendations and action plans are also put in place to prevent reoccurrence. The Medical Director and Director of Quality and Nursing chair our Peer Review Group, which looks at all incidents that happen at EMAS and reviews each incident to ensure learning is embedded. A review of learning and implemented actions is completed every six months by the Lessons Learned Group to provide assurance that the learning and actions are embedded practice and have resulted in service improvement. What we have done to improve patient experience Compliments During 2017/18, we received more 1,190 expressions of appreciation from patients or members of the public. This figure is an increase of 502 from 2016/2017, whereby the figure was 688. When the colleague can be identified by the information provided, the individual(s) are thanked personally by the relevant General Manager/ Director of Quality and Nursing in the form of a letter which accompanies a copy of the patient feedback. We are grateful to the patients and their relatives who have been happy to share their experiences at our public Trust Board meetings, via our social media channels, and with local and national media. We are tremendously proud to be able to promote the achievements of our colleagues in this way and it always gives a real boost to morale. Throughout the year, due to changes in the team, a backlog of compliments developed. Out of the 1,190 that were received, 808 were logged within the appropriate timeframe as set out by the Trust. 382 are currently still being processed by the Team and the action plan for the outstanding compliments will be completed by May To mitigate against a backlog forming the Patient Experience Team will be adopting Learning from Excellence approach, will see the logging of the compliments electronically within Ulysses in a smarter way in the future. By amending the set up within Ulysses, the compliments can automatically be sent through to the member of staff involved, meaning they will receive notification once the compliment has been recorded. Continuing improvements to the EMAS complaints system Following the 2013 Francis Report into Mid Staffordshire NHS Foundation Trust and the Clwyd/Hart Report, EMAS carried out a review of the complaints process to identify actions to improve the way complaints were handled. This improvement continued throughout 2016/17 as we benchmarked our processes and outcomes across other NHS ambulance services nationally, and with additional published advice from the Parliamentary and Health Service Ombudsman. 31

32 Changes implemented throughout both the Patient Advice and Liaison Service (PALS) and Complaints and Investigation teams, including the centralisation of processes and recruitment of additional team members, have helped the service to become more robust and to deliver a higher quality outcome for complainants. Improvement work will continue through 2017/18 to ensure that we respond to patient concerns in a timely manner and that learning is identified and actions are implemented comprehensively across EMAS, further improving the quality of patient care and the complaints service delivered. Formal Complaints (FC) During 2017/18, EMAS identified 188 formal complaints requiring investigation of which 175 are related to our Accident and Emergency Services 12 related to Patient Transport Services 1 trust wide Following investigation, 53 complaints were found to be justified and 38 partially justified. The remainder were not justified, not applicable or still being investigated (eg the complaint related to a different service). The four general themes related to: Delayed response Emergency Operations Centre issues Clinical and patient care issues Attitude of staff Compliments and complaints received per EMAS division or team during 2017/18: County Compliments Complaints Derbyshire Leicestershire and Rutland Lincolnshire Northamptonshire Nottinghamshire Derby PTS EOC Trust-wide issue 0 1 All formal complaints require investigation to establish the facts of the case and identify learning for both individuals and the organisation. The investigation also allows us to provide recommendations to prevent reoccurrence. Action plans are completed following each investigation and actions are closely monitored until closure. 32

33 General approaches to learning from serious incidents and formal complaints include: communication of key learning points through education, training, communication and awareness clinical case reviews and reflection of the practice by individuals amendment to policies, procedures and practices themes being reviewed by our Lesson Learnt Group which consists of multi-disciplinary membership. Ombudsmen requests Case Reference Date received Case upheld/not upheld by PHSO Financial remedy value if paid Recommendations to Trust PALS /05/2017 Not upheld None None N/A Recommendations completed Yes/no FC /05/2017 Partially upheld None Individual learning for EMD PALS /09/2017 Awaiting PHSO decision PALS /11/2017 Awaiting PHSO decision Yes PALS PALS /11/2017 Awaiting PHSO decision 20/04/2018 Awaiting PHSO decision Patient stories EMAS captures patients experience in a variety of ways. One way is by inviting patients and carers into our Trust Board meetings to tell their story. We have included two examples below of where we have done well or where we have identified areas for improvement. Mrs D experience reported at the Trust Board on 7 November 2017 On 29 March 2016, at hours, the first in a series of eight 999 calls were received by EMAS for a patient who had terminal cancer (Mr D). Mr D was an end of life patient and was cared for by his wife Mrs D. The first call was attended by a double crew ambulance (DCA) who treated the patient until a district nurse arrived on scene to take over the care. At this point Mr D s bowel had ruptured, there had been previous discussions with the hospital whereby a Consultant had advised that if Mr D s bowel did rupture the pain level would be very high and therefore the pain would need to be managed with a medication pack. Considering that he would probably only have 24 hours to live from this point, it 33

34 was Mr D s wish that he was to die at home. No issues were identified with the call or the care provided at this time. Following the crew leaving the scene, the district nurse discovered that the medication pack that had been provided by the hospital had not been signed off correctly and, therefore, the medication could not be administered. The out of hours GP was called, and arrived 1.5 hours after the rupture had occurred. He found that the medication provided was insufficient for the grade 10 pain that Mr D was experiencing. This resulted in a second call being made to EMAS at for an ambulance. A DCA arrived on scene at 23.31, left scene at and conveyed Mr D to hospital, arriving at on 30 March Taking Mr D to hospital was not as he had wished, however, due to the lack of support at home in terms of the medication pack, the crew conveyed to hospital. Mrs D s area of complaint The main terms of reference for the complaint were as follows: Were the 999 calls handled and coded correctly? Why was there a delay in responding to the patient? How can EMAS ensure that other families do not experience the same type of incident? EMAS assurance EMAS investigated the formal complaint following our procedure and concluded the following in line with the terms of reference set Were the 999 calls handled and coded correctly? Yes, all 999 calls were correctly handled and coded with the appropriate levels. There were some procedural issues, however, these did not relate to patient care or the timescale required to attend him. Why was there a delay in responding to the patient? The main reason for the delay in attending the patient was due to hospital handover issues. Twenty DCAs were unable to hand over their patients for between 20 and 30 minutes. This meant that they were unavailable to attend any calls. As healthcare practitioners were on scene it was not possible to assign a Fast Response Vehicle (FRV) to the patient. This reduced the available number of resources that could be allocated. A significant shortfall in FRVs of 38.5% further hindered the ability of EMAS to attend this patient. With DCA coverage included in the calculation the shortfalls for the division were within the tolerance level of 28%. However, the FRV issue meant that any DCAs clearing from the hospital would have to be used for all levels of call, making it more difficult to assign a resource to this 34

35 patient within a timely manner. How can EMAS ensure that other families do not experience the same type of incident? The issue with hospital delays is a recognised national issue. Hospitals in the region covered by EMAS have been experiencing high demand, which results in lengthy delays in handover. EMAS has formally escalated the impact that these delays have upon its ability to respond to patients in the community to its regulators. The complaint was upheld by EMAS. Conclusion EMAS is involved in end of life pathway discussions across the health community and that this patient experience was complex due to the number of services involved and was particularly challenging regarding the prescribing of medication. EMAS noted the need to work with partners regarding the impact on patients of insufficient medication being provided at home. Changes in our emergency operations centre are now in place following the number of times Mrs D had rang. Now if a caller rings three times, this is flagged to a clinician in the call centre. EMAS was to reflect on the findings of the case to identify ways of raising concerns regarding other healthcare providers with the Sustainability and Transformation Partnerships. Mrs W s experience reported at the Trust Board on 9 January 2018 On 14 August 2017, at 18.38, a 999 call was made on behalf of Mrs W, via Lifeline. The call was correctly coded (Falls) CAT 3, Yellow response. It was noted that an 87 year old female had fallen and hurt her hip. Capacity Management Plan (CMP) 3 script 4 was given. At a 2nd 999 call was received, and Mrs W neighbour now with her. A third call was received at At the Clinical Assessment Team (CAT) made a welfare call and noted in the system spoke to patient s daughter, patient had a fall at the top of the stairs landing on the left side, patient has pain in her left hip and back. Patient unable to take any analgesia as flat on her back. At the CAT team upgraded to CAT 2 amber response and a DCA was dispatched at with an estimated arrival time of 11 minutes, arriving at Our response time had been 2 hours and 44 minutes. After arriving at hospital at handover then took 1 hour and 6 minutes. 35

36 Mrs W daughter area of complaint The main terms of reference for the complaint were as follows: Why was her mother left in extreme pain when she was very frightened? Why had it taken so long for the ambulance to arrive when her mother lives about three minutes drive from the county hospital? Was EMAS under-staffed and that s why her mother had to wait for so long, which has left her leaving her disappointed and angry? EMAS Assurance EMAS investigated the formal complaint following our formal complaint 1 procedure and concluded the following in line with the terms of reference set and the complaint was found to be upheld. The Resource Log details that at hours at Boston Pilgrim Hospital as described above there were eight crews waiting. The Silver On Call Officer had been made aware of the situation as the hospital had been on internal critical incident all day due to high demand. At the time of the initial call there were 42 patients in the department, resus was full and the eight EMAS patients were all waiting for beds, no trolleys were available. Conclusion The compliant was upheld by EMAS with the following explanation was provided Our investigation has established that the calls were coded correctly. Unfortunately, the overall delay was due to high demand for emergency ambulances at the time of the call. As this was the case EMAS had invoked the Capacity Management Plan (CMP) at level 3, where level 0 is the lowest and level 4 is the highest level of the plan. The CMP is implemented when the demand is greater than our available resources and we must carefully prioritise so that we are able to respond to patients most at risk as soon as possible. In addition, our delayed response in attending to Mrs W was compounded by delays our ambulance crews were experiencing in waiting to handover the care of patients at local receiving hospitals. We are very sorry that on this occasion our service has failed to meet with the high standards that we aspire to achieve and for which, Mrs W and her daughter, had every right to expect. 36

37 Extracts from messages of thanks during 2017/18 Ms S has written to thank Shaun Barsby, from Ashbourne, Rachel Douglass, from Mickleover, and Tristan Powell who attended a cardiac arrest at a care home. She said: "Shaun, Rachel and Tristan worked on the patient for 45 minutes and were absolutely amazing. Not only dealing with the patient but also the residents, and supported the staff on scene too. This was an upsetting incident for both residents and staff and, although your staff were busy, they found time to make sure everyone on scene felt valued and supported - they were simply outstanding." Ms PS has thanked Joseph Hemming and Annable Kelson, from Coalville Station and Paul Staples; Steven Taylor, from Loughborough Station; and Rhys Joshua Adams who cared for her father. Sadly, he passed away, but she wanted to ensure that her heartfelt thanks got to the crew that attended. Mrs IL has praised colleague Deb Clarke, from Barton Station, following an incident in October this year. She said: I work as a Senior Carer and last night needed the assistance of 999 for a palliative patient, the response was quick, and the paramedic was amazing. Deb explained everything and liaised very well with both the carers and our patient. Deb also did everything she could to help and was very professional and respectful. She put all our minds at ease. Unfortunately, I forgot to thank her before I had to leave, so I'd like to take this opportunity to do so. Mr RL has written to thank Andrea Fenton and Paul Whiting, from Mereway Station, when they attended when he was not feeling well. He wrote to say: "The whole experience was an absolute credit to the NHS and its systems. The staff were fabulous in their detailed and courteous treatment." Ms L has been in touch to thank the huge team of people who attended her following a road traffic collision. The crews included Stuart Warsop, Jonny Kirk, Andrew Barret and Rachel May from Beechdale, Edward Cannon from Carlton, Audrey Askham from Wilford and Michael Hayden from Stapleford. Liam Waring from our HART team also attended. Ms L said: "The crews did their very best to help me, and are the reason why I am still here now. I also know that they would have tried their best to help my partner, who sadly died on scene. Thank you to whoever it was that attended, I know you all would have tried your hardest to not let him slip away. I am so grateful for all you do every day." Cary Ward from Nottingham Emergency Operations Centre has been thanked by Ms M for the care provided when her mother-in-law became unwell. She said: "Cary was both professional and sincerely caring, talking me through what was required and re-assuring me as we proceeded." Mr W has thanked Ambulance Care Assistant John Powell, based at Matlock Ambulance Station, for picking him up and taking him to hospital. He said: "He was so kind and helpful and drove right up to the door to collect me. The outbound journey was also John and he did everything right, so please say thank you." 37

38 Community engagement Throughout the year we continue to deliver a range of engagement activities to improve patient experiences. We do this by listening to patient and relative s stories and experiences, capturing their feedback and sharing it with the organisation. This allows us to respond to concerns raised, share praise with colleagues, and identify potential for improvement. We have increased the public s knowledge and understanding of EMAS by producing materials and distributing them at events, and using social media to help explain: how emergency and urgent calls are graded (categorised) and responded to alternative pathways to emergency care where professional medical advice can be gained for non-urgent problems methods of self-care and good health and wellbeing. Staff from our divisions and Emergency Operations Centres visited nursery and school children showing them an ambulance, talking to them about the service we provide and teaching them lifesaving skills. Everyone has a role to play in an emergency and giving first aid within the first few minutes of an incident can make the difference between life and death. Educating young people in lifesaving skills was a highlight of the year as EMAS joined in the international initiative Restart a Heart Day 2017 where students across the East Midlands where taught CPR. EMAS and partners trained more than 4,000 students on the day contributing to the national figure of 195,000 students taught in one day. 38

39 Staff engagement In October we launched our Conversation Cafe staff engagement pilot. To make sure the engagement with our staff is more than just conversation, our approach has three phases: Communicate our story and co-design plans Influence perceptions and behaviour Act and evidence accountability. During the seven pilot cafe sessions held at hospitals across our region and at our Emergency Operations Centres, our Executive and Senior Leadership Teams engaged with 168 colleagues on a range of topics featured on our Café hot topic menu. Evaluation of their feedback forms told us that 93% said they felt listened to at the cafe, and 95% would visit a future session. In response, we have committed to holding the Conversation Cafe sessions across our region, repeating the three-phased approach, starting on the first month of each quarter. 39

40 Communications and social media Everyone in our service plays their part in saving lives, from our ambulance support teams to our frontline clinicians, each person works hard to ensure our patients across the East Midlands receive the best possible patient care. We are extremely grateful to the patients and their family who share their stories and positive experiences through social media, and with local, regional and, in some cases, national media. Here are a few examples of the stories that have been promoted this year: Mum in anaphylactic shock thanks ambulance crew who saved her life A mum-of-three who collapsed and went into anaphylactic shock on her bathroom floor has been reunited with the 999 call handler and ambulance crew who saved her life. Gaynor Mallard, who has a serious nut allergy, unwittingly covered her body with a moisturising cream containing nuts and collapsed at her home in Long Eaton. Thankfully, her daughter Frankie was off school sick and so rang 999 when she discovered her mother struggling to breathe on their bathroom floor. Jessica Berenzyckyj, 999 call handler, provided instructions over the phone and kept Frankie calm until Paramedic Gary Staley and Emergency Care Assistant Lynsey Burton arrived just nine minutes later. Gaynor said: I put the cream on and could feel the burning sensation straight away. I tried to get in the shower, but my daughter found me collapsed on the bathroom floor. I couldn t get any air in. I don t remember much until the ambulance crew had given me adrenaline. Without Frankie, the 999 call handler and the ambulance crew, I wouldn t be here today, and we wouldn't be celebrating Christmas. I can never thank them enough. 40

41 Cardiac arrest survivor says thanks to life-savers A holiday maker who suffered a cardiac arrest at East Midlands Airport has been reunited with the team of heroes who saved his life. Francis Dempsey, 82, from Derby, was jetting off to Ireland with his family to attend his nephew s wedding, when he went into cardiac arrest at the airport. Fellow passengers quickly came to his aid, followed by airport personnel. Alex Booth, a member of the airport security team and a duty first aider was one of the first people to get to Francis. He immediately assessed the situation and started CPR. The airport also had a defibrillator which was used by the airport staff to shock Francis heart. A 999 call was made to our control room and Paramedic Graham Ballard was first on scene followed by Dr Matt Woods, from the East Midlands Intermediate Care Scheme and ambulance crew Malcolm Storey and John Filby. Thanks to the life-saving action of his fellow passengers, the airport team, and the emergency services colleagues who managed to resuscitate Francis, he is now on the road to recovery. Francis and his family were reunited with the heroes who saved his life on Friday 27 October Francis is not able to remember much of what happened that day, but says that he owes his life to all those that who helped him. His son Gary, who witnessed everything, said: It was incredibly humbling to see everyone trying to help my father. I just want to say thank you to all the staff at the airport and the emergency services. My father would not be here today without all of their assistance." 41

42 Mum reunited with ambulance crew who saved her unborn baby's life An expectant mother feared for her and her baby s life when her waters broke at home and she delivered the baby s cord. Beverley Wood, 32, from Beeston, was 38 weeks pregnant with her second child when labour took an unexpected turn and she felt the cord between her legs. Having attended prenatal appointments, she knew how dangerous this was because a prolapsed cord can starve the unborn baby of oxygen, leading to brain damage or death. Thankfully 999 call handler Georgetta Goulds was able to flag the call as time critical meaning ambulance crew Michael Halpin, Stuart Warsop, and Richard Henton were on scene within 6 minutes of the 999 call and were able to intervene to save baby s life. Richard, Stuart, Bev, Mike and Georgetta with baby Aoifa Beverley said: When they turned up I was so relieved. I knew time was of the essence but despite the seriousness of the situation the team were so reassuring and kind to me. The crew rushed Beverley straight into the maternity operating theatre after pre-alerting staff at Queens Medical Centre that they were on their way. I remember seeing the paramedics dressing the theatre team and hearing the organised chaos around me as they prepared to put me under anaesthetic. All I was thinking was please let my baby be ok. Baby Aoife was born by caesarean on 3 January 2018 and after being resuscitated has now recovered from her dramatic entry into the wold. Beverly, Aoife and five year old big brother Finley met the team who helped them. "It's been amazing to see them again" said Beverley. "They continue to be so lovely and will be a part of Aoife's story forever." Stuart Warsop, Ambulance Technician said: These types of jobs thankfully don t come around very often but when they do they leave a lasting impression. We did everything we could to help Beverley and only when the family wrote to us to say thank you did we hear that both mum and baby were doing well. It s an honour and a privilege to see the family again. 42

43 Five year old Kyran makes 999 call when his mum collapsed A five-year-old boy who called 999 to help his mum who fell unconscious has been presented with an award for his bravery and quick-thinking. Kyran Duff from Daventry, Northampton leapt into action when his mum Nikki collapsed at home. He immediately called 999 as he had been taught by his mum, and gave his full address, explained what had happened and followed instructions to unlock the front door to let the ambulance crew in. On the call Kyran, who celebrated his sixth birthday this month, can be heard reaching above the door to get the key to unlock it telling he audibly cheers when he s reached it telling our control Nurse I ve got it down, yes, I ve unlocked it. He made sure his mum was comfortable and told us he was worried that now he d be late for school. Nikki said: I am so proud of my little boy. He got me a teddy bear because he thought I might be scared and covered me in a blanket so I didn t get cold. I was so surprised when I gained consciousness and heard him on the phone to the emergency services. He s my hero. Kyran s Dad had already gone to work when the fall happened so Kyran s bravery meant paramedics were able to arrive within minutes. It is so important that parents prepare their children for what to do in an emergency situation. I ve always taught Kyran how to call 999 and more importantly when. I was relieved to know help was on its way to support Kyran and help me. He was presented with a prestigious Laverick Award presented by Paramedics at East Midlands Ambulance Service for his quick thinking and bravery. The Laverick Award recognises children and young adults who have gone above and beyond to help another and is in memory of Nick Laverick a paramedic team leader who died of cancer on his 37th birthday in September

44 Retired miner thanks 'marvellous' Patient Transport Services A former miner from Shirebrook thanked colleagues in our Patient Transport Service (PTS) for enabling him to get to and from his pain management appointments over the last 10 weeks. Robert Walker, 63, a retired miner and soldier, suffers from osteoarthritis in his knees, hips and back, and was invited to the pain management clinic at Royal Derby Hospital. However, without our PTS, Robert would have struggled to get to the appointments and, so he was keen to thank all the crews who have cared for him over the last few months. He said: I ve been having a rip-roaring time with the crews, and every one of them has been polite. They put you at ease as they know what they are doing and are reassuring. They really are marvellous, and I cannot praise them enough. The vehicles are all so clean, and they get me from A to B and B to A in a safe manner. I would have struggled to go by public transport, as I cannot walk very far. I m so grateful that PTS come and pick me up. 44

45 Equality and diversity Equality, diversity, inclusion and human rights are at the forefront of our quality agenda. Valuing and promoting equality and diversity are central to the effectiveness of EMAS. Our ability to provide quality through equality depends on understanding the diverse communities we serve, to plan and deliver services that take account of their needs. If we can fully engage with our communities, they will have greater confidence in us and are more likely to accept our professional support and advice. An effective relationship with our communities is therefore vital to ensure both quality and equality. We deliver a public service and have a duty to ensure: equality of access equality of impact, and equality outcomes for all. In other words, a service which equally meets the needs of all people we serve. For our staff the right to ensure equality of opportunity for all, to treat people with respect, dignity, fairness and to create a culture which benefits everyone is key. Underpinning this approach is legislation. The Equality Act 2010, the Public Sector Equality Duty and the Equality Framework (EDS2) help shape the quality agenda, thus allowing for effective service delivery and community engagement. We held our first Equality and Inclusion day in March 2018 attended by 70 internal and external stakeholders. The day included presentations from our staff with a focus on their individual protected characteristics. Workshops held included: disclosure of protected characteristics building a positive culture Workforce Race Equality standard commencement of our EDS2 grading. Other events attended during 2017/18: Equality Diversity and Inclusion manager and Workforce Development Manager attended the EMAS Patient Voice event to raise awareness of the EDS2. Assistant Director of Workforce gained a place on the first national Workforce Race Equality Experts (WRES) programme joining colleagues from NHS Services across the UK to become the first network of this kind. In 17/18 EMAS engaged in a national pilot to develop the workforce disability equality standard and undertook an assessment with Job Centre Plus to gain our Disability Confident status. 45

46 EMAS has developed the following during 17/18 to aid managers in equality matters: Transgender Guidance Equality Everyday Disability Passport Continued to deliver Professional Behaviours in the Workplace training Improving the care environment We have made numerous improvements because of learning from a wide-range of sources including serious incidents, complaints and patient experience surveys. Some examples are shown below, with more to feature in the EMAS Lessons Learned Annual Report. Pre-hospital Sepsis screening tool revised. New medicine management procedure covering the recording, issuing and restocking of medicines to stations and vehicles. Cardiac arrest on scene checklist and addition of adrenaline Patient Group Direction (PGD) for haemodynamic support post return of spontaneous circulation. On-going work to further align acceptance criteria of local patient pathways so that of amber outcome on paramedic pathfinder will increase non-conveyance with appropriate care. Bespoke mental health training in safe holding techniques unique to any ambulance trust. To support patients experiencing a hospital handover delays, an Emergency Department Standard Operating Procedure was designed. Introduction of Absconding Patients Procedure. Revised on scene conveyance procedure which ensures staff have the ability to safety net prior to leaving a patient at home. Improved mental health triage and training packages for EMAS staff, designed to improve the triage and outcome of all mental health patients. New management of chest pain procedure for all clinicians following serious incidents. Improved resilience for our Emergency Operations Centres in the event of the IT systems crashing. This includes better paper process, monthly system upgrades and testing of resilience and the introduction of tabards for specific roles. Early escalation for patients that have called 999 more than once within 30 minutes. These calls will be escalated early to a clinician for further triage. Improved business continuity plans. 46

47 Appendix 1 Workforce We have developed a new People Strategy with a vision to develop and support our people to be highly skilled, motivated, caring and compassionate professionals proud to be part of the EMAS family. Our aim is to develop EMAS as an Employer of Choice. We will achieve this by ensuring a safe and healthy workplace where colleagues feel valued, their views are heard, that they have a sense of purpose and direction, are able to reach their full potential and contribute to achieving our strategic vision and objectives. The People Strategy Framework reflects our approach to developing positive employment relationships with our staff and is modelled on recognised motivational theory Maslow s Hierarchy of Needs, ensuring a person centred approach in its development, and acknowledgement of the range of mutually reinforcing factors that impact on motivation and satisfaction. Desired outcomes of the strategy include: Planning and attraction: comprehensive and integrated workforce planning that supports the delivery of the right care, with the right resource, in the right place and at the right time. Retaining and valuing: positive employment relationships where individuals value the contribution of each other, wish to remain working with at EMAS and recommend EMAS as a place to work. Development and career progression: an engaged, committed, motivated and skilled workforce that has the capability to deliver effective patient care and drive organisational development, improvement and transformation. Exiting: to manage those who exit the EMAS sensitively and effectively, ensuring feedback contributes to organisational learning and development. We have strengthened our workforce plans to ensure our focus on capacity and capability to support transformation to the new service model and achievement of the qualityimprovement programme. This will provide assurance that we have the right number of resources with the right skill mix required to meet operational demand, ensure business continuity and meet the regional and national standards. More frontline staff We have a wide variety of frontline personnel at EMAS, who as part of a team provide professional healthcare services to the people of the East Midlands all day, every day. Examples of the different role types can be found under the careers section of our website During the year we experienced a 6% turnover rate of frontline staff and our recruitment plan reflects the rate needed to maintain establishment and skill mix. 47

48 In line with our Workforce Plan, during 2017/18, we recruited over 190 new frontline staff (qualified paramedics, trainee technicians and trainee emergency care assistants) to respond to 999 calls. 53 Emergency Operations Centre colleagues were recruited during the same period. Career progression opportunities have been increased for our existing frontline workforce, and a major recruitment and education campaign has been launched. This involves a range of options including: trainee technicians emergency care assistant to technician technician to paramedic. Supporting young people at the start of their career Associate Ambulance Practitioner Apprenticeships In 17/18 we launched our #EMAZING campaign using social media platforms to attract graduating paramedics. In addition, we held welcome events for those due to graduate to facilitate conversations about the role. Since the 1 May 2017, EMAS has recruited 109 Trainee Technicians who are currently signed onto the Associate Ambulance Practitioner apprenticeship, across the divisions and, being delivered by EMAS Education Centres. Current workforce engaged in apprenticeships From the 1 May 2017, when the apprenticeship levy was introduced, 23 of our current workforce have engaged in a variety of apprenticeship standards/frameworks to support their knowledge and career aspirations. These standards/frameworks include: Customers Services Level 2, Team Leading Level 2, Management Level 3 Pharmacy Level 2 Business Admin Level 2, 3 and 4. 48

49 Apprentices Individuals appointed on a fixed term contract 13 apprentices have been appointed on a 13 months contract, in various roles in Enabling Services teams. The below job roles are all apprentice roles within the Enabling Services: Community First Responder Admin Apprentice Emergency Operation Centre Admin Apprentice Fleet Administrator Apprentice Governance Apprentice Mechanics Medical Device Apprentice Performance Management Office Admin Apprentice In addition, EMAS has engaged, nationally, with the development of the emergency operations centre apprenticeship standard and the paramedic apprenticeship standard. We have continued to work with Higher Education Institutes and developed new partnerships to increase the number of undergraduate paramedic programmes on offer in the East Midlands footprint. Values based recruitment improves quality of care Through our recruitment campaigns we have ensured a values-based approach focussed on attitudes, behaviours and ability. While assessment of ability has remained an integral component of the recruitment process, it is now widely recognised that employees values, attitudes and behaviours have a significant impact on the quality of care and patient experience. To better support values-based recruitment, we have employed a number of strategies during the year including education and training for recruiting managers, values-based interview techniques, questions to explore attitude and behavioural factors, use of psychometric instruments, assessment centres, and patient and stakeholder involvement. Education and development In December 2013, we developed our People Capability Framework to define the competencies, attitudes and behaviours for staff and managers at every level. The framework supports leadership and management development; cultural development and underpins workforce planning, values-based recruitment, education and training, appraisals and succession planning. We have continued to offer leadership programmes and master classes to existing and aspiring managers and have facilitated a level 4 business administration course for existing administrators within the service. 49

50 During 2017/18, our Education team continued to support the annual statutory and mandatory education programme supporting essential standards of quality and safety, statutory and mandatory requirements, and clinical updates. Staff support and wellbeing During 2017/18 EMAS has progressed initiatives to enhance staff support and wellbeing. Key achievements are detailed below. Staff Support: Peer to Peer In February 2015 the Peer to Peer (P2P) and Pastoral Care Worker (PCW) support network was launched with 90 volunteer staff from across EMAS trained in supporting and signposting colleagues to further support where required. During 2017/18 the P2P/PCW support network has grown from strength to strength demonstrated through over 3,997 support contacts being made during the year. The success of the scheme means staff are now requesting the training to support their colleagues and an additional 110 more P2P/PCW volunteers. Trauma Risk Management (TRiM) As part of the staff support initiatives within EMAS we introduced TRiM. It was launched in May 2015, initially with 16 TRiM practitioners (including 2 TRiM managers) we have now expanded this to 66 TRiM practitioners (including 9 TRiM Managers/Coordinators) operating across EMAS supporting staff who have been exposed to traumatic situations. Induction Staff support information sessions are now integrated into all induction courses for new staff joining EMAS to ensure awareness of the different support mechanisms that are available. Internal Support Network Groups (Lesbian, gay, bisexual, transgender (LGBT) support group launched in March 2015 and continues to represent and support employees. The Disability and Carer s Group launched in December 2015 and the Black Minority Ethnic (BME) support group launched in March These support groups focus on issues poignant to individuals and provide a group voice and support mechanism for staff within their community, and providing valuable contribution to support learning and development of the working environment. Mediation service EMAS provides an internal mediation service to employees who are experiencing conflict, frustration or disagreement with another employee or manager. The mediation service provides an informal approach to resolving issues in 50

51 an aim to avoid escalation or formal processes being initiated. Lead Chaplain (established in February 2015) providing pastoral support to any employee when required. Health and wellbeing: Throughout 2017/18 EMAS introduced a Health and Wellbeing Programme that focused on health and wellbeing topics each month, providing information, guidance and support and promoting the NHS national One You campaign. Topics covered have included; mental health, anxiety, stress and depression and PTSD, back care/musculo skeletal, keeping fit and healthy, smoking cessation, healthy heart, men s and women s health and winter wellbeing. Mental health awareness In May 2016 EMAS focused on mental health support and information promoting discussion of mental health and resources to support staff. During 2017/18 EMAS continued to work with MIND on the Blue Light Programme to recognize the prevalence of mental health within emergency service personnel and promote mental health awareness within the emergency services. Throughout 2017/18 mental wellbeing was promoted via bespoke stress bucket posters, high 5 for mental wellbeing bookmarks, specific mental health awareness training for EOC staff and some divisional staff called my resilience matters and taster sessions on resilience and mindfulness and yoga. Occupational health EMAS has continued to work in collaboration with our contracted occupational health provider to ensure the provision of a high quality, prevention focussed, and comprehensive occupational health service. This includes reviews with PAM and the HR team assessing each individual case. Through a monthly contract meeting with Occupational Health and key members of EMAS, KPI s and trends are monitored, and actions agreed. Additional staff support is provided through Peer to Peer, Pastoral Care Workers and Trim and The Ambulances Services Charity (TASC) has also been utilised. Sickness/attendance EMAS has continued to actively manage sickness absence in accordance with the Managing Attendance Policy with action plans continuing to be monitored through the Workforce Committee. Declaration of Tobacco Control This pledge is aimed at encouraging organisations to commit to taking action on tobacco. EMAS commitment to health promotion is evidenced by the signing of the tobacco pledge in March 2016 and smoking cessation has continued to be promoted. Seasonal influenza vaccination programme 2017 This year EMAS vaccinated 73.5% of staff against the seasonal flu virus. This was a 12.4% increase in staff vaccinated compared to the 2016 programme with EMAS achieving fourth best performing ambulance trust for the campaign. 51

52 Staff engagement Through 2017/2018 we have engaged with our staff through a variety of approaches, including Staff Opinion Survey, Staff Friends and Family Test, working groups and our flu campaign. It is positive to note that we have again seen improvement in our level of staff engagement in 2017/18 as measured through the annual staff opinion survey. During 2017/18 we continue to prioritise staff engagement, health and wellbeing and we have a Health and Wellbeing campaign including Topic of the Month with a 12 month programme which commenced in April NHS Staff Opinion Survey The annual NHS Staff Opinion Survey was conducted by the Picker Institute on behalf of EMAS. Picker also administered the survey for five other ambulance services enabling us to have some comparative data ahead of the Department of Health report which details results from other parts of the NHS. Our response rate for 2017 was 37.6%. The average response rate for the five other ambulance trusts was 47.3%. Overall the results were positive with increasing numbers of staff looking forward to going to work, enthusiastic about their job, feel they that they are able to do their job to a standard that they are pleased with and there are enough staff in EMAS to do their job properly. Have we improved since the 2017 survey? A total of 88 questions were used in both the 2016 and 2017 surveys. Compared to the 2016 survey, EMAS is: significantly better on 12 questions significantly worse on 7 questions the scores show no significant difference on 69 questions. A full and comprehensive staff survey analysis report was submitted to the Workforce Committee on 14 March To view a full breakdown of the results, refer to the report. 52

53 Summary Our Organisational Development and Workforce Transformation Plan continues to be informed by the feedback from the Staff Opinion Survey. This includes a range of actions and support key performance indicators to continue to improve: workforce resourcing workforce flexibility health and wellbeing staff engagement, involvement and experience equality, diversity and inclusion line management capacity and capability appraisal and development communication and engagement. 53

54 Appendix 2 IG Toolkit Our Information Governance Toolkit assessment overall score for 2017/18 was 90% and was graded satisfactory. The EMAS Head of Information Governance is responsible for collating, checking and uploading evidence to support the Information Governance Toolkit for our service. Assurance on the process to collect the evidence is overseen by the EMAS Information Governance Group, chaired by the Senior Information Risk Owner (SIRO), which is accountable to the Finance and Performance Group. Requirements within the Information Governance Toolkit were assessed by Internal Audit in December 2017, who was able to provide significant assurance that there is a sound system in place to support Information Governance. General Data Protection Regulation (GDPR) The forthcoming changes to Data Protection legislation, in the form of the General Data Protection Regulation (GDPR) (supported in the UK by the Data Protection Act 2018), has meant that considerable work has been ongoing to ensure EMAS meets its requirements under this new law. In June 2017, 360 Assurance were commissioned to conduct and audit on EMAS readiness for GDPR. We were able to provide significant assurance, at that early stage, as we had developed an action plan based upon the Information Commissioners 12 steps. This action plan has since formed the basis for the work programme and has been updated as and when new guidance has been produced. The action plan has been monitored by both the Information Governance Group and the Finance and Performance Committee. One of the key milestones completed has been to identify the Data Protection Officer a mandatory requirement under the new legislation. This role is being fulfilled by the current Head of Information Governance. They are managing the virtual work-streams including communications, to support the fair processing notices and procurement, to support the contract reviews. The Board attended an awareness session on GDPR which detailed the impact the new legislation will have on EMAS and the penalties that may be imposed for any breaches that may occur. Communications are also planned for all EMAS staff. 54

55 Appendix 3 Research and Development EMAS research status to date for year 2017/2018 During EMAS Research generated several positive news stories. There are several ways that research is recognised and EMAS has achieved a variety of distinctions. There have been: presentations on basic life support (BLS) education, circle of life, mechanical resuscitation and paediatric pain posters on sepsis, cardiac arrest, stroke and mental health individual recognition in the form of the Golden Nugget Award, Best Abstract Presenter Award and International Presenter Award which were presented to Greg Whitley and EMAS Research team most likely to affect practice award presented to Jon Chippendale. The Research Team has continued to enhance the EMAS reputation as a research active organisation with national recognition with the award from Clinical Research Network (CRN) for Exceptional Research Delivery EMAS Research is the first ambulance trust to present to staff from conferences both national and internationally using Twitter via Periscope. This innovation has allowed staff to listen and learn from research both by EMAS and other organisations. Projects currently being undertaking by EMAS research include: OCHAO A project using statistics to explain the reasons why survival rates vary between regions ERA Electronic Records in Ambulances to support the shift of out of hospital care. AIRWAYS2 - a randomised control trial led by Prof J Benger at the Bristol Clinical Trials unit, is in its final year and is expected to meet its target for patient recruitment RIGHT2 a Rapid Intervention with GTN in Hypertensive Stroke Trial 2 The Ambulance Hypo Study - CLARHRC funded Hypoglycaemia Pathway project. 55

56 Below are the projects which contribute to the EMAS portfolio of research Project A Pilot Study to Assess the Feasibility of Paramedics Delivering Antibiotic Treatment to Red Flag Sepsis Patients AIRWAYS-2 Type Chief Investigator (CI) / Funding Organisation Overarching study aim Status Governanc e/ Monitoring Recruitment Evaluation Jon Chippendale This is an evaluation Completed and published Completed N/A NIHR Portfolio Prof Jonathan Benger Funder NIHR Health Technology Assessment (HTA) Programme Total funding to EMAS over 2 years 8 months 205,206 AIRWAYS-2 aims to determine the best approach to the management of a patient s airway during an out of hospital cardiac arrest The study began in 2015 and is continuing to recruit well. CPR cards have been rolled out across EMAS. So far 55 cards have been used. The cards will measure chest compression depth, rate and fraction in the intubation and i-gel arm of the trial. If there is no difference in chest compression quality between both arms then any difference in ROSC, survival or disability will more likely be caused by the airway HRA Internal Governance Monitoring EMAS/CI/ Funder Current recruitment: 2107 (target 2,268) 56

57 The Ambulance Hypo Study Avoidable Mortality in Patients with Low Risk Conditions AQUEDUCT BeArH CFABPH CFR NIHR Portfolio Evaluation NIHR Portfolio NIHR Portfolio Evaluation Evaluation Prof Kamlesh Khunti University of Leicester Funder Collaborations for Leadership in Applied Health Research and Care (NIHR CLAHRC) Total funding to EMAS over 2 years 52,500 Prof Niro Siriwardena Martin Orrell Jonathan Chippendale Prof Niro Siriwardena To implement and evaluate the effectiveness of a diabetes specialist nurse (DSN) led intervention following a call out of an ambulance to treat a hypoglycaemic episode. Data study in Northamptonshire To be designed In set-up Being designed management device than chest compression quality. 131 EMAS clinicians have been recruited and trained to recruit to the study. EMAS Research team are working alongside the regional DSN to implement the intervention and follow up with patients for full study consent and completion of follow up questionnaires. HRA Internal Governance Monitoring through EMAS Current recruitment: 63 (target 216) 57

58 Cultures of Openness (COO) Delivering ambulance service care that meets the needs of Eastern European migrants Diabetic Emergencies in Care Homes EDARA EEAT Nonportfolio Prof Graham Martin Academic Viet-Hai Phung As described On-going To be assessed NIHR Portfolio NIHR Portfolio Prof N Siriwardena Dr Simon Moore Prof Niroshan Siriwardena Funder The Welcome Trust Total funding to EMAS is 1,000 Protocol being devised. Will form part of a larger study with potential for NIHR funding The study aims to explore experiences, perceptions and challenges reported by patients and/or their relatives and paramedics regarding ethics of recruiting patients to a trial in a prehospital setting In Set Up The study began in July Recruitment has been difficult particularly patient recruitment. The study is recruiting from a pool of patients and paramedics who have participated in other studies carried out within EMAS HRA/ EMAS Governance Monitoring EMAS/CI/ Funder HRA / EMAS Governance Monitoring EMAS/CI /Funder HRA / EMAS Governance Monitoring EMAS/CI/ Funder N/A Current recruitment: 9 (target 30) 58

59 Endotracheal Intubation by Paramedics in the Urgent and Emergency Care Environment ERA Evaluation of telephone advice for low urgency ambulance service calls ExPLAIN Academic Sarah Cross NIHR Portfolio Nonportfolio Evaluation Dr Alison Porter University of Swansea Funder NIHR Health Services and Delivery Programme Total funding to EMAS over 12 months 21,500 Joanne Coster University of Sheffield PhD study partly funded by the PHOEBE Programme Grant Dr Zahid Asghar The study aims to find out how ambulance services can make best use of information technology to support people with good quality care out of hospital The study aims to investigate the clinical safety, appropriateness and acceptability to patients of the hear and treat response The study began in March 2017 and will be recruiting for one year The study began in March It will involve sending questionnaires to patients who receive hear and treat advice over the phone HRA /EMAS Governance Monitoring EMAS/CI/ Funder EMAS Governance Monitoring EMAS R&D Current recruitment: 6 (target 35) Non portfolio recruitment: Expected

60 Mental Wellbeing and Coping Strategies in Ambulance Workers OCHAO Data Quality and 30-day survival for out of hospital cardiac arrest registry: data linkage study Academic NIHR Portfolio NIHR Gabriella Caetano / Dr Gemma Witcomb Prof Gavin Perkins- University of Warwick Funders British Heart Foundation & Resuscitation Council UK Prof Gavin Perkins- University of Warwick Funders British Heart Foundation & Resuscitation Council UK To develop a standardised approach to collecting information about out of hospital cardiac arrest and how outcomes are followed up to confirm if a resuscitation attempt was successful Data quality This is a national study involving all ambulance services in England and Wales. The OHCAO project team are supporting the services to assist with improvements in data capture, quality and quantity. EMAS has continued to provide data for this database Completed EMAS Governance Monitoring EMAS/CI EMAS Governance Monitoring EMAS/CI None. This study does not involve taking consent from patients and therefore considered a nonrecruiting study None. This study does not involve taking consent from patients and therefore considered a nonrecruiting study 60

61 Physical activity Implementation Study in Communitydwelling AduLts (PHYSICAL) Professional Women's Experience of a Doctorate NIHR Portfolio Nonportfolio Dr Elizabeth Orton University of Nottingham Funder NIHR CLAHRC East Midlands Dr Michele Platt To understand the factors that influence the successful implementation of the Falls Management Exercise (FaME) programme, a community based physical activity programme for older people that is being commissioned and provided in Derby City and Leicestershire and Rutland Counties. The research team are currently collecting data and analysing results. Expected completed is in August HRA/EMAS Governance Monitoring EMAS/CI/ Funder None. This study does not involve taking consent from patients and therefore considered a nonrecruiting study 61

62 RIGHT-2 NIHR Portfolio Prof Philip Bath University of Nottingham Funder British Heart Foundation Total funding to EMAS over two years five months 296,607 The purpose of this study is to determine whether early use of GTN within four hours of suspected ultra-acute stroke, and continuing administration once daily for a further three days, is associated with improved outcome The study commenced in 2015 and is continuing to recruit well. All nine Stroke Centres across the EMAS region are open to receive RIGHT -2 patients. This is a fantastic achievement and allows paramedics across the whole of EMAS an opportunity to participate in this high quality study HRA EMAS Governance Monitoring EMAS/CI/ Funder Current recruitment: 150 (target 142) EMAS the recruitment target has now been surpassed Seizure Outcomes Evaluation Prof Pareish Prioritising novel and existing ambulance performance measures through expert and lay consensus: a three-stage multimethod consensus study Understanding the Reconfiguration of Major Trauma Services Academic Nonportfolio Coster J, Irving AD, Turner JK, Phung VH, Siriwardena AN, (2017) This study continued the work included in the 5year PHOEBE Programme Grant Prof Justin Waring External study Completed HRA EMAS governance Monitoring EMAS/CI/Fun der EMAS governance Monitoring EMAS 62

63 EMAS Research has a reputation in helping new researchers complete small studies as part of their MSc or PHD. The table below shows the variety of subjects covered by these students during Project Type Chief Investigator / Funding Organisation Overarching study aim Root Cause Project Academic Heidi Scott-Smith Part of PhD study On-going Stress as a Cause of Sickness within the Ambulance Service Nonportfolio Laura Simmonds Part of a PhD study On-going Pain in Children Academic Greg Whitley Part of a PhD study On-going NEWS Academic Nadya Essam Part of a PhD study On-going How can I as a Leader positively improve the resilience of clinical teams within Lincolnshire s West locality, in EMAS Academic Paul Litherland Part of MSC study Completed Status Governance/ Monitoring EMAS Governance Monitoring EMAS EMAS Governance Monitoring EMAS/UofL EMAS Governance Monitoring EMAS/UofL EMAS Governance Monitoring EMAS/UofL EMAS Governance Monitoring Recruitment N/A N/A N/A N/A N/A 63

64 PROMPT Improving the models supporting changes in the ambulance service using simulation Nonportfolio Academic Mohammad Iqbal East Midlands Ambulance Service PhD Study Jiayi Wei The study aims to test the reliability and validity of the PROMPT and then to evaluate its effectiveness in prehospital pain management This study forms part of a MSc The study is in the process of being written up following the analysis the data collected. Completed EMAS Governance Monitoring EMAS R & D EMAS Governance Monitoring EMAS R & D Non portfolio recruitment: 77 N/A The above studies show the variety and scope of research in EMAS. However, successful research is measured by its effect on patient outcomes. This is achieved in a number of ways through dissemination at conferences, publications and clinical education and training. Over the year EMAS have given oral presentations and presented posters at 7 conferences both nationally and internationally and there have been 7 journal publications in prestigious publications such as the Annuals of Emergency Medicine and the Emergency Medical Journal to name but a few. Nearly 50% of EMAS clinicians are involved in research which has a significant effect on the quality of patient care. 64

65 The table below shows the type, title, date, location, authors and study. Type Journal Publication Poster Oral Presentation Title of publication / presentation Support and Assessment for Fall Emergency Referrals (SAFER) 2: Cluster randomised trial and systematic review of clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community based care when appropriate Analysis of Basic Life Support (BLS) knowledge and competence, identifying obstructing human factors to individual performance in University of Nottingham (UoN) Medical Students in the UK Analysis of Basic Life Support (BLS) knowledge and competence, identifying obstructing human factors to individual performance in UoN Medical Students in the UK Date published / conference 01/04/2017 Journal / location Health Technology Assessment 2017; 21(13) Authors / presenters Snooks HA, Anthony R, Chatters R, Dale J, Fothergill R, Gaze S, Halter M, Humphreys I, Koniotou M, Logan P, Lyons R, Mason S, Nicholl J, Peconi J, Phillips C, Phillips J, Porter A, Siriwardena AN, Smith G, Toghill A, Wani M, Watkins A, Whitfield R, Wilson L, Russell IT 05/05/2017 EM2C, Nottingham Bichmann A, Spaight R 05/05/2017 EM2C, Nottingham Bichmann A, Spaight R 65

66 Poster Oral Presentation Poster Oral Presentation Oral Presentation Poster An evaluative study into the introduction of the circle of Life cardiac arrest programme within EMAS An evaluative study into the introduction of the circle of Life cardiac arrest programme within EMAS An evaluative study into the effect of mechanical resuscitation in Cardiac Arrest with in EMAS An evaluative study into the effect of mechanical resuscitation in Cardiac Arrest with in EMAS Does current analgesia effectively reduce pain in children caused by trauma, within a UK ambulance service? A service evaluation A comparative evaluation of 999 call-to-needle time of patients presenting with 'red flag' sepsis treated with antibiotics by paramedics versus Emergency Department staff 05/05/2017 EM2C, Nottingham Spaight R, Bichmann A, Craft S 05/05/2017 EM2C, Nottingham Spaight R, Bichmann A, Craft S 05/05/2017 EM2C, Nottingham Bichmann A, Spaight R 05/05/2017 EM2C, Nottingham Bichmann A, Spaight R 09/05/2017 ParaCon, Solihull Whitley G A 09/05/2017 ParaCon, Solihull Payne T, Chippendale J, Lloyd A 66

67 Oral Oral Presentation Poster Oral Presentation Poster Poster Exploring factors increasing Paramedics likelihood of administering Analgesia in prehospital pain: cross sectional study (ExPLAIN) An evaluative study into the effect of mechanical resuscitation in Cardiac Arrest with in EMAS An evaluative study into the effect of mechanical resuscitation in Cardiac Arrest with in EMAS An evaluative study into the introduction of the circle of Life cardiac arrest programme within EMAS An evaluative study into the introduction of the circle of Life cardiac arrest programme within EMAS Does current analgesia effectively reduce pain in children caused by trauma, within a UK ambulance service? A service evaluation 09/05/2017 ParaCon, Solihull Williams J, Pocock H, Asghar Z, Lord W, Foster T, Phung VH, Shaw D, Snooks H, Siriwardena AN 23/05/2017 EMS2017, Copenhagen Bichmann A, Spaight R 23/05/2017 EMS2017, Copenhagen Bichmann A, Spaight R 23/05/2017 EMS2017, Copenhagen Spaight R, Bichmann A, Craft S 23/05/2017 EMS2017, Copenhagen Spaight R, Bichmann A, Craft S 23/05/2017 EMS2017, Copenhagen Whitley GA, Bath-Hextall F Poster a/a 17/08/2017 Prehospital Care Research Forum, UCLA Whitley, G 67

68 Oral Presentation Journal Publication Journal Publication Poster Oral Presentation a/a 17/08/2017 Prehospital Care Research Forum, UCLA An evaluative study into the effect of mechanical ERC 2017 vol.118 s.1 p.e78 01/09/2017 resuscitation in Cardiac Arrest AP95 within EMAS Improving data quality in a UK out-of-hospital cardiac arrest registry through data linkage between the Out-of-hospital Cardiac Arrest Outcomes (OHCAO project and NHS Digital) Improving data quality in a United Kingdom registry of outof-hospital cardiac arrests through data linkage between the out-of-hospital cardiac arrest outcomes (OHCAO) project and the Office for National Statistics Analysis of Basic Life Support (BLS) knowledge and competence, identifying obstructing human factors to individual performance in UoN Medical Students in the UK 01/09/2017 ERC 2017 vol.118 s.1 p.e37 AS090 23/09/2017 EUSEM 2017, Athens Whitley, G Spaight R, Bichmann A Rajagopal S, Booth S J, Brown T P, Ji C, Hawkes C, Siriwardena A N, Kirby K, Black S, Spaight R, Gunson I, Brace-McDonnell S J, Perkins G D Rajagopal S, Booth S J, Brown T P, Ji C, Hawkes C, Siriwardena A N, Kirby K, Black S, Spaight R, Gunson I, Brace-McDonnell S J, Perkins G D 28/09/2017 ERC, Frieburg Bichmann A, Spaight R 68

69 Poster Poster Journal Publication Journal Publication Journal Publication Analysis of Basic Life Support (BLS) knowledge and competence, identifying obstructing human factors to individual performance in UoN Medical Students in the UK An evaluative study into the effect of mechanical resuscitation in Cardiac Arrest with in EMAS A comparative evaluation of 999 call-to-needle time of patients presenting with 'red flag' sepsis treated with antibiotics by paramedics versus Emergency Department staff Interim analysis of ambulance logistics and timings in patients recruited into the Rapid intervention with Glycerol triturate in Hypertensive Stroke Trial (Right-2) A pilot study to assess the feasibility of paramedics delivering antibiotic treatment to 'red flag' sepsis patients 28/09/2017 ERC, Frieburg Bichmann A, Spaight R 28/09/2017 ERC, Frieburg Bichmann A, Spaight R 28/09/ /09/ /09/2017 Emergency Medical Journal 2017;34:e8 t/34/10/e8.2 Emergency Medical Journal 2017;34:e6-e7 t/34/10/e6.3 Emergency Medical Journal 2017;34:695 t/34/10/695.2 Payne T, Chippendale J, Lloyd A Dixon M, Scutt P, Appleton J, Spaight R, Johnson R, Siriwardena AN, Bath PM Chippendale J, Lloyd A, Payne T, Dunmore S, Stoddart B 69

70 Journal Publication Poster Poster Poster Journal Publication Journal Publication Paramedic assessment of older adults following falls including community care referral pathway: cluster randomized trial Service evaluation of how accurate the Medical Priority Dispatch System (MPDS) is at identifying patients calling 999 for a mental health problem An evaluative study into the introduction of the circle of Life cardiac arrest programme within EMAS Risk Prediction Models for Outof-Hospital Cardiac Arrest Outcomes in England RC(UK) Scientific Symposium Prioritising novel & existing ambulance performance measures through expert & lay consensus: a three-stage multimethod consensus study An approach to developing & prioritising ambulance performance measures 01/10/ /11/ /11/2017 Annals of Emergency Medicine 2017 Mid Trent Critical Care Annual Network Conference Mid Trent Critical Care Annual Network Conference 2018 Health Expect 2018 Health Expect Snooks HA, Anthony R, Chatters R, Dale J, Fothergill R, Gaze S, Halter M, Humphreys I, Koniotou M, Logan P, Lyons RA, Mason S, Nicholl J, Peconi J, Phillips C Porter A, Siriwardena AN, Wani M, Watkins A, Wilson L, Russell IT Craft S, Spaight R Spaight R, Bichmann A, Craft S Chen Ji, Mapstone, Nolan, Brown, Hawkes, Fothergill, Spaight, Black, Spaight, Booth, Perkins Coster J, Irving AD, Turner JK, Phung VH, Siriwardena AN (2017) Irving A, Turner J, Marsh M, Broadway-Parkinson A, Fall D, Coster J, Siriwardena AN 70

71 Journal Publication Journal Publication Journal publication Journal Publication Journal publication Data quality and 30-day survival for out-of-hospital cardiac arrest in the UK out-of-hospital cardiac arrest registry: a data linkage study Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review Community First Responders and responder schemes in the United Kingdom: systematic scoping review Paramedic assessment of older adults following falls including community care referral pathway: cluster randomized trial Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care BMJ Open 2017;7:e doi: /bmjopen BMJ Open 2017;7:e doi: /bmjopen Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2017; doi: /s z Annals of Emergency Medicine 2017 (online first). doi: /j.annemergmed BMC Medical Research Methodology 2017; 17 (11): doi: /s Rajagopala S, Booth S, Brown TP, Jia C, Hawkes C., Siriwardena AN, Kirby K, Black S, Spaight R, Gunson I, Brace-McDonnell CJ, Perkins GD, on behalf of OHCAO collaborators Armstrong S, Langlois A, Laparidou D, Dixon M, Appleton JP, Bath PM, Snooks H, Siriwardena AN Phung VH, Trueman I, Togher F, Orner R, Siriwardena AN Snooks HA, Anthony R, Chatters R, Dale J, Fothergill R, Gaze S, Halter M, Humphreys I, Koniotou M, Logan P, Lyons RA, Mason S, Nicholl J, Peconi J, Phillips C Porter A, Siriwardena AN, Wani M, Watkins A, Wilson L, Russell IT Johnson M, O Hara R, Hirst E, Weymann A, Turner J, Mason S, Quinn T, Shewan J, Siriwardena AN 71

72 Journal Publication Journal Publication Oral presentation Oral presentation Epidemiology and outcomes from out-of-hospital cardiac arrests in England Support and Assessment for Fall Emergency Referrals (SAFER) 2: Cluster randomised trial and systematic review of clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community based care when appropriate Improving measurement, performance and outcomes in prehospital ambulance care. National Association of Emergency Medical Services Physicians [keynote] Healthcare experiences of migrant and minority ethnic patients in Europe: a systematic scoping review Resuscitation 2017; 110: doi: j.resuscitation Health Technology Assessment 2017; 21(13) 2018 San Diego, California, US, Siriwardena AN 2018 EMS2018 Copenhagen Siriwardena AN Hawkes C, Booth S, Ji C, Brace- McDonnell SJ, Whittington A, Mapstone J, Cooke MW, Deakin CD, Gale CP, Fothergill R, Nolan JP, Rees N, Soar J, Siriwardena AN, Brown TP, Perkins GD and collaborators Snooks HA, Anthony R, Chatters R, Dale J, Fothergill R, Gaze S, Halter M, Humphreys I, Koniotou M, Logan P, Lyons R, Mason S, Nicholl J, Peconi J, Phillips C, Phillips J, Porter A, Siriwardena AN, Smith G, Toghill A, Wani M, Watkins A, Whitfield R, Wilson L, Russell IT (2017) 72

73 Oral Presentation Oral presentation Oral Presentation Oral Presentation Oral presentation Preventable mortality in patients at low risk of death requiring prehospital ambulance care: retrospective case record review study Modelling of patient outcomes after emergency treatment for out-of-hospital cardiac arrest by paramedics and community first responders Exploring factors increasing paramedics likelihood of administering analgesia in prehospital pain: cross sectional study (ExPLAIN) Interventions to reduce sickness absence within a healthcare population: a systematic review The perceptions and experiences of being Community First Responders: an interview study in the UK 2018 EMS2018 Copenhagen Siriwardena AN EMS Research Forum Conference 2018, EMS Research Forum Conference 2018, UK SAPC Regional Conference, 13 Mar 2018, University of Sheffield Psychology Presence in the Midlands 2017, 13 Sept 2017, Derby Mediterranean Emergency Medicine Congress, 8-10 September 2017, Corinthia Hotel, Lisbon, Portugal Smith M, Siriwardena AN, Spaight R, Norman J (2018) Asghar Z, Siriwardena AN, Phung V, Lord B, Foster T, Pocock H, Williams J, Snooks H Simmons L, Siriwardena AN, Bridle C (2017) Phung VH, Trueman I, Togher F, Orner R, Siriwardena AN (2017) 73

74 Clinical Audit Part of ensuring good clinical governance, is through clinical audit. This provides the means by which the Trust ensures quality clinical care by making individuals accountable for setting, maintaining and monitoring standards. It is focussed around the three domains of quality - clinical effectiveness, patient safety and patient experience. Clinical Audit and Research is led by our Clinical Audit and Research Unit which reports to the Clinical Governance Group. The department is responsible for developing EMAS clinical audit programme and ensures that all necessary support for the undertaking of clinical audit is readily available to staff and that progress is monitored. The narrative and report below are the final position of clinical audits completed during this year For Clinical Audit, topics are divided into 4 main types: Mandatory Discretionary Performance driven Staff initiation Clinical audit topics are selected according to priorities which may include some of the following considerations: 1. Is the area concerned of high cost, volume or risk to patients or staff 2. Is there evidence of serious quality problems eg patient complaints or high incident rates 3. Is there good evidence available to inform standards ie national clinical guidelines 4. Is the problem concerned amenable to change? 5. Is there potential for impact on health outcomes? 6. Is there opportunity for involvement in a national audit project? 7. Is the topic pertinent to national policy initiatives? 8. Does the topic relate to a recently introduced treatment protocol? 9. Subjects raised by Risk Management and Untoward Incident Reporting 74

75 Audit / monitoring activity Type Timescale Note Audits completed by Clinical Audit Department Ambulance Clinical Quality Indicators (ACQIs) Mandatory national performance monitoring Monthly as per NHS England timetable (see appendix 2) Cardiac arrest (ROSC and survival to discharge). Stroke (care bundle and arrival at hyperacute stroke centre (HASU) in 60 minutes). STEMI (care bundle, PPCI within 150 minutes). Data collection, analysis, report preparation and submission to NHS England/Unify. National Clinical Performance Indicators (NCPIs) Mandatory - national audit requirement These audits are reported on according to the timetable and the results published in the quarterly Clinical Effectiveness Report. Actions for improvement are included in the clinical effectiveness action plan Suspended pending outcome of review Audits completed by Clinical Audit Department EMAS Clinical Performance Indicators (ECPIs) Discretionary local clinical audit project Monthly Asthma Epilepsy Febrile convulsion Hypo Intubation / ETCo2 Single Limb Fracture 75

76 Controlled Drugs Usage Audit Local service monitoring Sepsis Discretionary Annual These audits look at the results at county level and are produced, published and distributed each month. This list is expected to be much more comprehensive for the year 2018/2019. The audits are presented to Clinical Governance Group and discussed at the Clinical Improvement Group Report completed by Accountable Officer for controlled drugs Monitoring the use of controlled drugs in line with the duties of accountable officers To investigate administration of fluids and oxygen for sepsis and recording of observations as per sepsis guidelines. Completed by Clinical Audit Manager Pain in Dementia Patients Discretionary Initial This is a preliminary audit pending new clinical performance indicator To investigate the assessment of pain in patients with dementia This is a preliminary audit and will be added to the Clinical Audit Plan CLINICAL AUDIT PLAN - FINAL REPORT Conclusion The Research and Clinical Audit departments have achieved and in many ways exceeded their work programme. Both the Research and Clinical Audit teams completed the required clinical audit programme. The value of both areas of work being closely linked did contribute to overcoming the difficulties associated with the substantial increase in processing the paper records. The team look forward to an electronic clinical record system being fully implemented. 76

77 Appendix 4 CQC registration The Care Quality Commission (CQC) carried out a planned inspection of the Trust in February This led to us being given an overall rating of "requires improvement on 13 June The CQC acknowledged that the Trust had made significant improvements since the last inspection in November The inspection did not look across the whole service at EMAS. They looked at: The safety and effectiveness of Emergency and Urgent Care Services The safety and effectiveness of the Emergency Operations Centre Safety, effectiveness and well led at provider level. 77

78 Appendix 5 Third Party Statements The views and opinions expressed in this section are the opinions of the third party stakeholders and do not necessarily reflect the views of the Trust. Statement from the Co-ordinating Commissioner Hardwick Clinical Commissioning Group (CCG) on behalf of 22 East Midlands Associate CCGs Statement from the Co-ordinating Commissioner Hardwick Clinical Commissioning Group (CCG) on behalf of 22 East Midlands Associate CCGs General Comments NHS Hardwick CCG, in its role as coordinating commissioner, has led the commissioning arrangements for the EMAS contract since July Commissioners have a pivotal role in assuring the quality of the service provided by EMAS in particular in relation to the delivery of national response targets. As a provider of emergency and urgent ambulance services EMAS receives considerable attention for the challenges surrounding the delivery of national response standards. There continue to be prolonged periods when service standards are not acceptable and as the coordinating commissioner we have worked closely with EMAS to ensure that lessons are learnt, and improvements are made when these occasions arise. This Quality Account presents an accurate reflection of the improvements made during 2016/17, to improve the quality of service, patient safety and patient experience. Priorities and Reporting from 2016/17 In addition to acknowledging the improvements made against the review of Quality Performance we would also like to highlight in particular: - The organisational wide review of Sepsis care within untoward incidents, where common themes were identified, and new innovative measures have been adopted to minimise the risk of reoccurrence and improve patient care across the region. Within this review it became evident that a growing body of guidance recommended treatment for a red flag or high risk sepsis patient within the hour of recognition. The recommended treatment for these patients was for use of oxygen, fluid resuscitation and early empiric antibiotic therapy. Within ambulance services only the fluid and oxygen elements of this treatment were given, leaving the antibiotic treatment until arrival at an emergency department. Given the benefits for sepsis patients in 78

79 terms of the reduction in mortality with early antibiotic therapy, EMAS worked with key stakeholders across the region, to conduct a service evaluation; assessing the feasibility of a paramedic delivering antimicrobial therapy in the pre-hospital environment - The ongoing development of an electronic patient record system which will allow improved access to electronic patient records on scene and communication with primary care, hospitals and other healthcare services. This included all Emergency Departments at the Acute trusts in region being able to receive paperless records from EMAS and for every face to face contact made the named GP would receive a discharge letter detailing that a patient contact has been made and what treatment was undertaken by the crew Looking Forward to 2018/19 The commissioners support the continued focus and development of the priority domains for quality, in particular around clinical effectiveness, patient safety and patient experience. The commissioners fully support the priorities for improvement identified for 2018/19 in relation to: - Improving Sepsis Care across the whole region - Reducing conveyance We will continue to work constructively with the Trust to ensure that deliverable outcomes are achieved, and progress is made against appropriate actions plans. 79

80 Statement from Derbyshire County Council Health Scrutiny Committee comments on the East Midlands Ambulance Service NHS Trust Quality Account for The Health Scrutiny Committee is pleased to receive the Quality Report for East Midlands Ambulance Service for 2017/18. The Committee will take the opportunity, over the coming year, to monitor the activities and progress of EMAS and both support and challenge EMAS as appropriate. 80

81 Nottingham City Health Scrutiny Committee Comment for inclusion in East Midlands Ambulance Service Quality Account 2017/18 The Nottingham City Health Scrutiny Committee welcomes the opportunity to comment on the East Midlands Ambulance Service Quality Account 2017/18. Our comment focuses on the areas in which we have engaged with the Trust during 2017/18. As in previous years, the Committee has found the Trust open and willing to engage with scrutiny when it has been requested to do so during the year. The Committee is supportive of EMAS s decision to keep its quality improvement priorities the same for 2018/19 to provide an opportunity to maintain its focus on the same issues and allow sufficient time to deliver sustained improvement. In particular the Committee welcomes the continued focus on working with commissioners and other providers to develop alternative pathways and reduce unnecessary conveyance to A&E. It is really important that patients can be transferred to A&E quickly and safety if that is necessary and the Committee would like to acknowledge the local work that has taken place between EMAS and Nottingham University Hospitals NHS Trust to improve hospital handovers for people taken to the Queens Medical Centre in Nottingham. This reflects well on partnership working in the local health system. However, the Committee frequently hears that A&E is not the most appropriate place for people to receive the care that they need, and it is really important that alternative sustainable pathways are developed and used. This will have benefits for patients and the whole health system. EMAS progress on early identification and treatment of sepsis including innovative work to trial the pre-hospital administration of intravenous antibiotics is acknowledged. Given the potential benefits for patients and our understanding of the initial positive outcomes from the trial in Lincolnshire, the Committee encourages discussions to continue in Nottinghamshire to explore the roll out of pre-hospital administration of intravenous antibiotics for sepsis in this part of the region. For some time, the Committee has been concerned about EMAS performance against response time targets and is interested in the local impact of the Ambulance Response Programme on performance, both in terms of patient outcomes and patient experience. This is an area that the Committee intends to explore with the Nottinghamshire Division during the course of the forthcoming year. 81

82 The Committee recognises that the service would not be possible at all without the staff and that many employees work in very stressful environments. Therefore, the continued focus on improving staff health and wellbeing is supported, including promoting good mental health and resilience and supporting all sections of the workforce. 82

83 Leicester City Health and Wellbeing Scrutiny Commission Comment for inclusion in East Midlands Ambulance Service Quality Account 2017/18 As Chair of the Health and Wellbeing Scrutiny Commission at Leicester City Council, I am writing to you to with some comments about your Quality Accounts but also about EMAS throughout the scrutiny year. I would like to reiterate a point which we have made previously - that we would have much preferred the Quality Account to come to commission members and be discussed at our scrutiny commission meeting. However, the timing of when we received it hasn t allowed for this to happen. Can I strongly request that in future EMAS could check the final date of our commission meeting and that it comes there? This will allow for a more meaningful engagement of this consultation process. Having made that point I hope you will be pleased to see that we have a number of positive observations about EMAS and its performance in what we know have been difficult circumstances for your organisation. We would like to: Commend the work done around sepsis, along with UHL, but also welcome that it is still seen as a priority in Quality Account Welcome the efforts being made to tackle A&E handover times although we recognise further work still needs to be done on this, particularly at LRI; and Recognise that the 15 minute target for handover seems to be difficult to achieve and may simply be unrealistic, particularly for Leicester. Although it has been achieved in some areas we recognise this is an issue for the whole of the health service and not solely an EMAS issue. We recognise the requirement to sometimes use non-emergency teams to respond to non-blue light calls but would urge caution about this possible trend and feel there is a need to focus on ensuring that the right response is taken by the right team for all patients. The Commission has heard that some patients with serious conditions are waiting longer before they call an ambulance, so we query whether the campaign to direct patients away from emergency services might be working too well in some cases, with patients not seeking emergency care when they really do need it. 83

84 We would like to underline our view that your staff s welfare is crucially important, with many staff doing many hours and sometimes multiple shifts. We feel this welfare issue should be a priority for you and welcome the fact that it is acknowledged in the Quality Account. We are aware EMAS has requested 20m of extra funding from the CCG and would be keen to see how you would anticipate spending this - or if it is not received in full, or only in part, what that would mean for the service going forward. Notwithstanding the above comments I would wish to put on record the high level of appreciation for the work done by your EMAS colleagues and teams, particularly in the context of a time of austerity for virtually every aspect of our health services. Yours Sincerely Councillor Elly Cutkelvin Chair, Leicester City Council Health and Wellbeing Scrutiny Commission 84

85 North Lincolnshire Council Health Scrutiny Panel s Quality Accounts comments for East Midlands Ambulance Service. North Lincolnshire Council's Health Scrutiny Panel welcomes the opportunity to comment as part of East Midlands Ambulance Service (EMAS) Quality Account. EMAS are a key partner and provider of local services, and members have built a valuable working relationship with EMAS personnel over recent years. The panel welcomes the Quality Account and its stated priorities for 2018/19. However, as stated by the panel for a number of years, members continue to be unclear why improving ambulance response times have again not been overtly identified as a stated priority for the service. Whilst we are naturally aware of the adoption of revised response rate criteria in recent months, response rates are the key indicator available to the public to accessibly understand local performance. In addition, concerns about response times were identified as a key finding within the CQC s latest inspection report. We would reiterate our wish for this to be clearly stated as the fifth EMAS priority for 2018/19, to ensure that the focus is maintained and so the Board and other stakeholders can ensure that progress is being made. The panel also notes the further concerns set out in the 2017 CQC report into EMAS services. Whilst we are aware of recent improvements, including those set out in the Quality Account, we signal our intention to EMAS that we will continue to work with colleagues from across the East Midlands to hold senior managers to account for local performance. As ever, we would wish to note the continued efforts and the levels of care shown by front-line staff and thank them for their hard work. On work-related issues, throughout 2017/18 EMAS continue their recent trend of improvements in patient and stakeholder engagement. Senior figures from the service, and other staff, have always been very open to attend meetings and to answer members questions. In addition, any day-to-day queries have always resulted in a swift and comprehensive response, and we thank EMAS for this. 85

86 Nottinghamshire Health Scrutiny Committee Comment on EMAS Quality Account The Health Scrutiny Committee for Nottinghamshire welcomes the opportunity to comment on the East Midlands Ambulance Service s Quality Account. The committee commends the organisation s focus on staff health and wellbeing, particularly in the context of the shortage of paramedics and paramedics leaving the NHS for alternative employment. The committee is gratified to hear that calls relating to mental health issues will be treated with greater priority. In addition, the committee also welcomes your extremely innovative use of prehospital antibiotics in cases of suspected sepsis in the North Lincolnshire pilot. We hope that the issue regarding the standardisation of antibiotics across all East Midlands hospital trusts will be swiftly and effectively resolved so that sepsis patients in Nottinghamshire are able to benefit. The committee is extremely concerned about the amount of time lost due to delays in hospital handover, and while such delays are a reflection of the pressures and challenges that all acute trusts face, the East Midlands Ambulance Service should ensure that good practice within better performing Trusts is disseminated across the region. The committee congratulates the East Midlands Ambulance Service on the extremely high take up for flu vaccinations amongst staff. During discussion of this Quality Account, the senior EMAS representative (the Deputy Director of Quality) indicated his support for the concept of a wellresourced, co-located Mental Health A&E this would seem to be a laudable objective and we hope that you explore with partner organisations all options for better supporting people suffering a mental health crisis (including during conveyance to treatment). The committee strongly encourages EMAS to undertake regular public involvement sessions across the region so that residents can gain a fuller understanding of both the challenges you face and your innovative work. The committee will be continuing ongoing monitoring of your performance and the implementation of your improvement plans. Senior EMAS representatives will be invited to attend Nottinghamshire s Health Scrutiny Committee to answer questions and be held to account against targets. 86

87 Statement on the Quality Account for 2017/18 of the East Midland Ambulance Service NHS Trust Lincolnshire County Council Introduction The Health Scrutiny Committee for Lincolnshire reviews and scrutinises NHSfunded health services in the administrative county of Lincolnshire, which forms a substantial part of the Lincolnshire Division of the East Midlands Ambulance Service region. Presentation of Information We recognise that we have reviewed a draft version of the document and would expect the layout and presentation to be improved for the final published version. As the Committee has previously advised, the mandated requirements in a Quality Account do not necessarily lead to a document that is accessible to an interested lay reader. However, we note the inclusion of a glossary to help with understanding. We suggest that in future consideration be given to providing more information at a county level, as this would allow local communities to relate to the document. For example, there could be a short chapter on each county, highlighting both the challenges and successes for the county. Progress on Priorities for The Health Scrutiny Committee for Lincolnshire would like to reiterate its previous requests for a clear statement in the Quality Account on whether each priority has been achieved. In relation to Priority 1 (Staff Health and Wellbeing), the Committee notes the high rate of flu vaccination achieved for staff at 73.5 %. This priority was strongly supported by the Committee in The outcome for Priority 2 (Improving Sepsis Care) advises that ambulance crews in the Lincolnshire Division are now administering antibiotics to patients with red flag sepsis. This is welcomed, but it is the sort of information that could be included in a chapter on each county, as suggested above. Whilst the draft version of the Quality Account states that Return of Spontaneous Circulation (ROSC) rates have improved (Priority 3 Cardiac Arrest Outcomes), we would have welcomed numerical information on this. For Priority 4 (Reducing Conveyance to Hospitals) we note the statement in the draft version that conveyance rates have reduced, but as above, we would have welcomed numerical information on this. 87

88 Selection of Priorities for The Health Scrutiny Committee notes that the four priorities for are continuations of this year's priorities and supports their continuation. As indicated above, we would like to see clearly defined targets for these priorities, and a clear statement in 2019 of whether the targets set have been achieved. Engagement with the Health Scrutiny Committee for Lincolnshire We would like to put on record that the Chief Executive and other senior managers from the Trust have attended two meetings of the Health Scrutiny Committee during the last year. At the first of these meetings in September 2017, the Committee was provided information on the Ambulance Response Programme (ARP), which had been implemented from July In March 2018 the Committee received performance information on the ARP, but was advised that the Trust was not resourced to reach the expected ARP standards, which is a disappointment for the Committee. The Health Scrutiny Committee for Lincolnshire's longstanding concern is the ambulance response times for life-threatening and serious emergency calls in Lincolnshire. The Committee would like to see more ambulance resources dedicated to Lincolnshire, and although not forming part of the Quality Account the Committee is aware of the Trust's request to commissioners to provide additional resources of 20 million per annum. Complaints and Compliments We note the overall level of compliments outnumbers the number of complaints, and note that this information has been provided at a county level. Care Quality Commission Inspection We note that the Trust's rating from the Care Quality Commission is still 'requires improvement', although there has been no formal inspection since Conclusion We look forward to continued engagement with the Trust in the coming year, together with improvements in the Trust's performance. 88

89 Northamptonshire County Council Re: Quality Account The NCC Health Adult Care & Wellbeing Scrutiny Committee formed a working group of its members to consider a response to your Quality Accounts Membership of the working group was as follows: Councillor Eileen Hales Councillor Chris Smith-Haynes Councillor Chris Stanbra Mr Andrew Bailey (Northamptonshire Carers Voice Representative) The working group also considered the following in relation to all quality accounts: It was felt it would be useful for Scrutiny to receive summary quarterly updates from providers of progress data against the key actions taken to deliver the objectives set in the Quality Account for that year. This would be consistent with the Department of Health guidance that discussions between OSCs and providers of the Quality Accounts should be conducted throughout the reporting year. It might be useful if a statement was included that stated how EMAS viewed its position in terms of security of data. The working group considered how far the quality account was a fair reflection of the healthcare services provided by EMAS, based upon members knowledge of the provider. The formal response from the Health Adult Care & Wellbeing Scrutiny Committee based on the working group s comments is as follows: The working group felt it was difficult to comment in some areas because of the lack of data. There was no explanation of why priorities had been chosen. Some more information on the staff survey would have been welcomed and to view what staff engagement there had been. There was no information on what EMAS had learned from the staff survey. There was no information on staff sickness and the working group would have liked to have known how they managed staff sickness. There appeared to be no figures relating to performance. Performance could have been better judged had the information been broken down by area, so they could see how well Northamptonshire had performed. It was difficult to identify anything that was Northamptonshire specific and they had difficulty to evidence the impact of anything on Northamptonshire. The working group wondered whether EMAS viewed the fact that 73% of the workforce had been vaccinated against a national target of 75% as a slight under-performance and cause for concern. 89

90 There was no data on SEPSIS and they would like to see evidence of the effect on patients that EMAS claimed it had. What percentage of patients in terms of priority 4 were seen and treated at home. An explanation would have been helpful of some terms used such as category 1 death. Some more detail on what the CQC wished to have improvements in and what they were doing to address these would have been nice. EMAS was congratulated on finding new ways working to combat SEPSIS which they recognised was a big killer in the elderly. They encouraged EMAS to roll it out across the whole EMAS area. They felt keeping aims small was a good idea as too many aims were impossible to achieve. Finally, some page numbering would have been helpful. 90

91 LEICESTERSHIRE COUNTY COUNCIL HEALTH OVERVIEW AND SCRUTINY COMMITTEE COMMENTS ON THE EAST MIDLANDS AMBULANCE SERVICE NHS TRUST QUALITY ACCOUNT FOR MAY 2018 The Health Overview and Scrutiny Committee welcomes the opportunity to comment on the Quality Account for of the East Midlands Ambulance Service NHS Trust. The Committee is of the view that the Quality Account contains a candid assessment of the Trusts performance in some areas, and the detailed patient stories clearly demonstrate some of the problems that have arisen. However, it is extremely surprising that the Quality Account makes little reference to handover delays at Emergency Departments. We are aware this has continued to be an issue in Leicestershire, particularly over the winter period with a spike in Ambulance handover delays in February 2018, and we are therefore of the view that the issue should be fully addressed in the report. We are informed that for the December 2017 to February 2018 period 3,500 hours were lost due to handover delays and whilst some of this may be due to factors out of the control of EMAS, further joint working is required. We note from the Quality Account that Trust Board members undertake Quality visits to Hospital Emergency Departments and it would be interesting to be advised what conclusions have been drawn about handover processes at Leicester Royal Infirmary. The Committee applauds the efforts of EMAS to reduce conveyance to Emergency Departments through appropriate use of alternative care facilities and providing more of the Hear and Treat, and See and Treat, type of response to incidents rather than the See, Treat and Convey (to Emergency Department) types of response. The Committee supports the implementation of the Ambulance Response Programme and looks forward to seeing the impact of the new model and rotas which went live during April At a previous Committee meeting we were informed that should there be a delay in attendance by a paramedic on the scene, the Clinical Assessment Team made welfare calls to monitor the condition of the patient. We hope that this monitoring still takes place and that there is less need for these calls as response times improve. The 2017/18 priorities and the 2018/19 priorities are clearly set out in the Quality Account as clinical effectiveness, patient safety and patient experience. The Committee is pleased that staff health and wellbeing is a priority for EMAS as we are aware recruitment and retention of staff has been an issue in the 91

92 past. Whilst it is disappointing that the Quality visits identified that staff were feeling pressurised and had issues with work life balance, it is positive that this engagement with staff has taken place and now action can be taken to improve the wellbeing of staff. The Committee endorses the EMAS involvement with the national apprenticeship programme and the increase in career progression opportunities within EMAS. At a Committee meeting in 2017 we were informed that there was a small number of vacancies which would be filled by EMAS staff that were currently in a training plan and would become operational during the autumn of It would be useful to be provided with an update on this and the current unfilled vacancies. It is pleasing to note the high priority given by EMAS to managing sepsis and the Committee was interested to note from the Quality Account that EMAS in Leicestershire are now administering antibiotics with RED Flag sepsis and we would like to learn about the results of this pilot. Overall the Committee is of the view that the Quality Account contains a fair reflection of the Trust s work albeit with greater emphasis required on handovers at Emergency Departments. 92

93 Healthwatch Response Re Quality Account 2017/2018 HEALTHWATCH DERBY RESPONSE: We would like to acknowledge the hard work done by colleagues at EMAS in the past year, and recognise the service continues to face challenges due to severe weather conditions over a harsh winter, as well as other issues such as delays at A&E handovers which directly affect its ability to meet targets. In the past year, Healthwatch Derby picked up an unusually large number of case studies about EMAS services which we presented to EMAS in a snapshot report titled 'EMAS in focus'. This report was also presented to Hardwick CCG's Quality Committee. The local intelligence was gathered primarily during the harsh winter conditions (as part of our Winterwatch review) experienced in the region, and its impact on services especially at A&E and EMAS. As a follow up to 'EMAS in focus, we met with the Chair and CEO at EMAS offices and had a honest discussion about the need to address the issues picked up by the report. We were advised EMAS will conduct internal reviews around the allocation of resources for emergency calls, and we welcome this. We also addressed issues around communication, and the willingness to be open to critical feedback, and were pleased with the way our concerns were taken forward. As part of our discussions, we also formed a programme of extensive outreach work to further study the service in detail. In the past year we have attended several comprehensive observational outreaches (12 hour shifts) studying 999 call handling at the EOC, EMAS crew observations, PTS observations, and observations of the EMAS Navigators service based at the Royal Derby Hospital. As we write this report, we are still undertaking this broad programme of observations, and continue to monitor and report what we are picking up through our work. We would like to thank all EMAS colleagues who helped facilitate the observational outreaches, as well as strong leadership from the CEO and Chair that drove this programme forward, helping us quickly remedy any obstacles to our work. It is essential independent patient experience champions from the Healthwatch network are given opportunities to work with and study EMAS services so that local intelligence helping to improve the service can come forward. We have also attended Ambulance Leads meetings hosted by EMAS as well as the EMAS EDS event. On both occasions, Healthwatch Derby championed the need for actual face to face engagement with communities, and the need to further educate and spread awareness about the correct usage of ambulance services. We are pleased our advice on both occasions was received positively and became a part of EMAS improvements going forward. 93

94 We also continue to work closely together through our IDEN platform Healthwatch Derby has a dedicated network of engagement leads (Insight Derby Engagement Network), and EMAS has continued to be a regular presence at our forum. This has led to an increase in the exchange of information about engaging communities, with EMAS colleagues taking part in Healthwatch Derby hosted public engagements. It is positive to note Patient Experience is one of the key areas the Trust has committed to improve. We would recommend enhanced public engagements which is human rather than digital as being the key to achieving this as well as efforts to hear from diverse communities. We look forward to another year of strong partnership work, and our joint efforts to hear from patients, and to improve services for all. 94

95 RESPONSE FROM HEALTHWATCH RUTLAND We strongly support EMAS s vision to providing care directly, signposting or referring patients to the best service that can support them in their homes and the community and reducing admission to hospitals where appropriate. We will do this by working closely with primary, community, social care, mental health and secondary care services. And hope that EMAS gets the support they require to work more closely with other services. The avoidance of unnecessary hospital admissions, where possible, is very much supported by the public. We welcome the work done on improving treatment of sepsis and other clinical improvements. The public rarely tell us they have any problems with the quality of care they receive and are highly complementary about the professionalism, care and compassion shown by EMAS staff. However, all of these improvements are moot if response times remain so problematic. We understand the system-wide pressures on EMAS, but response times HAVE to be addressed. I would query why response times are not listed as a priority. Patient Experience speaks only to cardiac arrest. The QA shows that the highest incidence of complaints is due to delayed response. In addition, we welcome their commitment to listening to stakeholders, such as HW, and the public, but it is extremely important that stakeholders such as ourselves have sight of response times across the EMAS region. We used to get stats broken down by HW area which were very useful in showing response times by area. These have been absence since last year, and we have yet to have sight of these again. This needs to happen as a matter of urgency. 95

96 RESPONSE FROM HEALTHWATCH LINCOLNSHIRE Healthwatch Lincolnshire Quality Account Working Group: Sarah Fletcher (CEO), John Bains (Board Chair), Clive Green (Trustee), Pauline Mountain (Trustee), Pam Royales (PA Administrator) Healthwatch Lincolnshire would like to thank you for sharing your Trust Quality Accounts for our representative s consideration and comment. Our observations include: The lack of information and data around performance and targets is not helpful. We acknowledge the good work around Sepsis management and are pleased to read that this work will continue in Lincolnshire. We found the Patient Stories very interesting and think they positively demonstrate how EMAS respond to patient concerns. Overall, we do not feel that the report content, style and layout demonstrates a good Quality Account. The report should be numbered to assist in navigating the reader around this report. We acknowledge the good work of the Patient Voice Group and support the continuation of this work. This group needs to be better advertised. Healthwatch Lincolnshire share all patient experiences with EMAS and thank you for your responses to these which are generally returned to us within the 20 day working day requirement. We would like to see specific narrative for each county that EMAS cover which provides more information about your delivery against goals, priorities and performance in each county. Last year we were advised that all frontline staff would be trained in mental Health awareness. HWL have not received any updates confirming that this training has been carried out, and would therefore appreciate an update on how many Lincolnshire staff have been trained? 96

97 Our EMAS members took time to review our draft Quality account. Here s how they rated our priorities 2018/19: Priority 1: This priority will focus on improving staff member s health and wellbeing at work. Do you agree with this priority? Red Flag Sepsis is the Sepsis Trust's definition of a patient who is presenting with clinical signs that suggest the patient is either suffering or approaching septic shock. EMAS will continue the work from last year that will focus on delivering antibiotics to Red Flag Sepsis patients.do you agree with this priority? Priority 3: During 2018/19 we will: Continue to develop and improve our cardiac arrest outcomes. Continue to see our Ambulance Quality Indicators and outcomes around stroke, chronic obstructive pulmonary disease (COPD) and asthma improve. Also see an increase in the presence of frontline clinical supervision to all active resuscitation attempts. Do you agree with this priority? Priority 4: During 2018/19 we will: Maintain and improve see and treat. Reduce conveyance by accessing alternative pathways that are available. Have robust patient safety plans in place that support non- conveyance. Do you agree with this priority? In Favour Against Other 93% 1% 6% 99% 0% 1% 99% 0% 1% 93% 1% 5% A full transcript of the feedback received from members has been shared with the EMAS Trust Board. Here s a selection of comments about our priorities and the Quality Account: Response: It is important but patient care must come first Response: Please ensure Parkinson patients still get their tablets on time also Response: I agree that this should be a priority but surely this is a clinical effectiveness rather than a patient experience priority 97

98 Response: there should be better use of the nearest conveyance - ie I had an ambulance taking an hour from Grantham to hospital 20 minutes away in Peterborough Response: I would support this priority provided the Paramedics are sufficiently well trained to make a safe judgement as to whether to take the patient to hospital. The other consideration is whether the patient would be safe and well cared for if they stay at home. The priority should be patient care and safety rather than avoiding transfer to A & E Response: Your name is East Midlands Ambulance Service, but 80% of your work is Accidents and Emergency, you only mentioned the Patient Transport Service side of your Trust in a very fleeting way. They are a very valuable resource for the A&E, but a lot of the report just mention's what the A&E are going to achieve, the way the pts work is very different from them, but can and do work alongside them. I believe you need to bring the Pts into any policy changes that you make, not as a side line, but as a working valuable partnership Response: An interesting and well set out document. I am aware of your bid for additional funding from the local CQCs and wish you good fortune. I have a feeling that you will receive additional funding but less than you request. My best wishes to you, you re backroom staff and the front-line teams 98

99 Appendix 6 EMAS Trust Board The main role of the EMAS Trust Board is to guide the overall strategic direction of our ambulance service, to ensure we can meet our current challenges, establish and achieve our objectives and plan effectively for the future. Our Trust Board has overall corporate responsibility for how EMAS runs and is led by our Chairman and comprises of executive and non-executive directors. Executive directors are responsible for managing our affairs on a day-to-day basis, while non-executive directors provide essential balance with their skills and expertise in the public and private business sectors to complement those of our executive directors. Chairman Pauline Tagg MBE Non-Executive Directors Stuart Dawkins, Rachel Morrison, Karen Tomlinson, Vijay Sharma and William Pope Chief Executive Richard Henderson Chief Operating Officer Dave Whiting Director of Operations Ben Holdaway Medical Director Bob Winter Director of Quality and Nursing Judith Douglas Director of Human Resources and Organisational Development Kerry Gulliver Director of Finance Mike Naylor Director of Strategy and Transformation Will Legge 99

100 Director s responsibilities in respect of the Quality Account The EMAS Trust Board has been involved in identifying the quality indicators, agreeing the content and endorsing the content of this Quality Account. We have developed our quality priorities and indicators in conjunction with our stakeholders and our staff. Non-executive directors continue to play a pivotal role in providing challenge and scrutiny, assessing our performance and contributing to our future strategy. Statement of Directors' responsibilities in respect of the quality account NHS Trusts are required under the Health Act 2009, National Health Service (Quality Accounts) Regulations 2010 and National Health Service (Quality Account) Amendment Regulation 2011 to prepare Quality Accounts for each financial year. The Department of Health has issued guidance on the form and content of annual Quality Accounts (which incorporate the above legal requirements). In preparing our Quality Account, the Trust Board has ensured that: The Quality Account presents a balanced picture of the trust s performance over the period covered The performance information reported in the Quality Account is reliable and accurate There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, and these controls are subject to review to confirm that they are working effectively in practice The data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review The Quality Account has been prepared in accordance with Department of Health guidance The Directors of the Trust Board confirm to the best of their knowledge and belief that they have complied with these requirements in preparing this Quality Account. This has been confirmed through a resolution of the Trust Board. 100

101 Glossary A&E Accident and Emergency, also referred to as A&E, is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention. Also referred to as ED or emergency department. ACQI Ambulance Clinical Quality Indicators, a set of 11 indicators introduced to the Ambulance Service by the Government from 1 April 2011 as measures of clinical quality. AMPDS Advanced Medical Priority Dispatch System is a medically-approved, unified system used by EMAS to dispatch appropriate aid to medical emergencies including systematized caller interrogation and pre-arrival instructions. Audit A continuous process of assessment, evaluation and adjustment. Board EMAS Trust Board of Directors made up of executive and non-executive members responsible for all that EMAS does. Clinical Assessment Team (CAT) A paramedic or nurse triage advisor who telephone lower priority patients to carry out a full assessment of the patient s condition and then suggest the best treatment, such as being cared for at home, being referred to a GP, pharmacy or community based care service. Clinical commissioning group (CCG) Clinical commissioning groups (CCGs) are NHS organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in England. Capacity (CMP) NHS organisations that effectively purchase services from EMAS Commissioners NHS organisations that effectively purchase services from EMAS, based on the identified health needs of their local population. NHS Hardwick Clinical Commissioning Group is the lead commissioner for EMAS. That is, they (on behalf of all the CCGs in our area) negotiate what level of income EMAS will receive and, alongside this, what quality measures we are expected to achieve as set out in our service level agreement. 101

102 CPI Clinical Performance Indicator is a way to measure quality. CQC The Care Quality Commission (CQC) regulates all health and adult social care services in England, including those provided by the NHS, local authorities, private companies or voluntary organisation. It also protects the interests of people detained under the Mental Health Act. CQUIN Commissioning for Quality and Innovation, known as CQUIN, is a payment framework that makes a proportion of NHS service providers' income conditional on quality and innovation. Its aim is to support the vision set out in High Quality Care for all of an NHS where quality is the organising principle. The framework was launched in April 2009 and helps ensure quality is part of the commissioner-provider discussion everywhere. DCA Double crewed ambulance the vehicle which responses to patients and in the majority of cases will transport patients to hospitals. EMAS East Midlands Ambulance Service, also referred to as EMAS, is part of the NHS and provides emergency and urgent for the six counties of Derbyshire, Leicestershire, Rutland, Lincolnshire (including north and north east Lincolnshire), Northamptonshire and Nottinghamshire. Patient Transport Services are provided in Derbyshire. Enews Weekly newsletter to all EMAS staff. EOC Emergency Operations Centre (control) at East Midlands Ambulance Service. One based in Nottingham and one based in Bracebridge, Lincoln. The centres receive the emergency and urgent 999 calls and dispatch ambulance crews to them or give hear and treat advice via the Clinical Assessment team (paramedics and nurses who work in the control centre). FRV Fast response vehicle a car normally manned by a solo clinician. IG Information governance is the way by which the NHS handles all organisational information, in particular the personal and sensitive information of patients and employees. It allows organisations and individuals to ensure that personal information is dealt with legally, securely, efficiently and effectively, in order to deliver the best possible care. 102

103 NHS National Health Service. Established in 1948 to provide free state primary medical services throughout the United Kingdom. NICE National Institute for Health and Clinical Excellence. The health technology assessment body in the UK providing guidance to clinicians relating to authorised treatments, devices, diagnostics and techniques. PALS Patient Advice and Liaison Service offers confidential help, advice, support and information and are responsible for any compliments and complaints. PAM PAM Assist is a free confidential support service provided to you by your employer. ROSC Return of Spontaneous Circulation. Following a period when the heart stops, providing life support is aimed at restoring the body s circulation. SI Serious incident STEMI ST Elevation Myocardial Infarction is a heart attack. STP Sustainability and Transformation Partnerships are the NHS and local council s development and implementing of shared proposals to improve health and care in every part of England. Ulysses EMAS computer system for recording compliments and concerns from service users, friends and family. 103

104 Contact details We welcome your comments about our Quality Account. Please contact us using the details below: East Midlands Ambulance Service NHS Trust Trust Headquarters 1 Horizon Place Mellors Way Nottingham Business Park Nottingham, NG8 6PY Telephone communications@emas.nhs.uk Visit Facebook: EMASNHSTrust To receive this report in other formats, such as large print, audio or another language, please call our Communications team via

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