Agenda item

Presentation/report by Trust Chief Executive

NB. Mark Docherty, Executive Director of Nursing & Clinical Commissioning to be in attendance  

Note by Clerk: The Chairman made a call for evidence to all Members of the County Council in respect of this item, in advance of the meeting.

The Committee considered a PowerPoint presentation/report (slides attached at Appendix A to the signed minutes) by West Midlands Ambulance Service University NHS Foundation Trust’s (WMAS) Chief Executive regarding their recent reconfiguration of the Community First Responders Service (CFRs) in the County.

Mark Docherty, Executive Director of Nursing and Clinical Commissioning, Nick Henry, General Manager and Murray McGregor, Communications Director at the Trust were present at the meeting.

During their presentation the representatives of WMAS highlighted (i) background information regarding the Trust and its operations; (ii) their vision, strategic objectives and priorities; (iii) activity during 2019/20; (iv) performance by category during 2019/20; (v) 999 call answering performance during 2019/20; (vi) percentage of patients conveyed to healthcare settings compared to other UK Ambulance Services; (vii) Care Quality Commission’s ‘Outstanding’ rating awarded to the Trust during 2019; (viii) the Trusts University accreditation; (ix) recent investments made by the Trust in staff and vehicles; (x) Trust Make Ready Hubs located in Staffordshire; (xi) The Trust’s current Operating Model; (xii) assistance given to neighbouring Trusts by WMAS; (xiii) the Trust’s recent endeavours to improve patient outcomes.

With regard to CFRs in particular Members learned that the service had been operating in mainly rural areas throughout Staffordshire since the 1990s and played a vital role in responding to the highest priority 999 calls whilst paramedics were en-route. This model had also been widely adopted throughout the UK where CFRs were commonly trained in Cardio-Pulmonary Resuscitation (CPR), defibrillation and basic first aid techniques. In addition, enhanced training had been given to some CFRs in Staffordshire enabling them to administer a range of drugs and use vehicles similar in appearance to ambulances. However, enhanced CRFs were unable to claim the same exemptions as ambulance crews when responding to calls meaning that they were unable to exceed speed limits and pass through traffic lights whilst on red etc.

The representatives of WMAS outlined the recent changes which had been made to the service in the County (some of which had been as a result of legislative changes made by Central Government) including:- (i) withdrawal of blue lights from CFR vehicles; (ii) withdrawal of green and yellow ‘Battenberg’ livery from CFR vehicles; (iii) withdrawal of six drugs for administration by CFRs; (iv) introduction of a new training scheme across the West Midlands incorporating a regulated qualification.

Members then scrutinised WMAS closely and held them to account over the changes set out above, seeking clarification and asking questions where necessary, as follows:- (i) details of the rapid response vehicles used by CFRs; (ii) the role of CFRs in treating rather than transporting patients to hospitals; (iii) access by patients to CFRs particularly in remote areas; (iv) location and proximity of emergency vehicles under the new arrangements; (v) coverage of the County by doubled crewed ambulances now and in the future; (vi) speed of access to life saving drugs by patients and the potential for delays; (vii) de-skilling of CFRs brought about by the unavailability of enhanced training and the impact on the number of people volunteering; (viii) the consultation which had been undertaken in local communities prior to implementation of the new operating model; (ix) the evidence used to support the changes made in terms of improved response times and patient outcomes; (x) safety implications for CFRs arising from the withdrawal of vehicle’s blue lights and high visibility livery; (xi) the duty of care owed to CFRs by WMAS; (xii) consultation undertaken with Primary Care prior to implementation of the changes; (xiii) proactive measures by the Trust to increase numbers of those trained in CPR and the use of  Automatic External Defibrillators (AED); (xiv) the use of external voluntary organisations eg St John’s Ambulance by the Trust.

During the full and wide-ranging discussion which ensued representatives of WMAS emphasised that the aim of the reconfiguration was to improve incident response times and patient outcomes. Notwithstanding their current CQC rating (which Members commended the Trust for achieving), they cited statistics contained in the slides which suggested scope for improvement, particularly for ‘Category 2 patients’. Through the withdrawal of RRVs and greater reliance on ambulances, crewed by fully trained Paramedics, based at 15 ‘Make Ready Hubs’, it was hoped this could be achieved as soon as possible. In addition, the Trust had made a significant investment to ensure a proportion of ambulances in Staffordshire were double crewed. However, they were unable to supply figures illustrating the distribution of such vehicles in rural areas of the County, at the meeting.

With regard to recent changes in legislation on the use of blue lights by CFRs, the Committee were of the view that the Trust had not been sufficiently open and transparent in that the changes only applied where CFRs had not received appropriate driver training.    

On the administration of drugs, the representatives explained that although certain medicines had been withdrawn from CRFs, during 2019 their use had been limited (98 out of the 5,200 cases attended). However, they emphasised that this change did not apply to ambulance crews who would continue to provide the six drugs, where necessary. In addition, they clarified that the medicines in question were not necessarily life-saving and need not be given in the short time before fully qualified paramedics had arrived on scene. Notwithstanding the above, some Members remained concerned by this development particularly having regard to the current Covid-10 Pandemic.       

With regard to training, the new scheme was designed to ensure consistency throughout the West Midlands Region and protect patients and CFRs by improving standards of care. In co-operation with an external training and assessment organisation, all current CFRs and future candidates were to work towards attaining a formally recognised qualification. However, the representatives acknowledged that this change, together with the unavailability of advanced training might impact on the numbers of volunteers coming forward. The Trust could not give an undertaking to re-instate advanced training for CFRs in the future, at this time, but were prepared to deal with a reduction in volunteers, if that situation arose. 

In conclusion, the representatives said that whilst the Trust were unable to re-visit their decisions, they acknowledged the Committee’s criticisms regarding the limited consultation and communication with local communities which had been undertaken prior to implementation of the above-mentioned changes. They therefore undertook to ensure that such measures on future service reconfigurations were robust, meaningful and took account of local concerns. In addition, the Trust gave the Committee assurances regarding the future of the CFR service in general and the contribution they foresaw it would make to the continued provision of an ‘Outstanding’ service to the residents of the County.

The Chairman then thanked the representatives of the Trust for their attendance and an interesting and informative presentation.

RESOLVED – (a) That the report/presentation be received and noted.

(b) That the impact of the above-mentioned changes on the Trusts’ performance metrics be monitored closely and that further scrutiny of the Trusts’ operations be undertaken at the appropriate time, as necessary.