Special measures for struggling services

In November of last year, London Ambulance Service NHS Trust (LAS) became the first ambulance Trust to be placed under special measures following an inspection of the service by the Care Quality Commission (CQC) in June 2015. The overall rating given by England’s chief inspector of hospitals, Prof Sir Mike Richards, was that the service was inadequate, and it was acknowledged that improvements were needed on safety, effectiveness, responsiveness and leadership (CQC, 2015b).

Of the key findings, it was noted that LAS had a high number of front-line vacancies, with some employees saying that there were not enough appropriately trained staff to ensure that patients were consistently safe and received the right level of care (CQC, 2015a). As a result of staff working long hours, many reported feeling high levels of stress and fatigue. Additionally, while the CQC recognised that staff were ‘overwhelmingly dedicated, hardworking and compassionate,’ they revealed that ‘some reported a culture of harassment and bullying’ (CQC, 2015a). It was highlighted how until March 2014, LAS was consistently the best performing service in the country to category A calls. However, since then there has been a substantial decline in performance, and the target time of 75% of calls being responded to within 8 minutes has not been met. This is something that has been affecting ambulance services across England, although LAS response times for Red 1 and Red 2 category A calls were reported as being the worst in the country. Serious concerns were also identified about the service’s Hazardous Area Response Team (HART) capability due to an insufficient number of paramedics. The result was the feeling that there was not a safe system of working where an effective HART response could be utilised (CQC, 2015b).

The decision to place LAS under special measures is a considerable blow, not just to the service, but to all members of ambulance Trusts. Fundamentally it highlights the CQC’s belief that LAS is unable to provide the level of care expected of it. This is despite the dedication and commitment that is clearly apparent in front-line staff, alluded to in the report. But while it is easy to consider the negative connotations of the CQC’s report, it is important to remember that one of the key reasons why services are placed under special measures is to ensure they get the support they need to improve. External partners such as the NHS Trust Development Authority and NHS England will give LAS access to a package of additional resources and support.

Ambulance services throughout the country are struggling to deal with increasing pressures, a national shortage of paramedics and insufficient funding. It is hoped that other ambulance services will not suffer similar findings from the CQC, but it should be reassuring to know that there is a system in place to offer support to services that are unable to make improvements required of them on their own.

References

Care Quality Commission (2015a) Chief Inspector of Hospitals recommends London Ambulance Service NHS Trust is placed into special measures. CQC, London. http://www.cqc.org.uk/content/chief-inspector-hospitals-recommends-london-ambulance-service-nhs-trust-placed-special (accessed 4 January 2015)

Care Quality Commission (2015b) London Ambulance Service NHS Trust Quality Report. CQC, London. http://www.cqc.org.uk/sites/default/files/new_reports/AAAD5514.pdf (accessed 4 January 2016)

Taken from Journal of Paramedic Practice, published 8 January 2016.

Ambulance services run up £6 million deficit for first quarter

Ambulance services in England have run up a £6 million deficit for the first 3 months of the 2015–16 financial year.

According to figures published by Monitor and the NHS Trust Development Authority, four NHS Ambulance Trusts and four NHS Ambulance Foundation Trusts are in deficit.

These figures form part of the wider combined deficit of £930 million for the 151 Foundation Trusts and 90 other NHS Trusts and in England, which is more than the entire full-year deficit for 2014–15 of £829 million.

Foundation Trusts ended the first quarter with a deficit of £445 million, which was £90 million worse than planned. NHS Trusts were revealed to be £485 million in deficit, which was £63 million worse than anticipated.

David Bennett, chief executive of Monitor, said:

‘Today figures reiterate the sector is under massive pressure and must change to counter it.’

He added: ‘The NHS simply can no longer afford operationally and financially to operate in the way it has been and must act now to deliver the substantial efficiency gains required.’

Richard Murray, Director of Policy at The King’s Fund, said:

‘These figures confirm that NHS providers are heading towards an unprecedented end of year deficit.

‘The reported overspend of £930 million at the end of the first quarter is more than the deficit for the whole of last year. This reflects a very sharp deterioration in financial performance among all types of providers, with 96% of acute trusts and more than half of mental health trusts now reporting deficits.

‘On this basis, warnings of a deficit of at least £2 billion by the end of the year are well-founded.’

He added: ‘Unless emergency funding is announced in the forthcoming Spending Review, a rapid and serious decline in patient care is inevitable.’

Taken from Journal of Paramedic Practice, published 22 October 2015.

Looking forward: the Five Year View

On 23 October, Simon Stevens outlined his Five Year Forward View for the NHS. Developed by the partner organisations that deliver and oversee health and care services, including NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority, it offers a look at why change in the NHS is needed, what that change might look like and how we can achieve it (NHS England et al, 2014). This ‘upgrade’ to the public health system will take into account growing problems associated with obesity, smoking and the consumption of alcohol; greater control of patients’ own care through fully interoperable electronic health records that are accessible to the patient; and decisive steps to break down the barriers in how care is provided.

In line with the Urgent and Emergency Care Review (NHS England, 2013), the Five Year Forward View proposes an expanded role for ambulance services, highlighting the increasing need for out-of-hospital care to become a more notable part of the work the NHS undertakes. The plan highlights the need to dissolve traditional boundaries and integrate urgent and emergency care services between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Through empowering ambulance service staff—including paramedics—with the ability to make make more decisions, treat more patients and make referrals in a more flexible way, it is hoped that pressure on other services can be alleviated and patients can receive the care they deserve. Highlighting the success of the introduction of major trauma centres, it emphasises the need for developing networks of linked hospitals that ensure patients with the most serious needs get to specialist emergency centres.

The Five Year Forward View also promotes the need to engage with communities in new ways by involving them directly in decisions about the future of health and care services (NHS England et al, 2014). Through the encouragement of community volunteering, it is hoped that a critical contribution to the provision of health and social care in England can be made. It is suggested that this could be done through further recruitment of community first responders, particulary in more rural areas, who are trained in basic life support. In addition, proposals for new roles include family and carer liaison, educating people in the management of long-term conditions and helping with vaccination programmes.

The Five Year Forward View is a welcome proposal of how the NHS can tackle changing demands in health care. By recognising how and why the health system needs to evolve, it is hoped the NHS will be able to provide better, higher quality, and more integrated care to its patients.

References

NHS England (2013) High Quality Care for All, Now and for Future Generations: Transforming Urgent and Emergency Care Services in England – Urgent and Emergency Care Review End of Phase 1 Report. NHS England, London

NHS England, Public Health England, Health Education England, Monitor, Care Quality Commission, NHS Trust Development Authority (2014) Five Year Forward View. http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 1 December 2014)

Taken from Journal of Paramedic Practice, published 5 December 2014.

Hunt unveils plan to turn around NHS hospitals

Health Secretary Jeremy Hunt has set out the Government’s plans to help prevent future failures of care and safety at NHS Hospitals.

Following a review by NHS medical director Professor Sir Bruce Keogh, which investigated the quality of care and treatment provided by 14 hospital trusts that are persistent outliers on mortality indicators, Monitor and the NHS Trust Development Authority have already placed 11 of those Trusts into ‘special measures’.

According to the Health Secretary, ‘It is entirely possible, even likely, that other hospitals will have to go into special measures.’

The new inspection regime unveiled by the Health Secretary will identify more Trusts that need turning around.

Support given to the 11 Trusts already placed into special measures will come from NHS hospitals with the highest standards of patient care and safety.

Each of the 11 Trusts will be partnered with one of the best NHS Trusts in the country in innovative improvement contracts.

‘For too long, patients have had to put up with poor care because it was inconvenient to expose and tackle failure,’ said Hunt.

‘I am committing to total transparency on progress in these hospitals, and to leave no stone unturned in our mission to turn them round.’

Taken from Journal of Paramedic Practice, published 25 September 2013.