Improving our staffing, welfare and services to our people and our patients: this week’s executive message come from Director of Service Delivery, Kevin Brown.

Kevin Brown director of service delivery

Over the last three years we have had a massive recruitment drive and are currently looking at a snap shot of the figures. On 1st April this year, we had over 140 more patient facing staff than we did at the same point last year. This means we are on course to have many more completing training this year.  This is really good news as it has helped boost our capacity, enabling us to support some overdue training and one to one time, provide a better and faster service to patients and in time will help relieve pressure on existing staff. We have seen improvements in our retention – another welcome improvement, as keeping our staff is equally important as recruiting new staff. We now have some localities where staffing is fully established.

We know how challenging it can be working in the ambulance service, every day being different and potentially bringing unexpected challenges, which is why we have also focussed so heavily on staff welfare. As a result we have seen the rollout of TRiM, with a dramatic rise in the number of TRiM practitioners, of which I am one, measures to help tackle late finishes, improvements to rest breaks and the development of a health and wellbeing hub.  We continue to focus on how we can reduce late finishes, improve on rest breaks and, although this is still very hard, big strides are being made and we will continue to explore the best ways of embedding the intelligent x-ray approach as part of a further project to develop protocols within the EOC.

Last month, we responded to a fire in a care home in Cheshunt which was declared a major incident.  We treated more than 30 patients, providing an excellent emergency response and outstanding patient care. I would like to take this opportunity to thank everyone involved from the EOC, those responding to the scene, our commanders at all levels and through to our media team. This demonstrated, once again, how well prepared we are to respond to the unpredictable timing of such events. We have also written to the local hotel, who made their facilities available to us and our emergency service colleagues, so that we could set up a reception centre and have a place to work in a safe, warm and comfortable environment.  It was really pleasing to have this also fed back from the local Member of Parliament. It reminds us, along with other events we have seen in London, how we must all be ready to respond to whatever comes our way and why focus on keeping each other safe is so important.

This year our contract with our commissioners looks quite different and reflects the significant challenges faced in the NHS as a whole.  As you know, we are under the wing of the NHS Improvement Financial Improvement Programme which means every penny of the public money we spend, must be spent once and wisely. We have made significant investment into the clinical hub which saves thousands of ambulance sends every month and is reducing some of the calls which do not need an emergency ambulance response.  We know there is work to do, but with that investment we will see further improvement.

In line with spending once and wisely, we are having to change the way we plan and utilise all our resources – staff, private ambulance services and agency staff.  Given the increase in our staffing and our continued recruitment, we have already made some significant reductions on private ambulance service use and spend.  As we have differing vacancy levels in different areas, we have allocated our planned overtime spend more locally on that basis and local managers will be able to work with you on where there is overtime availability. To put this into some kind of context, we are currently planning to spend around £8 million in total overtime this year, so it is a significant size of our budget and the dependency on the availability of it is around ensuring patient safety and quality standards.

We are also focussing our agency staff spend mainly on manning RRVs where we do not have our own staff available to cover these. As this position changes, we will be able to move the spend back to overtime.  All our agency staff and private ambulance services go through an accreditation process before they can work for us. This is similar in many ways to how the CQC look at things and focuses on quality, safety, policies, procedures, infection control and safeguarding amongst many other aspects of what a professional ambulance provider does.  

We have shaped how we operate to ensure that every clinical and operational manager is available to respond and support with our Red 1 patients. This really helps us all work together with patients’ centric to our thinking and having visible leadership on the ground. I would like to thank our EOC colleagues who have shaped changes in how we respond to predicted immediately life threating calls and we are getting much closer to the national standard. In fact, whilst most Trusts are not meeting this standard, we are benchmarking very well in that context.

We have a capacity review due to start with our regulators shortly which we hope will finally bottom out how many people we need to provide the national standards of expected service, which we strongly believe is much more that we are currently funded for.  As we get more staff trained, we will continue to reduce our need and reliance on outside capacity.

We are investing in our EOCs, by recruiting more call handlers to reflect the growing demand we see year on year. I know this is something that Gary Morgan will touch more on next week as he writes the leadership message.

Last year we made tremendous strides forward – thank you all for your help and support.  I am continuing my ‘walk-around’ by visiting stations, meeting you at scene, hospital or wherever we can and welcome the feedback on how you think we can continue to improve. These conversations I find really valuable and informative. We are in a good place to keep that momentum going and continue to build our service so that we provide better quality of care and responses to patients and that we keep developing the services to support staff. Above all, I am focussed on getting to our sickest quickest, improving survival rates, improving patient outcomes and to get some of the long waits reduced by having better capacity available to you. 

Have a good week,


Published 4th May, 2017

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