28 JUL 2017

Ambulance Services in South Devon

Following concerns about long waits for ambulances and the withdrawal of local Rapid Response Vehicles, I invited South Western Ambulance Service NHS Foundation Trust, SWASFT, to an open meeting at Kingsbridge Community College. Chief Executive, Ken Wenman and the team leading operations in South Devon came to set out why services are changing and to answer questions. Many volunteer Community First Responders also joined the audience to share their experiences.

The Ambulance Service has undergone huge changes from one which primarily transported people to hospital to one staffed by highly trained paramedics with specialist equipment also capable of delivering treatment at home, backed up by a network of community first responders and co-responders from other emergency services.

The key challenge has been the rise in demand for their services. Over the past five years the number of calls has risen by 19.2% in the Totnes area, 29% in Plymouth and 23.7% in Torbay. One effect of this has been that once ambulances based in the rural South Hams have taken a patient to hospital in Torbay or Plymouth, they often get diverted to other calls in those urban areas rather than returning to base. The way that targets have been set in the past can mask poorer services in rural areas. Until now, those response targets only covered the most urgent calls with a requirement that a vehicle arrived on scene within 8 minutes in 75% of cases. Overall SWASFT met that target for the South Devon and Torbay CCG area at 75.65% of calls over the past year. But the figures I obtained for the Totnes constituency, which is more rural, tell a different story, with ambulances reaching just 61.1% of those calls in 8 minutes over the past three months. Targets need to be set in a way that doesn't lead to unintended consequences such as focusing on urban areas where they are easier to reach or allowing the arrival of an inappropriate ambulance vehicle to 'stop the clock' when measuring response times.

Now that many more treatments are available in specialist centres to help people who have suffered conditions like acute stroke and heart attack, it is more important than ever that the right vehicle attends a call. Ambulance cars, known as Rapid Response Vehicles, cannot take people to specialist centres but can distort the figures for waiting times. These vehicles are being removed but the meeting was told by SWASFT that overall ambulance hours cover would increase for the South Hams through a double crewed ambulance based at Totnes and use of a 'dynamic coverage tool', otherwise known as getting vehicles back out from urban centres to be closer to respond to emergencies across rural areas like the South Hams. Changes to targets will mean that all calls will count, and using mean average response times as well as the time taken to reach 9 in 10 calls will help to keep a focus on reducing long waits especially in rural areas. I will be following this carefully to make sure that the changes do lead to improvements in the service. These are being put it in place following the national Ambulance Response Programme trial and the following links give further background to this and to the changes:

https://www.england.nhs.uk/wp-content/uploads/2017/07/ambulance-response-programme-letter.pdf

https://www.england.nhs.uk/2017/07/new-ambulance-service-standards-announced/

At the meeting, volunteer community first responders spoke of their concern about not being able to deliver pain relief whilst waiting for an ambulance to arrive. Ken Wenman confirmed the good news that they will now be able to receive training in the use of pain relieving gas and air.

The service has been under increasing pressure due to rising demand and this has meant that it has been coping with 2.46% less funding per call over a three year period. SWASFT's operations director Neil Chevalier, told the meeting that they had received a £3.6m uplift in funding to implement the changes from the Ambulance Response Programme trial and, in response to questions about pay, said that paramedic staff had been put onto band 6 of the NHS pay scale up from band 5.

SWASFT representatives heard direct from volunteer community first responders and local residents about the pressure on services including examples of long waits and these were all examples of why the service needs to provide a better response to rural areas. I will be following this closely.

The message that came over loud and clear was the value that we all place on our ambulance service. Thank you to all our paramedics, support staff and volunteers.

5 comments

Very useful update. Can I encourage St John's ambulance to train its community volunteers in emergency IM hydrocortisone for relief of adrenal crisis? This authorised under Schedule 19 of the Human Medicines Regulations. Our charity's experience has been that this is straightforward to master, and saves lives. We have a first hand report from an untrained office first aider who successfully gave IM hydrocortisone earlier this year for adrenal crisis prevention: he watched our How To training video on his phone. http://www.addisons.org.uk/forum/index.php?/videos/category-2-emergency-injection-videos/ See www.addisons,.org.uk for more information and case studies about this life-saving technique.
- Katherine White

I'm pleased that attention is being given to the response times in rural areas after waiting three and a half hours in my next-door neighbour's house after he fell in his kitchen and broke his hip. He was not classified as life-threatening, though he died a few days later. Even the 999 system did not work as it should have. Everything under great stress. There is line in the sand, which when crossed in the quest to deliver greater efficiencies and particular Ministerial targets get in the way of caring for the customer. Delivery of patients to A&E and Ambulance crews having to wait crazy times in order to hand over patients (queueing in corridors) is another pinch point for availability of manned Ambulances. We need a good shake of the money tree for the NHS in particular.
- mike north

So the response to the ARP trial has been to reduce ambulance cover in S. Hams by removing all the RRVs. The ambulances spend most of their time in the urban areas leaving the residents of S.Hams with less medical help than before, a paramedic in a car can still give life saving treatment as Katherine Whites's post shows. Hypoglycaemic patients are another group of patients as are those with major blood loss etc etc. If the number of 999 calls has gone up so much the question is are all these calls appropriate? J. Hunt was pushing the idea that the NHS should be a 24/7 organisation, has that contributed to people calling 999? Perhaps the Government could help by not listening to lobbyists from the tobacco and food industry but to the health service instead. Educate the public on when and how to access the health service. Encourage people to take responsibility for their own health and not expect the health service to fix the problems arising from smoking, overeating and being lazy.
- S. Hams resident

When can local Conservatives have an MP who votes for their interests, who shows some loyalty to the government and respects the vote of 23 June 2016? It ain't Sarah Wollaston that's for sure.
- George, Paignton

Well done for defeating the government ! We need a second referendum and this time the people of Britian will give the right answer . With the humiliating defeat of Mrs May we are thankfully closer to a Labour or Lib Labour goverment which will end the folly of Brexit and bring the UK back to where it belongs ; an integral and vital part of the European Union. Thankyou so much.
- Peter Thompson

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