Surge black and student abstraction: update from CEO Robert Morton

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The last two weeks here at EEAST have been extremely busy, with everyone in every position working very hard to ensure we deliver services to our patients, against a backdrop of ever increasing demand. Thank you all.

We know that many of our healthcare partners across the east of England are also feeling this pressure and surge in activity. This is clearly evident through the significant increases in hospital arrival to handover delays we are seeing at a number of acute sites. In recent days, a number of hospitals have declared black status.

As a Trust, we are continuing to work collaboratively with other colleagues through the newly formed Local A&E Delivery Boards. These are charged with delivering on NHS England’s five mandated actions to improve patient flow in emergency departments:

  1. Streaming at the front door – to ambulatory and primary care (to improve flows to non-major areas)
  2. NHS 111 – increasing the number of calls transferred for clinical advice (to reduce 999 calls and emergency department attendances)
  3. Ambulances – dispatch on disposition pilot (to reduce the numbers of inappropriate responses/conveyances)
  4. Improved flow – ‘must do’s’ that each Trust should implement to enhance patient flow (improve in emergency department systems)
  5. Discharge – mandating ‘discharge to assess’ and ‘trusted assessor’ type models (release existing beds to speed up admissions).

Many of our managers are involved in discussions through the 17 A&E delivery boards across our patch. Both EEAST and our regulator, NHS Improvement, is also anxious that these boards focus on reducing arrival to handover delays. We also have an obligation to reduce hospital handover to clear times, to ensure we have resources available to respond to our patients, particularly those who are potentially seriously unwell. Collectively we will be expected to make progress in this area, particularly in those locations which are obvious outliers by comparison with others.

Over the last 10 days or so, the Trust has enacted surge black on at least six occasions which is indicative of the level of pressure we are under; anecdotally, it appears winter has arrived early. Our managers will be working to ensure that our winter plans are being implemented so that we can be as ready as we can be to deal with this pressure. Part of this plan is to ensure staff keep as healthy as possible and therefore, it is important that we all get vaccinated against the flu which seems to be well and truly amongst us already.

We are currently in half term week and also dealing with a massive increase in student paramedic abstractions.  Managing this level of abstraction is a challenge and that is why we have had to rely on using private ambulance service (PAS) and agency resources to support service delivery to patients, to offset the loss of many thousands of hours each month. As demand continues to increase, this challenge grows and in recent weeks, we have seen managers spending more time responding to calls. We now need everyone within the Trust to contribute to this effort to ensure we can sustain student abstraction across the most difficult time of the year. This means that we will now require everyone within the Trust payroll and whom has a level of clinical qualification to contribute to service delivery either on the road (emergency or PTS) or in EOC.

The Trust recognises that falls account for up to 23% of our 999 calls which inevitably means that a significant amount of ambulance resourcing is tasked to this category of call. In the coming week, we will be engaging with our community first responder schemes about how their regular offers to do more to support their communities through the Trust can be brought to bear to support these patients.

Our student paramedics are a key part of the Trust’s future. In this context, both the Trust and importantly our student paramedics now need your support more than ever.

Keeping our existing staff is also an important part of our future solution and the Trust has undertaken a lot of work in this area over the last year or so. It is really pleasing to see our attrition rates (the numbers leaving or retiring each month) drop considerably since July 2015 with us now having one of the lowest rates of attrition/best rates of retention amongst the other ambulance trusts in the country.

This week, funding has been awarded for two new mental health street triage vehicles in Bedford. This is really good news as the pilot scheme, has greatly improved mental health services in the area. Alistair Burt MP joined the team for a shift earlier this month to see the great work the service is doing.

In other great news, I received a letter this week from the National Institute for Health Research to inform me that we are in the top ten of all NHS trusts in England delivering clinical research. It’s another fantastic achievement and I would like to thank everyone who has contributed to this.

I finally would like to thank everyone who was involved with this year’s ‘restart a heart day’. According to the Resuscitation Council UK, more than 150,000 children and young people were trained on how to give CPR. This is an incredible achievement. You can still see all the updates by following #RestartAHeart.

Have a good week,

Robert

Published 27th October, 2016

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