Ambulance Trust Has Made Improvements Since Tragic Death, Finds Healthcare Watchdog

Main Category: Public Health
Article Date: 25 Aug 2008 - 1:00 PDT

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Great Western Ambulance Service NHS Trust has made improvements to services following a tragic death, the Healthcare Commission said recently.

The Commission's intervention follows concerns about an incident in May 2007, which ended in the death of a woman who was involved in a road traffic accident. The ambulance took 42 minutes to attend the scene at Cirencester in Gloucestershire - 34 minutes over the national target of eight minutes for attending an accident of this kind.

The Commission had also been aware of concerns that the trust had not been meeting national targets on emergency response times.

The Commission reviewed both the management arrangements that were in place at the time of the accident and subsequent changes made by the trust.

The review assessed the systems for dispatching ambulances and the planning and use of resources, including ensuring sufficient staff and equipment are in place to provide safe services to patients.

In its findings, the Commission says the trust has responded to concerns and made improvements to its service. It says changes such as the introduction of a new ambulance dispatch system, a centralised control room system and a review of its vehicle fleet have contributed to reducing the risk of this incident recurring. However, it also makes five further recommendations to continue progress and these have been accepted by the trust.

The review identified factors impeding a rapid response to emergency calls. These included systems for handling emergency calls, systems for monitoring the location of ambulances, prioritisation of incidents, upkeep of vehicles, staff sickness levels and delays in patient handover times at hospitals.

The Commission highlights that since the incident, the trust has improved its dispatch systems by:

- Merging three call handling systems into one central system based in Bristol. This has had a notable positive impact on response times.

- Implementing a computer-aided dispatch (CAD) system, allowing the position of all vehicles across the trust to be seen at any time so the nearest appropriate vehicle can be dispatched.

- The introduction of 'Drive Zones' whereby vehicles have an identified geographical patch to work within, enabling a more efficient response.

- Conducting a review of its air support. In addition to helicopters based in Gloucestershire and Wiltshire, the trust now has a dedicated air ambulance based at Filton near Bristol, manned by a critical care team of doctors and paramedics.

- The introduction of a new automated dispatch system from September. This should enable vehicles to be dispatched before the phone call is finished and improve the trust's response times even further.

Great Western Ambulance Service was formed in April 2006 by the merger of three county trusts, Avon, Gloucestershire and Wiltshire. The review notes that the new trust faced considerable challenges aligning policies and co-ordinating staff and equipment. To improve planning and use of resources the trust has:

- Reviewed policies to ensure that all dispatchers across the three sectors were following the same policies and protocols, for example when redirecting emergency vehicles to higher priority cases and sending back-up vehicles.

- Implemented a new staff sickness policy. At the beginning of 2007/08, sickness rates were at nearly 8% across the trust. After a new policy was introduced, rates reduced to less than 6% in the last two months. The trust is aiming to get the rate down to at most 5% by September 2008.

- Developed a fleet replacement plan in line with an operational review of ambulance vehicles by the trust. This was started in 2006 and still continues. It is expected that all existing stock will have been replaced by 2015.

The Commission urges the trust to continue driving down response times. Currently the trust is responding to immediately life threatening incidents within eight minutes for 72.2% of such calls. The national target is to accomplish this for 75% of calls of this nature.

Nigel Ellis, the Commission's Head of Investigations, said:

"The incident that triggered this intervention is a real tragedy. It follows that the trust should continue to do everything possible to ensure it does not happen again.

"We are satisfied that lessons have been learned and the trust is addressing the main concerns by making changes to its systems to reduce the risk of an incident like this being repeated. The new computer-aided dispatch system, staff sickness procedure and overhaul of the vehicle fleet have all contributed to the improvement of the service.

"It may be too early to see the full impact of some of the improvements that have been made, but the trust must maintain pressure to further drive down their response times."

The Commission has recommended that the trust should now ensure that there is a clear system for investigating all incidents, learning lessons when appropriate and monitoring any changes in practice which result.

It also recommended that the trust sets up a programme of regular workshops and team meetings which are open to control room and operational staff across the organisation to discuss performance issues and any lessons which can be learned.

The trust should implement a proposed new control room structure as soon as possible to provide clarity for staff about line management, roles and operational issues.

The Healthcare Commission will re-visit the trust in six months to check progress against these recommendations.

Summary of the intervention at Great Western Ambulance Service NHS Trust (pdf 155kb) (opens new window)

Notes

In the Healthcare Commission's annual health check for 2006/07 Great Western Ambulance Service Trust scored weak for both quality of services and use of resources. The Commission will give its latest assessment of the trust's performance when it publishes the annual health check ratings for all NHS trusts in October.

National standards for the maximum time an ambulance should take to attend to a call were last revised in 2004.

Category A calls are where patients are judged to have life threatening conditions. They should receive the quickest response, within eight minutes for 75% of calls. Responses can be by single responders but, if transport is required, an ambulance capable of transporting the patient must be on the scene within 19 minutes for 95% of calls.

Category B calls relate to patients who have serious, but not life threatening, conditions and should receive a response within 19 minutes.

Currently the trust is responding to Category A calls within eight minutes for 72.2% of such calls, according to the latest annual figures from the NHS Information Centre (2007/08).

Information on the Healthcare Commission

The Healthcare Commission is the health watchdog in England. It keeps check on health services to ensure that they are meeting standards in a range of areas. The Commission also promotes improvements in the quality of healthcare and public health in England through independent, authoritative, patient-centred assessments of those who provide services.

Responsibility for inspection and investigation of NHS bodies and the independent sector in Wales rests with Healthcare Inspectorate Wales (HIW). The Healthcare Commission has certain statutory functions in Wales which include producing an annual report on the state of healthcare in England and Wales, national improvement reviews in England and Wales, and working with HIW to ensure that relevant cross-border issues are managed effectively.

The Healthcare Commission does not cover Scotland as it has its own body, NHS Quality Improvement Scotland. The Regulation and Quality Improvement Authority (RQIA) undertakes regular reviews of the quality of services in Northern Ireland.

Healthcare Commission