Welcome to the East of England Ambulance Service NHS Trust Quality
Account for 2009/10. This document has been approved by the Trust Board and reflects an accurate account of the level of quality of service provided to patients using the service during 2009/10. In developing this set of quality accounts the Chief Executive has set out a summary of the Trust’s values, achievements for 2009/10 and goals for 2010/11. The Trust has drawn on information from a range of data sources and in setting the priorities for
2010/11 it has engaged with staff and service users to identify the key clinical areas which require its focus to further improve the quality of services to meet patient and public expectation.
NHS Bedfordshire our lead commissioner, the Ambulance User Group, Local
Involvement Networks (LINks) and the Health Overview and Scrutiny
Committees (HOSCs) have been asked to contribute to this document.
This Quality Account will be made publically available on the NHS choices http://www.nhs.uk/servicedirectories/pages/trust.aspx?id=ryc by 30 June 2010 and hard copies are available on demand by contacting:
East of England Ambulance Service NHS Trust
Hammond Road
Bedford
MK41 0RG
Telephone: 01234 408999
A copy of the Account will be sent to the Secretary of State.
Improving Quality is an overarching priority of the Ambulance Trust and this report lays out plans for developing future services to improve patient care and patient outcomes by delivering the right resource at the right time so that we are publicly accountable for driving clinical quality higher.
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Summary .................................................................................................................... 2
Contents ..................................................................................................................... 3
Background ............................................................................................................... 4
Introduction ............................................................................................................... 4
PART 1 – Statements on Quality ............................................................................. 5
Statement on Quality from the Chief Executive .......................................................... 5
Statement on Quality from the Director of Quality ....................................................... 8
PART 2 – Priorities for Improvement ...................................................................... 9
Priorities for coming year ............................................................................................ 9
How we developed our priorities ............................................................................... 10
Patient Safety: Priority 1 – Reducing Preventable Falls ...................................... 10
Clinical Effectiveness: Priority 2 – Increase the number of patients accessing an appropriate stroke patient care pathway ......................................................... 12
Patient Safety: Priority 3 – Improve the Quality of Patient Handovers .............. 13
Clinical Effectiveness: Priority 4 – Increase the percentage of patients accessing preferred type of end of life care ......................................................... 14
Clinical Effectiveness: Priority 5 – Improve the cleanliness of the pre-hospital environment and reduce infection ........................................................................ 15
Statements of Assurance ....................................................................................... 17
Review of Services .................................................................................................... 17
Participation in Clinical Audits ................................................................................... 19
Measuring Participation ............................................................................................. 22
Participation in Clinical Research .............................................................................. 23
Goals Agreed with Commissioners ........................................................................... 23
Care Quality Commission ......................................................................................... 24
Data Quality .............................................................................................................. 26
Information Governance Toolkit ................................................................................ 27
PART 3 – Review of Quality Performance ............................................................ 29
Patient Safety ............................................................................................................ 29
Clinical Effectiveness ................................................................................................ 31
Patient Experience .................................................................................................... 33
PART 4 – Comments from Key Stakeholders ....................................................... 40
Statement from Local Involvement Networks ............................................................ 41
Statement from Overview and Scrutiny Committees ................................................ 43
Statement from Primary Care Trusts ........................................................................ 44
Providing Feedback ................................................................................................ 46
Glossary ................................................................................................................... 47
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The East of England Ambulance Service NHS Trust covers the counties of
Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk. The
Trust is geographically the second largest ambulance service in England and the third largest in the UK. The Trust employs over 4,000 staff and has 2,800 volunteers who support the Community First Responder Scheme.
The quality of services and the delivery of high standards of patient care is core to the Trust’s business and strategy and central to all staff both clinical and non clinical.
The National Health Service (Quality Accounts) Regulations 2010 came into force on 1 April 2010 which requires the Trust by law to publish a set of quality accounts by 30 June 2010. The Quality Accounts document will consist of four parts:
(a) Part 1, containing a statement summarising the provider’s view of the quality of NHS services provided or sub-contracted by the provider during the reporting period and the statement referred to in regulation 6;
(b) Part 2, containing the information relevant to the quality of NHS services provided or sub-contracted by the provider during the reporting period which is prescribed for the purposes of section 8(1) or (3) of the 2009 Act by paragraph (2) and the information required by regulation 7;
(c) Part 3, containing other information relevant to the quality of NHS services provided or sub-contracted by the provider during the reporting period which is included in the document by the provider; and
(d) Part 4, an annex containing statements or copies of the statements from key stakeholders. (See Regulation 5).
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This section outlines a statement from the Trust’s Chief Executive and
Executive Trust Board members on the quality of services delivered and provides a commitment to the list of priorities identified for improving the quality of services during the coming year.
The Trust’s vision is to become the “r ecognised leader in emergency, urgent and out-of-hospital care in the “East of England” .
It is committed to continuing to work closely with its patients, staff, commissioners and other key stakeholders to ensure that it has the capacity and capability to respond positively to the growing expectations and rising aspirations of its patient population.
The vision acknowledges that the Trust holds a unique position in the health economy by being the only 24/7 provider of emergency and urgent care within the region, together with its statutory duty to provide resilience. It recognises the ability of the Trust to contribute to the patient pathways outlined by NHS
East of England in the documents “Towards the Best, Together” and
“Improving Lives; Saving Lives” by developing and providing access to a range of urgent and out-of-hospital care services.
The NHS Constitution also clearly sets out a duty for compliance with the rights and pledges to patients and public. Improving quality is an overarching priority of the Ambulance Trust and this report lays out plans for developing future services to improve patient care and patient outcomes by delivering the right resource at the right time so that we are publicly accountable for driving clinical quality higher.
The Trust places patient safety and clinical quality at the heart of all its work. It is committed to delivering high standards of clinical quality and patient care to improve patient satisfaction and the patient experience. There are some challenges ahead to further improve quality.
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The values of the Trust were formally adopted in November 2008 and support the NHS Constitution, which became law in January 2009. They are reflected in decision-making at all levels within the Trust, and are summarised as follows:
Respect and dignity Commitment to quality of care Compassion
Improving lives Working together for patients Everyone counts
The Trust has also set out a number of key messages to promote the Trust’s vision and values including that it will:
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ƒ put patients first in all that it does; be committed to the highest standards of patient care; treat all patients with compassion, dignity and respect; improve the quality of services and the patient’s experience.
As a learning organisation the Trust values the contributions from its workforce and key stakeholders, the Ambulance User Group, Local
Involvement Networks (LINks) and Health Overview and Scrutiny Committees
(HOSCs) and PCTs to provide the best possible service to meet the needs of the patients and communities that it serves. It welcomes all forms of feedback in order to continuously learn to improve services and to build on its successes.
A high quality service can only be delivered if there is a focus on three key dimensions of quality: clinical effectiveness, safety and patient experience. In light of the significant external environmental changes and the economic challenges which the NHS faces, the Trust has revised its previous strategic objectives to support innovation in current clinical practice and to develop pathways to improve clinical effectiveness, patient outcomes and experience which are cost effective. The Trust Board will receive regular reports at its public meetings on its achievements against the new strategic objectives.
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Strategic Objectives
The Trust’s strategic objectives are:
1. Implement a new integrated operating model to improve patient outcomes by delivering the right resource at the right time
2. Enhance management capacity and capabilities to provide leadership and strategic direction and ensure the organisation is fit for purpose as a
Foundation Trust and meets the requirements of the NHS Constitution
3. Generate productivity and efficiency savings evidencing value for money
4. Implement strategic and financial planning to involve stakeholders and improve control
The Trust Board is accountable for quality and monitors performance on a monthly basis. The introduction of a set of quality accounts requires renewed focus on the development and delivery of the Trust’s clinical strategy to ensure that it is working for the benefit of the patient population served. As
Accountable Officer and Chief Executive of this Board, I have responsibility for maintaining the performance and standards achieved of the Trust’s services and in supporting an environment of continuous quality improvement.
This document is the first set of Quality Accounts by the East of England
Ambulance Service NHS Trust, in line with the requirements of the Health Act
2009. The Quality Account contains details mandated by the Regulations and also the measures that the Trust in association with our NHS and public partners, have decided best demonstrate our work to improve the standards and the quality of clinical care. The results of these measures in this first report indicate that there is scope for further quality improvements to ensure that all our patients have a positive experience in using our service. As
Accountable Officer it is also my responsibility to ensure that the data included
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in this Quality Account is accurate. I can provide this assurance based on the
Trust’s internal processes for ensuring the quality of data and the opinion of our internal auditors who completed and delivered the annual audit programme including an audits records management.
To the best of my knowledge the information contained within this set of quality accounts for the East of England Ambulance Service NHS Trust is accurate.
Signed:
Hayden Newton
Chief Executive, East of England Ambulance Service
Having taken up a new Executive appointment within the Trust as the Clinical
Director of Quality I have been struck by the commitment of staff to improving care to patients and the examples of excellent practice I have seen and I am therefore pleased to be able to commend our first Quality Account to you.
Patients and the care they receive, matter to us every moment of every day, the Trust is continually striving to further improve the quality of care we deliver to patients, often in very difficult circumstances and there are areas in which we have some challenges to overcome. However the Trust Board and our staff are committed to this task and my appointment is an endorsement of that commitment. I look forward to working with patients and users, partner organisations, regulators and of course our staff in improving further the quality of our care and the experience that our patients receive.
Quality Innovation Prevention Productivity (QIPP)
“High Quality Care for All” Lord Darzi is about using the NHS reforms to transform and redesign services to deliver high quality care for patients that is
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value for money and meets public expectations as well as the changing health profiles of patients. Darzi set out an ambitious commitment for making quality the organising principle of the NHS. His vision is that all NHS staff will measure what they do as a basis for improving quality. He defined quality as safe and effective care of which the patient's whole experience is positive and stated " We can only be sure to improve what we can actually measure ". This set of quality accounts will inform you of the Trust’s clinical performance achieved during 2009/10 through the measurement of the clinical performance indicators which were set for that year.
Darzi argued that quality, innovation and prevention are inseparable.
Therefore the challenge for the Trust is to work with staff who play a crucial role in delivering frontline services to patients and use their first-hand experience and knowledge to review, redesign and innovate services to make a difference to patients. It is important that the Trust takes this opportunity to bring about transformational change to improve clinical quality particularly in preparation of a predicted tighter economic climate.
A set of Quality Accounts will be produced annually which will provide the
Trust with an opportunity to look forward and identify priorities for improvement during the following year. Priorities which the Trust achieves in year will need to be continuously measured and maintained to ensure the quality of service after the priority has been retired.
Priorities for the coming year
The Trust has aligned two of its priorities for improvement 2010/11 with its
Commissioning for Quality and Innovation (CQUINs) schedule which has been discussed with its lead commissioner. The CQUIN schedule and the following priority areas for development and improvement have been selected through building on themes from last year arising from the Trust’s complaints,
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PALS and comments system and in engaging the views of users, staff and patients in the areas they felt the Trust should focus on.
Priority areas for development for 2010/11 include:
2) Increase the number of patients accessing an appropriate Stroke
Pathway
3) Improve the quality of patient handovers by improving the quality of patient care records
4) Increase the percentage of patients accessing preferred type of end of life care
5) Improve vehicle cleanliness and infection prevention and control in line with the Hygiene Code.
How we developed our priorities
In developing the priorities for 2010/11 with the Trust’s key stakeholders it has also considered national strategic direction and the outcome of a number of local audits which were completed over the past 12 months. All areas identified for quality improvements link to the three domains set out in Lord
Darzi’s document and set out to improve patient safety by developing robust mechanisms to ensure that the Trust records the quality of all care provided as well as developing clinical practice and care to ensure a greater focus on clinical effectiveness and the patient experience.
Patient Safety: Priority 1 – Reducing Preventable Falls
Calls categorised as a ‘fall’ account for over 18% of the Trust’s accident and emergency patient activity. Many of these emergency calls are to older patients who have fallen and 50% of which are treated at scene without transfer to hospital. National statistics state that approximately 30% of patients aged over 65 living in the community will fall each year of which 60% are nursing home residents. Evidence suggests that up to a third of falls are preventable if the right support systems are put in place. The Ambulance
Service has a major part to play in identifying those patients who are at risk of falling and in ensuring that they access falls prevention services to reduce the risk of repeat occurrences.
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Aim
To work collaboratively with other healthcare providers to reduce the number of falls and avoidable admissions and to increase identification and referral of those patients at risk of falling and to reduce future falls.
Current status
Referral to falls services across the EOE region is not consistent at present.
Currently our staff assess patients for injury but are often left without referral options for those patients who have not sustained an injury. The Trust has a number of pilot schemes operating across the region but this needs to be extended across the whole Trust.
Identified areas of improvement
We have recognised the need for a simple trigger tool for identifying those at risk of falling and requiring specialist referral and have identified a need for a simple consistent referral system across the Trust.
Current initiatives 2009/10
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The Trust operates a number of falls car(s) in some localities. These projects are staffed by Paramedics, community nurses and social workers
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The introduction of a shared falls register.
New initiatives to be implemented in 2010/11
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A regional trigger tool for all staff to use to identify patients needing referral to a falls prevention service.
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Setting up a regional single point of contact for referral of patients 24/7 who have fallen.
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Setting up a regional register for patients who have fallen so we can monitor trends and inform public health strategies.
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Carrying out a review of the pilot schemes.
Board Sponsor: David Donegan
Implementation Lead: Clinical General Manager
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Clinical Effectiveness: Priority 2 – Increase the number of patients accessing an appropriate stroke patient care pathway
Stroke is a major cause of mortality and morbidity. Since the stroke strategy was published in 2008 the Trust has made significant progress on the quality markers outlined. However, there is still more that can be done to ensure that the Trust is consistently getting the right patient to the right place for stroke and transient ischaemic attack (TIA) services.
Aim
To increase the number of patients who present with a stroke or TIA with access to the correct treatment pathway.
Current status
The Trust currently assesses all patients using the FAST system and our clinicians are trained in the use of ABCD2 for risk identification of TIA. In some parts of the region the Trust has access to 24/7 thrombolysis centres for stroke patients but this is not across the whole region. Currently, TIA patients are either transferred to hospital for treatment or referred to their GP.
Identified areas of improvement
The Trust needs to develop a single patient care pathway for those patients experiencing acute stroke and who are eligible for thrombolysis to ensure that they reach a specialist centre offering this service. Likewise the Trust needs to develop a TIA patient care pathway to identify high and low risk patients. In this way high risk patients could be conveyed to hospital and low risk patients could be referred directly to a TIA clinic within 7 days.
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Current initiatives 2009/10
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An acute patient care pathway is in place
Clinicians use the ABCD2 early warning scoring system
The Trust has appointed two new stroke leads.
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New initiatives to be implemented in 2010/11
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Introduction of a TIA patient care pathway to identify high and low risk patients by employing the ABCD2 system.
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Introduction of a low risk TIA referral system
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EoE regionwide access to acute thrombolysis service 24/7 for all stroke patients.
Board Sponsor: Dr Pam Chrispin
Implementation Lead: Stroke Lead
Patient Safety: Priority 3 – Improve the Quality of Patient Handovers
A key component of continuing care is that the patient is effectively handed over from one healthcare professional to another, using both verbal and written skills. Generally this happens in the Accident and Emergency
Department, but may also occur with GPs, Nursing Teams and Social
Services. Last year the Trust set a priority for ensuring that all paper patient care records were accurately completed and submitted. In discussion with clinicians and staff this year the Trust will focus on improving the completion of the paper patient care record.
Aim
To improve the completion of both paper and electronic patient care records to support effective patient handovers.
Current status
A web report was run on the Trust’s CAD database for the 1 November 2009 identifying 1821 emergency responses for which 919 patient care records were found (50.5% compliance). The accuracy of the PCRs audited ranged from 16% to 100% for key indicators and from 0 to 14% on new form indicators.
Identified areas of improvement
The Trust needs to significantly improve the quality of the completion and submission of its paper.
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Current initiatives 2009/10
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Guidance on completion and submission of PCRs
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Monitoring of completion and submission of PCRs
New initiatives to be implemented in 2010/11
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Improve the completion of patient care records to 90%
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Improve submission of Patient Care Records to 90%
Board Sponsor: Sheilagh Reavey
Implementation Lead: Clinical General Manager
Clinical Effectiveness: Priority 4 – Increase the percentage of patients accessing preferred type of end of life care
In discussion with patients and in line with national guidance the Trust will adopt and implement the principles of the Liverpool Care Pathway to ensure palliative care patients avoid inappropriate admission to hospital and are able to die in a place of their choice. The majority of people would like a dignified death and would like to remain at home. As such this year the Trust will work in partnership with end of life care (EOLC) networks to decrease the number of palliative care transfers to hospital and increase the number of Computer
Aided Dispatch (CAD) system flags indicating the preferred place of death for palliative care patients.
Aim
To increase the number of eligible patients accessing the right form of treatment when they have a cardiac arrest.
Current status
The implementation of a palliative care register covering some of the region covered by the Trust.
Use of CAD flags for living wills, patient directives and do not attempt resuscitation (DNAR) orders.
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Identified areas of improvement
Whilst we have clear guidance on resuscitation we feel the area that needs improvement is identification of those patients who are at the end of life where resuscitation would be inappropriate. For these patients we should ensure our practitioners have the skills to deal with end of life care.
Current initiatives 2009/10
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Full monitoring of compliance with resuscitation guidelines
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Review of CAD flags
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New initiatives to be implemented in 2010/11
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Develop an end of life care training for staff
Develop access to palliative care teams and medicines
Flagging of patients on the palliative care register and CAD with living wills and advanced directives re DNAR
Board Sponsor: Dr Pam Chrispin
Implementation Lead: Dr Nick Morton
Patient Experience: Priority 5 – Improve the cleanliness of the pre hospital environment and reduce the risk of infection
A clean environment provides the right setting for good patient care and good infection prevention and control. This is very challenging in the pre-hospital arena where Paramedics are required to treat and stabilise patients in a variety of settings and environments which are often not clean. All staff play an important role in quality improvement, in the confidence the public has, and in reducing infection related risks. The areas that are to be cleaned in the prehospital environment are divided into functional areas. Maintaining the required standard of cleanliness is more important in some functional areas than in others. In line with the revised National Specifications for Cleanliness in the NHS: a Framework for Setting and Measuring Performance Outcomes
(2007) the functional areas are grouped into three levels of cleaning intensity, based on the risks associated with inadequate cleaning in that functional area, for example:
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1. High risk areas - includes ambulance vehicles and station sterile storage areas, dirty utilities and toilets.
2. Significant risk areas includes the staff kitchens, rest rooms, locker rooms and response post rooms.
3. Low risk areas - includes administrative areas, non-sterile supply areas, record storage and archives.
In addition Trust will adhere to the Revised Healthcare Cleaning Manual
(2009). Both documents provide comprehensive guidance on all aspects of cleaning performance and frequency together with audit.
Aim
To minimise the risk of infection to patients, staff and visitors and in response to the inspections undertaken by the CQC the Trust has developed additional systems and key performance indicators to monitor and improve the cleanliness of all its risk areas listed above.
Current status
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Average vehicle cleanliness equals 38.5% (The audit tool initially implemented was not robust and requires further development. In addition the audit samples have been too small to be representative of the standard
•
• being achieved)
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Average estates cleanliness equals 12.8% (small sample audits)
Sterile stores and dirty utility facilities not adequate in some areas
Average staff hand cleanliness equals 80%.
Identified areas of improvement
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Define routine cleaning schedules for all patient-carrying vehicles – after patient journey, end of day, monthly and implement same
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Introduce robust cleanliness audit schedules
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Increase the sample size of all audits undertaken to meet the 95% target set
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Trust-wide audit of estate to determine refurbishment programme of defined clinical areas within stations/depots.
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Current initiatives 2009/10
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Monthly deep cleansing of vehicles
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Make ready depots x4 to improve cleaning performance of vehicles in
NSC
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Commence audit programme and develop tools/processes.
New initiatives to be implemented in 2010/11
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New clinical governance structure
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New continuous professional development (CPD) programme for all staff
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Comprehensive regular vehicle cleaning schedules and audit of cleaning programme
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Creation of new vehicle washer posts to undertake cleaning tasks
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Trust-wide new cleaning contracts to be implemented using healthcare contractor to deliver robust cleaning programme in all Trust premises
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Standardisation of all products used for cleaning across the Trust
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Review of all patient equipment and decontamination processes to ensure all equipment is adequately decontaminated after use.
Board Sponsor: Sheilagh Reavey
Implementation Lead: Dr Scott Turner
The Health Act 2009 requires the Trust to make a number of statements of assurance within this set of Quality Accounts. These statements are common to all NHS providers and will provide a benchmark against other similar services.
Review of Services
During the period 2009/10 the Trust provided and/or sub-contracted four services:
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An accident and emergency service which covered ambulance and rapid response provision, air ambulance, GP urgent transfers and operational resilience
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•
A special operations service which included resilience and emergency planning, air ambulance services and the hazardous area response team
(HART) who responded to major incidents including chemical, biological, radiological and nuclear
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Out of hours and Medicom including primary care call handling, remote triage and face to face patient consultations and district nursing service
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Patient transport services and courier transport services.
The income generated by the NHS Services provided and reviewed during this reporting period represents a total of £1,273,236. The Trust subcontracted part of the out of hours service to Care UK and Take Care
Now; for 2009/10 the Trust spent £1,273,236 with Care UK and £855,884.26
Take Care Now. The total un-audited income for 2009/10 is £228,076k.
During 2009/10, the Trust attended 778,099 emergency and GP urgent calls and transported 920,207 non-emergency patients. In addition it provided primary care services in Norfolk, Suffolk, Cambridgeshire, Bedfordshire and
Essex.
The Trust Board received regular operational performance reports on the quality of care provided through this service portfolio.
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Participation in Clinical Audits
During 2009/10, one national clinical audit and one confidential enquiry covered the NHS services provided by the East of England Ambulance
Service NHS Trust.
During that period East of England Ambulance Service NHS Trust participated in all (100%) national clinical audits and all (100%) national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that East of
England Ambulance Service NHS Trust was eligible to participate in during
2009/10 are as follows:
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National Clinical Audit: Myocardial Ischemia National Audit Project
(MINAP)
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National Confidential Enquiry: Centre for Maternal and Child Enquiries
(CMACE) Confidential Enquiry into Head Injury in Children
The national clinical audits and national confidential enquiries that the Trust participated in, and for which data collection was completed during 2009/10, are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.
Myocardial Ischemia National Audit Project (MINAP): The Trust submits information on specific patients conveyed to hospital at the request by acute trusts rather than submitting a number of cases directly to the data base.
There is no system in place for direct submission of Trust data.
During 2009/10 the East of England region changed its model of care for cardiac patients during from operating a pre hospital thrombolysis care system to one of primary angioplasty. Professor Boyle reviewed the plans in the Eastern region to introduce Primary Angioplasty (PPCI) after concerns were expressed about whether the new service would offer better patient outcomes. Professor Boyle visited the EoE area and noted the consensus of
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local opinion and shared with the local people clinical data and trials which showed that PPCI was better than the current treatment of thrombolysis. A
PPCI service was immediately implemented alongside the treatment of thrombolysis and the Trust was asked to monitor travel times and to transport patients to specialist PPCI centres located at Papworth Hospital in
Cambridge, the Norfolk and Norwich University Hospital in Norfolk and the
Basildon University Hospital Cardiothoracic Centre in Essex. The Trust also transports patients to Harefield outside the patch. There are also 9-5 services in West Herts.
The Trust continuously monitors its performance in this new clinical practice area.
The Trust published 10 patient related clinical audit reports during
2009/10 with the following recommendations to be actioned:
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BME Patients in Pain: Action
1. No action necessary
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Patient Care Record minimum Data Set: Action
1. PSIAM software designers should be requested to add the required missing fields.
2. Adastra software designers should be requested to add the required missing fields.
3. Review Trust Minimum Data Set with next review of PCR Policy
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•
Stroke
1. Use ambulance services National Clinical Performance Indicators to continue monitor further clinical performance and improvements in care
2. Feed results back to clinicians via Trust Intranet and Focus East Bulletin, including a reminder that oxygen therapy must be recorded .
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1.
Cannulation
Highlight the risks of infection through cannulation to clinicians. Publish a Clinical Quality Memo
2. Include in CPD training
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PPCI Pathway
1. The trust should monitor the use of Clopidogrel to patients in Bedfordshire and Hertfordshire, and support efforts to improve replenishment of the drug from PPCI centres.
2. Trust Cardiac Lead to report to next ESCG on time performance
3. Call to leaving scene performance should continue to be monitored during
2010-11
4. Call to Balloon in less than 150 minutes and Call to Needle in less than 60 minutes should be included in the trusts Clinical Performance Indicators for
2010-11
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Private Ambulance / Voluntary Ambulance Services
1. Terms and conditions set in the contract document need to be reviewed to ensure inclusion of sufficient clinical quality aspects of the submission and completion of a patient care record.
2. Contractor’s performance against contract to be discussed with contractors accordingly.
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Ambulance Support Workers (ASW)
1. Ensure systems in place to enable offline reporting of ambulance support worker activities. (Have the grade available for selection on web reports as well as being able to view them when a call is investigated).
2. Review deployment of ASW and associated risks
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•
Drug recording
1. Pass report to Medicines Management Group for review and action
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Stroke patient survey inclusion
1. When selecting samples of a particular clinical group, only the clinical impression field should be used for inclusion whenever possible.
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1.
Patient Care Record (PCR) Submission
Continue PCR submission monitoring during 2010-11 using the Trust
CPI system
2. Feed audit results back to clinicians and improve, record submission and completion including: child patient details and handover details.
3. Publish a Clinical Quality Memo to outline the performance of completion of
PCRs
4. Re- Audit during 2010 / 2011
Head Injury in Children:
The Trust signed up to take part in the CMACE national confidential enquiry during 2009 however to date the Trust has not been asked to submit the ambulance data element of the enquiry. The Trust has also applied to be included on the review committee but no committee meetings have been scheduled yet.
The data collection process is reliant upon the collection of data from hospitals before the ambulance service data is collected which may explain the delay in the proceedings.
Measuring Participation
National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) appears not to include the participation of ambulance services.
Centre for Maternal and Child Enquiries (CMACE): The Trust is registered to participate with this project and is waiting for the Acute Hospital data phase to be completed before receiving the ambulance service data request.
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National Confidential Inquiry (NCI) into Suicide and Homicide by People with
Mental Illness (NCI/NCISH): This project reviews psychiatric reports and does not include ambulance services.
Participation in Clinical Research
The number of patients receiving NHS services provided or sub-contracted by
East of England Ambulance Service NHS Trust in 2009/10 that were recruited during that period to participate in research approved by a research ethics committee was 18.
The 2009/10 reporting period represented the baseline year for the Trust with regard to the hosting of and accrual to the National Institute for Health
Research portfolio activity. Three such projects were given approval to proceed during this timeframe; one of which was subsequently completed and two remain on-going.
Participation in clinical research activity demonstrates the Trust’s commitment to improving the quality of care we offer and to making our contribution to wider health improvement.
Goals Agreed with Commissioners
Commissioning for Quality and Innovation (CQUIN) is a system that aims to support a cultural shift towards making quality the organising principle of NHS services. It does this by setting areas for development across the year and only receiving payment when the quality and innovation has been achieved.
A proportion of the income received by the Trust during 2009/10 was conditional on achieving quality improvements as described in agreement for the provision of emergency and urgent ambulance services CQUINs schedule.
The CQUIN schedule incorporated the following metrics:
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Patient report form completion
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Effect of Implementing Hygiene Code
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•
Safeguarding Children: Ensure regional, local and internal pathways are developed to ensure best practice in line with national and local guidelines
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•
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MINAP data flow
100% of stroke patient destination recorded
Data flow for resuscitation rates
Increase patient satisfaction and patient experience
End of life Care and DNAR pathway
AMPDS repeat callers’ activity data
Implementation of National Patient Safety Agency recommendations
Further details of the agreed CQUIN schedule for 2009/10 and for the following 12 month period are available on request. Please see page 2 for contact details.
Significant financial consequences are attached to the CQUIN schedule for
2010/11 as this equates to 1.5% of the total contract value. Regular reports on milestone achievements against the stretch targets will be provided to the
Trust Board and sub committees of the Board.
Care Quality Commission
The Trust is required to register with the Care Quality Commission and submitted its application for registration on 29 January 2010 and applied to be registered against three regulatory activities to cover the services provided by contracts and service level agreements. The Trust declared non compliance to four regulations namely Regulation 14 Outcome 5 Meeting nutritional needs, (not applicable to Ambulance Trusts) Regulation 13 Outcome 9
Management of medicines, Regulation 11 Outcome 7 Safeguarding and
Regulation 12 Outcome Cleanliness and infection control. Action plans were submitted and the medicines management plan has now been completed so that the Trust is compliant to Regulation 13. Work is continuing to achieve specified actions in the remaining two plans.
On 23 March 2010 the Trust was awarded registration for each of the three regulated activities for which it applied without conditions. The Trust will
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therefore be required to submit payment to the CQC for its registration and will be subject to periodic reviews in the near future.
The Trust has not participated in any special reviews or investigations conducted by the Care Quality Commission however it did carry out two unannounced visits, one in August and one in November 2009 relating to the
Hygiene Code. This resulted in two improvement notices being served in relation to the breach of 3 of the duties.
The Trust has implemented a comprehensive action plan following these visits which has been monitored by the Trust Board. It has taken the following action to address the conclusions/requirements by the CQC:
A detailed analysis of the Trust’s position against every section of the Hygiene
Code was completed. This has been reviewed recently in line with the updated Health and Social Care Act 2008 Code of practice for health and adult social care on the prevention and control of infections and related guidance.
For the first time the Trust has started to collect information on the cleanliness of its vehicles, buildings and staff. This has proved complex to achieve taking into account the geographical spread of properties and vehicles. The public
LINks group is starting to get involved in this process of quality assurance and the Trust is also inviting PCTs to review ambulance cleanliness and feedback results. Whilst the system is in its infancy it is already producing interesting results. It is accepted that the initial results have been based on small samples and that significantly more effort and resource will have to be put in to ensure validity of the data. The aim in the coming months is to make the system far more robust and with the ability to give information back to staff and managers on what they are doing well and where they may need to be a focus of increased effort.
The audit of policy and practice will be key in ensuring quality and compliance. An internal review of the Trust’s audit structure and plan is currently underway.
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A number of very detailed reviews have already been done or are in progress to show us organisationally where we need to focus in the coming year. As a
Trust we have enlisted the help of a private external organisation with expertise in IP&C to ensure that we do achieve compliance against all areas of the hygiene code. This working relationship is likely to persist for some time to come. Key focuses already identified will be audit, training and policy.
Significant work has already been done with our make ready teams and depots. Continued Professional Development (CPD) for the coming year has been designed to take forwards some of the critical issues that have come out of the last year. However CPD on its own will not be enough on its own to ensure continued compliance and success in this area. Continued engagement with staff and managers will be vital.
The Trust uniform policy has been reviewed and will be reissued and “Bare below the elbows will be expected.
All ambulance sites will be audited to identify required improvements; cleaning contracts will be enhanced and a programme of regular cleaning implemented against an agreed specification.
The new Director of Clinical Quality has taken on the mantle of Director of
Infection Prevention and Control (DIPC) and has a background in this field.
Her expertise will focus the Board on infection prevention and control issues in coming months to ensure that the Trust works towards closing all weaknesses in this area.
Data Quality
Good quality information underpins the effective delivery of patient care and is essential if improvements in quality of care are to be made. Lord Darzi stated that “We can only be sure to improve what we can actually measure”.
Improving data quality which includes the quality of ethnicity and other equality data will assist in improving the quality of patient care. The Trust has implemented a three year IM&T strategy to improve the quality reliability and accuracy of the Trust’s data processes.
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The Trust did not submit records during 2009/10 to the Secondary Uses service for inclusion in the Hospital Episode Statistics.
Information Governance Toolkit
To improve the level of risk associated with the use of information the Trust is required to work within the parameters of an information governance framework. Information governance is an umbrella term used within the NHS to inform all stakeholders that there is a set of standards, processes and procedures to be used when using information which the Trust is required to achieve and to remain compliant. The level of compliance attained will provide the level of assurance to the Executive Management Team and to the
Trust Board that all information created and used by the Trust is kept confidential and secure and that all records held by the Trust meet the NHS
Code of Practice which is based on current legal requirements and professional best practice. It encompasses legal requirements, central
•
•
•
• guidance and best practice in information handling and includes:
•
The common law duty of confidentiality
•
Data Protection Act 1998
Information Security
Information Quality
Records Management
Freedom of Information Act 2000
To measure the Trust’s compliance across a broad spectrum of information initiatives the Trust is required to complete a self assessment using the information governance toolkit. This toolkit contains a set of six work areas
•
•
•
•
• covering:
•
Information Governance Management
Confidentiality and Data Protection Assurance
Information Security Assurance
Clinical Information Assurance
Secondary Uses Assurance
Corporate Information Assurance
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The Information Governance toolkit is monitored and audited externally and has been approved by Health Ministers, the Review of Central Returns
(ROCR) team and Monitor. Final assessments are submitted on 31 March each year and are shared with the Care Quality Commission, the Audit
Commission, Monitor and the National Information Governance Board. The toolkit is the principal method of assessing the Trust’s Information
Governance framework and its performance during the year and is a key element of the NHS Information Governance Assurance Framework.
The Trust met the deadlines for the three scheduled returns for 2009/10 as follows:
1. Baseline assessment by 31 July 2009 - 56%
2. Performance update by 31 October 2009 – 65%
3. Final submission by 31 March 2010 – 70%
The final self assessment using the information governance toolkit was submitted on line on 31st March 2009 with scores recorded against each of the six work areas. Within each work area there are a number of criteria - 47 in total for the Ambulance Service Trust 2008/09 toolkit. Each criterion is scored as nil if nothing is in place, as 1 if policies/strategies exist; as 2 if the process can be evidenced as being implemented and embedded within the
Trust and as 3 if the process is mature with regular audits and reviews being undertaken. The scoring thresholds are Red - below 40%, Amber - 40% to
69% and Green - 70% and above. The Trust reported a green RAG rating scoring 70% compliance having been at an amber rating for the past two years.
In respect of the criteria relating to standards 401, 403, 405, 408, 601, 602 which scores a maximum of 18 the Trust scored 12 out 0f 18 which was an achievement of 66.67%.
The East of England Ambulance Service NHS Trust was not subject to the
Payment by Results clinical coding audit during 2009/10 by the Audit
Commission as it is not applicable to the organisation and its service portfolio.
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The aim of Quality Accounts is to enhance public accountability to improve patient safety, clinical effectiveness and patient experience and to inform the public about the quality of the services that are being delivered. The Health
Act 2009 has now placed a statutory requirement on the Trust to produce a quality account from April 2010.
The Trust reviewed its performance during 2009/10 and took into account a number of internal self assessments and dashboard data sources as well as external audit reports and regulator inspection reports to identify its quality indicators for improvement. The priorities for 2009/10 consisted of the following metrics:
Vehicle cleanliness
In response to the CQC rating for C4a, the Trust has developed additional systems and key performance indicators to monitor the cleanliness of the vehicle fleet. Initial reports demonstrated an improvement in both hand hygeine scores, estate cleanliness and vehicle cleanliness scores. However, the vehicle cleanliness has shown a decline during the winter periods although it is fair to say that these scores are still being obtained from a small sample of the total vehicle fleet which must be improved upon during 2010/11.
Which is why this still needs to be one of our priority areas
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Current
(b)
Current month result
No.
(c)
%
(d)
1.1 Number and percentage of vehicles audited for this report
95% 702
Ambulance vehicles
Estates
Staff
1.2 Number and percentage reported as completely clean
Target to be set after bench marking in QTR1
236
1.3 Average vehicle cleanliness
2.1 Number and percentage of buildings audited for this report
2.2 Number and percentage reported as completely clean
95%
95%
To be confirmed
2.3 Average estates cleanliness
95%
3.1 Number and percentage of staff hands audited for this report
3.2 Number and percentage reported as completely clean
Target to be set after bench marking in QTR1
Target to be set after bench marking in QTR1
3.3 Average staff hands cleanliness
95%
95%
147
56
92.3%
289
282
82.7%
198 69.2%
110 38.5%
Not applicable
96.9%
48 36.1%
28 21.1%
Not applicable
74 76.3%
97 87.7%
Not applicable
97.2%
83.3%
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Number of patient care record submissions (PCRs)
In response to the CQC rating for C9, the Trust will develop key performance indicators to monitor the number of PCR submissions versus the number of responses and as a priority for 2010/11 monitor their completion to improve handovers.
Quality & Accuracy of Information collected on PCR, using a snapshot of 50 records for operational areas (Apr 2009-Mar 2010)
Apr
09
83.0
%
May
09
82.0
%
Jun
09
Q1
09/
10
82.3
%
Jul
09
Aug
09
Sep
09
Q2
09/
10
81.2
%
Oct
09
Nov
09
Dec
09
Q3
09/
10
79.2
%
Jan
10
Feb
10
81.8
%
82.0
%
79.2
%
79.1
%
78.1
%
73.5
%
73.7
%
74.8
%
76.0
%
Clinical Effectiveness:
Asthma
In response to the CQC report on the standards of care, the Trust has continued to contribute to the national audit on the management of asthma by examining up to 300 records (or up to 300 if there were fewer than this) with a clinical diagnosis of asthma. The Trust’s performance has been analysed and compared using funnel plots which have the advantage of avoiding inappropriate ranking against the other 11 ambulance services in England but which identifies outliers above and below the mean. Criterion A2 below relates to the taking of a peak flow reading prior to treatment. Current JRCALC guidelines (2006) advise staff to check peak flow if practical’ but this is open to interpretation as it gives no further clarification as to what constitutes
‘practical’ or ‘not practical’. The Trust (number 8) on the graph below which demonstrates that it is above the mean and just below the upper control limit and expects to continue to improve its performance during 2010/11.
Mar
10
77.4
%
Q4
09/
10
78.4
%
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EEAST Total
Sample
Size
791
Performance
Cycle 3 (%)
Performance
Cycle 2 (%)
Performance
Cycle 1 (%)
37.06% 29.11% 28.92%
Cardiac arrest
In response to the CQC report on the standards of care, the Trust decided to re-audit and to continue to contribute to the national audit on the management of cardiac arrest. During the year the definition of ‘return of spontaneous circulation’ at the hospital, has been further clarified. The CPI sub committee recommended that criterion C1 ROSC on arrival at hospital be revised to look at cases of ROSC at hospital where the initial rhythm had been shockable or
VF/VT. This would bring it into line with Utstein criteria. The Trust has demonstrated a 2% improvement to its ROSC standard however this needs to be improved further and will continue to be monitored during 2010/11.
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EEAST Total
Sample
Size
534
Performance
Cycle 3 (%)
Performance
Cycle 2 (%)
Performance
Cycle 1 (%)
18.49
9.88
16.28
Patient Experience
Clinical Audit and Patient satisfaction
I t is both a national and Trust priority to receive feedback from patients and users to improve the service provided.
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Patient Satisfaction for Emergency Services (April 09-Dec 09)
April 09 May 09 June 09
95.8% 96.4% 95.7%
Q1 total
95.9%
Jul 09 Aug 09 Sept 09
95.9% 96.2% 98.6%
Q2 total
97.1%
Oct 09 Nov 09 Dec 09
Q3 total
Nine month total
Number of
52,278 55,197 54,263 161,738 57,384 54,918 52,918 61,300 56,050 61,216 emergency and urgent responses
69 53 88 210
Number of
113 114 125 352 864 feedback
Percentage of patient’s responses
97.4% 98.3% 99.2% 98.3% 97.3% overall
‘Satisfied’ or
‘Very Satisfied’
As part of the clinical audit annual programme and the need to continuously improve patient services the Trust planned and conducted a number of patient surveys and interviews. This was to actively seek user feedback on experiences including comments on staff attitude, cleanliness and comfort of vehicles and whether users are treated with dignity and respect. Part of the annual audit programme has been carried out in partnership with other NHS providers to improve the overall effectiveness survey activity. The Trust’s
PPI&E managers have worked with the Ambulance User Group consisting of volunteer public and patients, and works with a variety of external patient groups. Patients’ overall satisfaction remains high (Emergency Services 97%,
Out Of Hours services 88%, Patient Transport Services 91%).
Recent developments
During 2009 a range of developments took place; the roles of existing clinical directorate staff were changed to allow an increase of staff resource for the purpose of gaining patient feedback.
The surveying of users of the Out of Hours service went through changes to a telephone type survey and was altered so all Trust areas undertake the same activity allowing for better internal comparisons.
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A continuous postal survey of ES patients commenced, increasing the number of responses from patients in accordance with the new ES CQUIN requirement; such continuous survey allowed the Trust to report performance each month. A system of interviewing patients was introduced for ES patients with interviewers consisting of a Trust staff member and a Patient User Group volunteer.
A new team has been set up to manage patient engagement. This team worked with the Trust User Group and external groups such as Local
Involvement Networks (LINks). This activity was planned to be a part of the
Trust Communications & Engagement Department (Associate Director and
Director yet to be appointed).
Current programme and performance
The agreed programme for patient feedback activity was split into the three service areas:
1. Emergency Services
A continuous postal survey was started during 2009-10 and seven topic specific projects were programmed: BME patients, patients suffering a stroke x 2, patients suffering hypoglycaemia, patients using the PPCI pathway, patients treated by private and voluntary ambulance services and mental health. The number of patients expected to receive feedback from during
2009-10 was approximately 2500. Overall patient satisfaction for ES was around 96%.
2. Primary Care Services
The continuous survey was continued for 2009-10, moving from postal to telephone method part way through the year. The number of patients expected to receive feedback from during 2009-10 was approximately 2800.
Overall patient satisfaction for PCS tended to be around 86%.
3. Non-Emergency Services
Three topic specific surveys were programmed: patients travelling in Essex,
West Suffolk and NNUH. The number of patients expected to be surveyed
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during 2009-10 was approximately 600. Overall patient satisfaction for NES tended to be around 91%.
In the future the Trust wishes to develop the work carried out around patient interviews and improve the direct feedback to staff.
Patient Experience via Complaints Monitoring
The Trust is committed to improving the service it provides to the people it serves and is continually working towards a culture that seeks and then uses patients’ experiences of care to improve and shape services. Staff work very hard to meet patient and public expectations however in a busy public service organisation mistakes can occur which need to be resolved and systems put in place to ensure that services are improved.
All patient related complaints, queries and concerns about the Trust are managed through two main departments located in Norwich and Bedford.
Each department has a dedicated team of staff whose aim is to forge a link with the patient or member of the public so that there is a clear understanding of the issues being raised and how best they can be resolved.
Complaints are relatively small in number compared to the volume of patient activity undertaken by the Trust. However we believe that any comments received or any bad experiences felt by patients and brought to our attention must be fed back into the organisation to enable learning to take place to continually improve our patients’ experience of using our services and to also support our staff in delivering high quality care to all our patients.
During the period April 2009 to March 2010 the Trust registered 452 complaints compared to 389 for the previous year. 98% of all complaints received were acknowledged by the patient experience teams and were all handled in accordance with the new Local Authority Social Services and
National Health Service Complaints (England) Regulations 2009. Joint working with other social services and health organisations has also been established to improve the complaints process when the complaint extends beyond organisational boundaries and involves more than one organisation.
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In terms of comparing activity with complaints received for the period, for every one complaint that the Trust received it responded to and managed
1768 patient episodes satisfactorily.
The majority of complaints have been resolved locally however 12 went on to independent review with the Health Service Ombudsman. Six of these were closed with no further action required, two required some additional work and four are still currently under review by the Ombudsman.
Patient Advice & Liaison Service (PALS)
The PALS service is an integral part of our patient experience departments dealing with up to 961 enquires ranging from feedback on how to improve services, giving advice on any NHS matter and helping to find misplaced personal belongings.
Lessons Learned
For every registered complaint or concern raised by the public the Trust seeks to learn from this positive feedback. The majority of lessons learned have been managed at local level by the management teams and Clinical
Operation Managers through direct feedback to those staff involved. Where complaints have had a wider implication for the Trust then lessons learned and changes to practice have been published via bulletins so that learning can be shared across the whole organisation. For example as a result of complaints and concerns received there have been bulletins issued to staff on the management of paediatrics, swine flu, clarification on seeking clinical advice and support, operational guidelines on procedures, good practice guidelines in the non emergency setting and the introduction of a trial scheme to transport patients’ medication safely to name a few.
Compliments
The Trust is also proud of the many compliments and thank you letters sent to our staff. This year over 1390 staff received a “thank you” in recognition of their hard work, dedication and professionalism. For every “thank you”
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received by the Trust each member of staff has received a copy of the letter and their names have been published in our Trust bulletin.
Complaints are categorised into the following areas to assist the Trust to identify any relevant trends which require changes to training programmes, equipment and/or services to improve the patient experience. The number of complaints during 2009/10 has increased by 60 compared to 2008/09 but this should analysed in the context of an additional 6% increase in patient activity.
What is pleasing is to see the number of complaints relating to attitude decrease although there is further work needed to reduce these types of complaints to an acceptable level. Patient care complaints have increased and further analysis will be undertaken to identify the root cause of the increase.
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Comparative Complaints Data 2008/09 and 2009/10
Area of
Complaint
Apr
08
May
08
Jun
08
Jul
08
Aug
08
Sep
08
Oct
08
Nov
08
Dec
08
Jan
09
Feb
09
Mar
09 TOTAL
Attitude of staff 7 12 20 13 9 11 15 10 8 22 6 11 144
Patient 15 14 11 7 8 10 9 13 15 128
Call 6
Driving 6
Delay to
Infection
Other non specific
3 1 0 0 0 0 0 0 0 0 0 1 5
Hospital
Transport 2 3 1 2 2 2 2 2 2 3 3 0 24
Equipment 0 0 0 0 0 0 0 0 0 0 0 0 0
1 0 0 0 0 0 1 0 0 1 0 0 3
Medication
Error
Total
0 1 0 0 0 0 0 0 0 0 0 0 1
27 25 40 36 29 33 31 31 30 45 30 32 389
Area of
Complaint
Apr
09
May
09
Jun
09
Jul
09
Aug
09
Sep
09
Oct
09
Nov
09
Dec
09
Jan
10
Feb
10
Mar
10 TOTAL
Attitude of staff 7 10 3 15 13 9 11 14 13 15 11 13 134
Patient 12 6 21 18 13 12 22 11 10 15 20 18 178
Call 43
Driving 14
Delay to attend/arrive 4 3 4 4 4 7 6 5 2 3 2 5 49
Infection 0 2
Hospital
Transport 0 1 4 2 0 0 1 1 1 0 1 1 12
Equipment 1 0 0 0 0 0 0 0 0 0 0 0 1
Other non specific 0 0 0 0 3 2 1 5 3 0 2 2 18
Medication
Error
Total
0 0 0 0 0 0 0 0 1 0 0 0 1
29 22 34 44 35 39 46 39 34 42 43 45 452
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If the aim of improving public accountability is to be achieved, the Trust has asked for the views of its local communities to ensure that the Quality
Accounts are accessible and informative. A glossary has been developed having taken the advice of the chair of the Trust’s ambulance user group.
Copies of the quality account have been circulated to all members of the
Ambulance User group and Local Involvement Networks (LINks) and Health
Overview and Scrutiny Committees (HOSCs) to develop the Quality Account further and to ask for comments on the priorities identified for improvement with regards to quality of care for 2010/11.
Comments have been received from the stakeholders:
The Trust User Group (TUG ) were very pleased to receive and note the
Quality Accounts for the East of England Ambulance Service Trust.
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The Group are pleased with the progress on last year’s initiatives and the improvements on those initiatives planned for 2010/11.
They also especially welcome the planned improvement for patients accessing preferred type of end of life care. They would like to see training for all staff to the level of the Trusts ECPs in this area to ensure that these patients receive the very best of care at all levels without any delays.
The TUG are committed to helping the Trust improve its vehicle and station cleanliness by carrying out impartial cleanliness audits throughout the year and feeding back to the Clinical Quality team its findings and comments for action. They look forward to working with the Trust on appropriate use of the ambulance service through public awareness.
They are happy with what you have written. The statement is just the length it should be. They would have liked to see something about the falls project at
Hemel which has had a good outcome and could save a great deal of money for the NHS. Hertfordshire Link has put a short paragraph in its response as it was funded by the County Council and Ambulance Trust. Herts OSC may also mention it as they have been asked to do look at it at a meeting today. Perhaps it could be mentioned next year.
Bedfordshire LINk welcomes the opportunity to comment on the Quality
Accounts for the East of England Ambulance Trust.
We would like to acknowledge the input of the PPI Lead for the Trust, Gina
Pryor at Bedfordshire LINk Board meetings, which has allowed for two-way communication and speedy responses to questions. We have also been fortunate to have a member of the Trust’s Ambulance Patient User Group in the LINk, which has meant that when the issue of ambulance crew attendance at homes of the visually impaired/blind patients or carers caused some concern, it resulted in the Trust implementing changes to the crew ID cards to include Braille and a revision to the crew induction process. The LINk membership including the Central Bedfordshire Access Group, where the issue was raised, welcome these changes.
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Luton LINk has representation on the Trusts User Group and has maintained a close interest in the services provided in the town. It is pleasing to note the very low level of complaints originating from patients in the area. Active participation has been given to the Turnaround, Patient Interview and
Cleanliness projects as a contribution to the Trust’s service improvement programme.
Thank you.
Rutland LINk has no comments
Thank you for asking Cambridgeshire LINk to comment on the 2009/10 Draft
Quality Accounts.
We would firstly like to comment on the restricted timescale that the LINk has been given to respond to this document. The draft document was only received by our facilitator on 6 th
May 2010 with an e-mail asking for us to respond by 20 th
May 2010. This has only given us 14 days to respond and not the 30 working days as recommended in the DoH letter dated 14.01.10,
Annex 1 (Gateway No: 13393) QUALITY ACCOUNTS: Roles of
Commissioning PCT’s, Local Involvement Networks (LINks) and local authority Overview and Scrutiny Committees (OSCs). As a result of this we shall only be able to comment at a local level as we have not had time to discuss this with our counterparts across the Region.
The group applaud the priorities that you have identified for the forthcoming year at the same time recognising that performance against category A, B and
C response times is measured Trust wide. The group have shown concern during the year that there is a huge local variation between response times, especially rural versus urban and would suggest that this is monitored very
Cambridgeshire.
Hertfordshire LINk strongly supports the values and priorities for quality improvement set out in the East of England Ambulance Service NHS Trust’s
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Quality Account. Priorities are set out with clear aims and objectives and lead responsible.
For ‘Priority 1 – Reducing Preventable Falls’, Hertfordshire LINk commends the six month Fall Prevention project run by Hertfordshire County Council and the East of England Ambulance Service NHS Trust which aimed to help older people avoid unnecessary trips to A&E and promoted joint working. LINk would like to see this good practice rolled out and further collaborative working with healthcare providers.
A key concern of Hertfordshire LINk is the care of the very vulnerable
(children and adults) in hospital and in the community. There is a need for patient surveys and possibly clinical audits to identify the level of patient satisfaction and care outcomes for the very vulnerable. The very vulnerable are defined as those with severe sensory or physical disabilities, learning disabilities, Autism, Dementia and complex mental as well as physical health problems.
Staff are involved with quality improvement through the Compliments and
Complaints system and as patient surveys include dignity and respect, could be encouraged to become Dignity Champions.
Hertfordshire LINk looks forward to working with the East of England
Ambulance NHS Trust to support quality improvement.
This is to give feedback from Cambridgeshire County Council Health and
Adult Social Care Scrutiny Committee on the EEAS Quality Account, as follows:
The Committee thanks the East of England Ambulance Service for the opportunity to comment on the Quality Account. We are concerned that the
Cat A 8 minute ambulance response time target is not being achieved in the
Cambridgeshire PCT area outside Cambridge City, ie East Cambridgeshire,
Fenland, Huntingdonshire, and South Cambridgeshire. We therefore suggest that the Quality Account include as one of its priority areas for development improvements in Cat A ambulance response times for those localities within
43

PCT areas which are underperforming, with targets set for each locality, in discussion with the commissioners.
We particularly welcome the priorities being given to: increasing the number of patients who have suffered a stroke going to the most appropriate clinical setting as this should result in improved outcomes improving the quality of patient handovers, which should lead to a more effective use of resources as well as impacting on patient safety.
The Suffolk Health Scrutiny Committee
Many thanks for the opportunity to comment on the East of England
Ambulance Service NHS Trust’s Quality Accounts publication. The following statement is the Health Scrutiny Committee’s formal response:
The Suffolk Health Scrutiny Committee has decided not to comment on any of the Suffolk provider NHS Trust's Quality Accounts for 2009/10 and would like to stress that this should in no way be taken as a negative comment. The
Committee has taken the view that it is appropriate for Suffolk’s Local
Involvement Network to consider the Quality Account and comment accordingly.
Please note, this decision was taken on the on the basis that the Health
Scrutiny Committee feels that Suffolk LINk is better placed to comment from the public / patient point of view.
NHS Bedfordshire as the Lead Commissioning Primary Care Trust for East of
England Ambulance Service NHS Trust has a duty under the National Health
Service Act 2006, to confirm that this Quality Account contains accurate and relevant information in relation to the NHS services provided. Reasonable steps have been taken to ensure the data has been checked for accuracy against data supplied during the year. This process is part of the contractual quality monitoring systems.
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A description of services provided has been identified. The CEO statement confirms that internal quality assurance process including data is scrutinised and can be evidenced. NHS Bedfordshire supports the plan to provide regular reports to the Public Trust Board meetings on the achievements against new strategic objectives. Board sponsors and implementation leads are clearly identified demonstrating Executive ownership and commitment to this agenda.
Clinical Performance indicators for 2009/10 are utilised to set targets for this year, it is acknowledged that these have not been nationally benchmarked but due to the nature of the organisation this has been done within the East of
England.
The five priority areas for 2010/11 have been identified from various sources and the new initiatives when achieved will enhance the quality of service and outcomes for the patient. Progress on achievement will be monitored via the existing quality monitoring processes.
NHS Bedfordshire notes and confirms the position in relation to the hygiene code. The detailed review of work and progress will be monitored closely, it is noted that there is a new Director of Infection Prevention and Control who has been appointed and is named as championing this agenda at the Board.
A detailed list of involvement in clinical audit both National and local is clearly illustrated and the findings and actions required identified. The service changes are described and NHS Bedfordshire will continue to review impact and patient outcome measures.
NHS Bedfordshire is satisfied with the challenge of identified CQUIN
(Commissioning for Quality and Innovation) indicators and looks forward to the improved patient experience and the impact on patient care outcomes and the impact on demand management.
NHS Bedfordshire acknowledges that the East of England Ambulance Service
NHS Trust has been registered unconditionally, with the Care Quality
Commission from 23 March 2010 for its three regulated activities.
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NHS Bedfordshire can confirm that the Quality Account provided for 2009/10 contains accurate information and reflects the quality of current service provision. The account contains the challenges for continued improvement and monitoring of effective patient outcomes which NHS Bedfordshire will continue to review and validate in year.
Yours Sincerely
Andrew Morgan
Chief Executive
Providing Feedback
If you would like to provide comments and feedback on our quality account you can write to:
Sheilagh Reavey
Director of Clinical Quality
East of England Ambulance Service NHS Trust
Hammond Road
Bedford
MK41 0RG.
Or Telephone: 01234 408999
Or email: qualityaccount@eastamb.nhs.uk
46

Term
Glossary
ABCD2 Algorithm
Acronym Description
ABCD2
A simple score ( ABCD2 ) to identify individuals at high early risk of stroke after a transient ischemic attack
Advanced Directive
Advanced Medical Priority
Dispatch System
Ambulance support worker
Auditors’ Local Evaluation
Care Quality Commission
AD
AMPDS
ASW
ALE
CQC
Also known as living wills , advance directives , or advance decisions , are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity.
Licensed software to clinically triage the category of emergency calls.
A new support worker introduced to work on urgent tier vehicles and or teamed up with a Paramedic to enable them to concentrate on delivering clinical care and treatment to patients.
External auditor assessment of how well NHS organisations manage and use their financial resources. Highlights areas for improvement
The independent watchdog for healthcare in England. It assesses and reports on the quality and safety of services provided by the
NHS and the independent healthcare sector, and works to improve services for patients and the public
Term in common use worldwide, to refer to incidents in which any of these four hazards have presented themselves
Clinical, biological, radiological, nuclear
CBRN
Clinical performance indicator
Clinical support desk
CPI
CSD
A performance indicator designed to monitor important aspects of clinical which require either monitoring or improvement
Clinically trained individuals providing telephonic support following an emergency call. Generally utilised for lower acuity calls not necessarily requiring attendance at scene or a transportable response
The processes which local authorities and PCTs undertake to make
Commissioning sure that services funded by them meet the needs of the patient with the financial envelope
Commissioning for
Quality and Innovation
Community first responders
CQUIN
CFR
The incorporation of quality metrics within three-year contracts. Full reimbursement of activity is made upon delivery of quality initiatives
Teams of volunteers who are trained by the ambulance service to a nationally recognised level and provide life saving treatment to people in their local communities
47

Computer aided dispatch system
CAD
Computer hardware used to record all patient calls and patient activity.
Continuous professional development
Courier transport service CTS
Directory of service DoS
Do not attempt
Resuscitation
Emergency operations centre
Emergency service
CPD
DNAR
EOC
ES
An updating of professional knowledge and the improvement of professional competence throughout a person's working life. It is a commitment to being professional, keeping up to date and continuously seeking to improve.
Transports medical freight, mail and supplies
A live list of available health and social care provision
A patient with capacity has the right to refuse CPR and agrees to an advance decision refusing CPR, this should be respected. A Do
Not Attempt Resuscitation (DNAR) decision does not override clinical judgement in the unlikely event of a reversible cause of the patient’s respiratory or cardiac arrest that does not match the circumstances envisaged. DNAR decisions apply only to CPR and not to any other aspects of treatment.
Control centre for managing call receipt, triage and dispatch functions
999 ambulance service providing patient care, treatment and transport to acute hospitals
End of life care
Foundation Trust
Hazardous Area
Response Teams
Health Overview and
Scrutiny Committee
Joint Royal Colleges
Ambulance Liaison
Committee
EOLC
FT
HART
HOSC
Inpatient quality indicators IQI
JRCALC
A DH programme, to improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.
A type of trust created to devolve decision-making from central government control to local organisations and communities so they are more responsive to the needs and wishes of their local people
Specially trained personnel who provide the ambulance response to major incidents
The Committee provides external assessment of any NHS consultation process giving local assurance that the businesss case for any future NHS developments are robust
IQIs are a set of measures that provide a perspective on the quality of care given to patients
A committee that provides robust clinical speciality advice to ambulance services and is well known for the development and the production the UK Ambulance Service Clinical Practice Guidelines.
JRCALC Works closely alongside the Directors of Clinical Care of all UK ambulance services, local Ambulance Paramedic Steering
Committees, the British Paramedic Association and other interested groups it effectively fulfils the liaison role of its title.
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Knowledge and skills framework
KSF
The NHS KSF process involves managers working with individual members of staff to plan their training and development
Local involvement networks
LINks
Run by local individuals and groups and independently supported.
The role of LINks is to find out what people want, monitor local services and to use their powers to hold them to account
Set of ways of quantitatively and periodically measuring
Metrics performance.
Myocardial Infarction
National Audit Project
MINAP
The Myocardial Infarction National Audit Project (MINAP) was established in 1999, in response to the national service framework
(NSF) for coronary heart disease, to examine the quality of management of heart attacks in England and Wales. The project uses a highly secure electronic system of data entry, transmission and analysis developed by the Central Cardiac Audit Database
(CCAD). This system uses encryption of patient identifiers to allow secure transfer of data between hospitals and central servers and allows linkage with the Office of National Statistics for tracking of mortality.
NHS East of England
Quality Innovation
Prevention Productivity
NHS EoE Strategic health authority (SHA) in the East of England
QIPP
Lord Darzi argued in High Quality Care for All that quality, innovation and prevention are inseparable. QIPP is a concept for delivering quality services through a period of tighter financial challenge.
Patient and public involvement
PPI
Patient public involvement
& engagement
Patient care record
Patient transport service
Primary and urgent care
Primary care operations
Primary care trust
PPI&E
PCR
PTS
P&UC
PCT
Involving the public in shaping a care system’s development, and keeping patients well informed of clinical processes and decisions
The NHS fully supports engaging people in the design and delivery of services. They are routinely asked for their views, about their experience of services, to contribute to staff training and to be members of NHS foundation trusts.
All NHS providers are required to record the care given to a patient on a patient care record
Provides transport to and from premises providing NHS healthcare and between NHS healthcare providers
The term for out-of-hospital health services that play a central role in the local community
Comprises the patient transport service (PTS) and courier transport services (CTS)
NHS bodies with responsibility for delivering health care services and health improvements to their local areas
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Primary percutaneous coronary intervention
PPCI
Commonly known as coronary angioplasty or simply angioplasty, is a therapeutic procedure to treat the narrowed coronary arteries of the heart found in coronary heart disease
Return of spontaneous circulation
ROSC A palpable pulse is present after clinically documented asystole
Service user
Single point of contact SPoC
Anyone who uses, requests, applies for or benefits from health or local authority services
A single telephone number which will facilitate patient navigation to a range of health and social care services around the clock and prevent unnecessary admission
A stroke happens when the blood supply to the brain is disturbed.
Transient ischaemic attack (TIA) or 'mini-stroke' has similar symptoms to stroke but these symptoms are resolved faster and
Stroke TIA the person usually will get better within 24 hours. The TIA may be a warning sign of a more serious stroke and always requires further immediate medical attention.
Anyone with an interest in the way services are delivered including service users, carers, patients, service providers, staff, health
Stakeholders professionals and partner organisations, councils and other
Strategic health authority SHA community or voluntary groups
Regional NHS headquarters, responsible for ensuring national priorities are integrated into local plans and PCTs are performing well
The delivery of health-related services and information via
Telehealth telecommunications technologies
Voluntary and community sector
Groups set up for public or community benefit such as registered charities, and non charitable non-profit organisations and associations
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