Agenda item

[To receive an information pack and presentation from the West Midlands Ambulance Service University NHS Foundation Trust on their response to the Covid-19 pandemic].

[Mark Docherty (Director of Nursing and Clinical Commissioning) and Pippa Wall (Head of Strategic Planning) will be in attendance]. 

The Panel agreed to take the West Midlands Ambulance University NHS Foundation Trust item before the item on Covid-19 cases, testing and vaccinations due to the Director of Public Health experiencing IT issues.

The Director of Nursing and Clinical Commissioning, and the Head of Strategic Planning of the West Midlands Ambulance University NHS Foundation Trust gave a presentation on their Trust’s response to Covid-19 and on some other matters that had been requested.  Members complimented the representatives from the Ambulance Service on their thorough presentation, the slides of which were despatched with the agenda.  They also thanked the Ambulance Service for their vital courageous work in the health system.  They noted the outstanding rating of the service.

The Chief Executive of the Royal Wolverhampton NHS Trust remarked that the Royal Wolverhampton NHS Trust’s performance of ambulance turn around times in the last few months of 2020 had been appalling.  This was because normally to release ambulances they would put patients in corridors in the Accident and Emergency Department and provide nurses.  Due to Covid-19 they were not able to continue with this practice.  He therefore considered it remarkable the performance of the West Midlands Ambulance Service, in terms of response times, in Wolverhampton had not suffered.  They had provided a brilliant service.  He was pleased that the performance at New Cross Hospital had improved substantially, in terms of releasing ambulances. 

The Chair asked for the results of the Covid-19 antibody testing carried out on West Midlands Ambulance Service staff.  The Head of Strategic Planning responded that 22% of the staff tested for Covid-19 antibodies had them.  It had been sometime though since the tests had been conducted.  

The Vice-Chair stated that the NHS 111 Service was a vital service to help prevent A&E attendance and unnecessary ambulance call-outs.  He asked what steps were being taken to improve the service further.  The Director of Nursing and Clinical Commissioning responded that the 111 Service had been provided by West Midlands Ambulance service for approximately the last 18 months.  They had already carried out a number of improvements including ensuring that calls were answered promptly.  They had ensured that the training of the call handlers was robust and that they were appropriately supervised.  Every single call was recorded.  There was now a much larger clinical support into the 111 Service.  This included pharmacists, mental health nurses and Doctors.  People working for the 111 Service would also be trained to answer 999 calls and so the service was becoming more integrated.  He hoped this would encourage people to stay with the Ambulance Service.  He saw no reason why a call handler or paramedic could not one day work their way up the organisation to the role of Chief Executive.

A Panel Member complimented the Ambulance Service on their performance during the last year.  She asked how reflective the West Midlands Ambulance staff profile was of the general population in terms of equalities.  She also asked about the service’s Whistleblowing Policy for in the event of inappropriate behaviour.  The Director of Nursing and Clinical Commissioning responded that the service’s staff were their greatest asset.  Staff retention was very important to them.  Their staff had access to the most modern vehicles and up to date equipment.  They were also looking at introducing stab vests and body cameras.  The service was not fully reflective of the general population.  The gender balance was almost right.  Just over half of the service’s paramedics were female.  There was a good gender balance at Board level, as was the diversity level from a BAME perspective.  The general diversity of the staff though was not at the point which they wanted.  The service employed local people.  Brierley Hill had been chosen as a site for a new control centre, this was a deprived area.  The career opportunities offered to staff would help the local people in the neighbourhood.  The paramedic programme offered people the chance to obtain a foundation degree.  They were hoping to increase the diversity at student paramedic level.  There was a Whistleblowing Policy for people that had concerns, there was also the Freedom to Speak up Policy and Freedom to Speak up Champions.  Significant development work was taking place on equalities.  The Head of Strategic Planning referred to the staff networks for staff in certain groups, which were hugely beneficial.  There was also an extensive staff liaison service.  Staff engagement events and surveys were conducted.   

A Panel Member commented on a personal experience, where in their family a premature baby had died after an ambulance was called but was diverted to Hereford for a coronary heart case.  It was 24 hours before the baby was picked up and had by that time had two cerebral haemorrhages.  She asked if this was still a possibility today or whether there were now safeguards in place.  The Director of Nursing and Clinical Commissioning firstly expressed how sorry he was to hear of the Councillor’s experience.  Babies were incredibly sensitive to temperature changes.  He could guarantee that an ambulance would not be diverted in a case like this in the future, because in situations like these babies were now treated as category one patients.  The West Midlands Ambulance Service were one of the few ambulance services that had put a lead mid-wife into the organisation.  There were currently about three babies being born a day in the region before they were at hospital.  They wanted to provide a safe service to a high standard.  They were still looking to make improvements to the service. 

A Panel Member asked for the statistics relating to the promotion prospects for people falling in the BAME group.  The Director of Nursing and Clinical Commissioning stated that he would send him some figures about the diversity within the organisation.  He thought that he personally had never worked for an organisation in the NHS as diverse.  There was a well-established LGBTQ Group in the organisation.  There was not the amount of diversity he would like at senior manager and paramedic level.  The Head of Strategic Planning referred to the mentoring services available to help BAME staff receive promotions.   They were also doing some useful work with the University of Wolverhampton.

The Chair asked about the overall financial situation of the West Midlands Ambulance Service University NHS Foundation Trust.  The Director of Nursing and Clinical Commissioning responded that for the last fifteen years as an organisation they had balanced the accounts.  The accounts would also be balanced for the current financial year.  The moving towards the Integrated Care System meant the financial position was uncertain for the future.  For the first half of the next financial year they would be going into a blocked contract.  He did have some concerns that the finances might suffer in the future if the Ambulance Service was asked to do more.  He was also concerned, that as part of the Integrated Care System, they potentially might not be given the finances to continue high standards such as having the latest equipment and vehicles, if other organisations within the system were in a bad position financially.

The Vice Chair asked for more information about the lateral flow testing process at the organisation.  The Director of Nursing and Clinical Commissioning demonstrated how a test was done and added that staff had been issued the test kits for them to use in the home environment.  The test was not 100% accurate.  Staff were asked to conduct a test twice a week which increased the accuracy level.  People who tested positive from a lateral flow test were generally asked also to take a PCR test, which were more than 90% accurate.  The Head of Strategic Planning added that 70,000 tests had been taken by the staff and 69,500 of them had been negative. 

The Chair asked if there were any more infection prevention measures planned to help keep patients and staff safe from the more transmissible Covid-19 variants.  The Director of Nursing and Clinical responded that staff were able to wear level 3 PPE in ambulances if they wished to, even though level 2 was deemed sufficient by national guidance.  Air changes in ambulances was important, therefore having the doors and windows open was encouraged.  For new vehicle procurement in the future they were looking at better air flow systems and supplementary heating systems, which were not dependent on the main engine running.  Cleary vaccinations and social distancing were important measures.  They had not run out of PPE during the pandemic.  They had introduced the electrical charged peroxide cleaner which was sprayed in ambulances to disinfect them. Thankfully no member of staff had lost their lives.  

The Chair thanked the representatives from the West Midlands Ambulance Service for an excellent informative presentation.  He asked for the compliments of the Panel to be passed on to the staff for their excellent work.