Late finishes and meal break Q&A

Following the agreement between the Trust and UNISON over late finishes and meal breaks, we’ll be running a series of updates in Need to Know over the next few weeks about the pilot and how it is progressing. 

You can view the joint agreement here on Need to Know. 

What are the changes to meal breaks?

The interruptible period of meal breaks has changed so that, for the duration of the pilot, crews will no longer respond to Green 2, Green 3, Green 4, or any Urgent calls during this time. This in effect removes more than 50% of calls from the interruptible meal breaks. We hope that as a result more crews get their full meal break entitlement. This pilot started Trust-wide on 26th July. 

Why is the Trust piloting measures around end of shift?

We know that late finishes are a key issue for staff and pose staff and patient safety risks. We know that our capacity gap compounds these issues and we are working hard to address this through a proactive recruitment strategy and working with UNISON to address retention issues. The pilot of intelligent Xray (IX) is one of the steps we are taking as part of this work. 

How will IX work?

Initially IX will be limited to one EOC environment to assist with monitoring and implementation. Based on the number of late finishes in each locality, the pilot will commence in NSC. If an NSC resource (DSA or RRV) is due to be more than 30 minutes late finishing, based on their travel time to base, they will be booked out of service as IX (intelligent Xray). This will be introduced from 2nd August.

What calls can be allocated to IX crews?

Confirmed and predicted Red 1 calls, Hot 1 backups and a small number of pre-agreed (confirmed only) Red 2 code sets. These R2 code sets have been evidenced as increasing R1 of the purpose of IX from 3% of calls to 5% of calls. This has been evidenced against current call data from EEAST.

What about Norfolk, Suffolk and Cambridgeshire (NSC) crews who end up working outside NSC during their shift?

Any resource starting their shift within NSC will come under the pilot and can be booked out of service IX (intelligent Xray), regardless of the area they find themselves in during their shift. This is to ensure crews out of area are protected.

How will the pilot be monitored?

The negotiating team will meet regularly to review a range of data to monitor the pilot and measure its success. The negotiating team is made up of senior Trust management and senior UNISON staffside. 

When will the pilot be extended to other areas?

There’s a commitment for IX to be rolled out to other areas if it is successful in reducing late finishes, this is expected to be by the 12 week point. 

Who makes the decision over a crew being IX?

Over the past few weeks a staff support liaison team have been set up to work in Norwich EOC. Their main aim is to support and assist staff to help reduce late finishes. They’ll be booking crews (DSA and RRVs) out of service under IX (intelligent X-ray), if the crew is already going to be more than 30 minutes late finishing their shift based on their travel time to base. The staff support team will also be proactively letting crews know they can be booked IX, towards the end of their shift. The team will also be assisting crews who end up out of area towards the end of their shift, enabling them to get back to base safety and helping to reduce late finishes.

Why aren’t all Red 2 calls included in IX?

Red 2 calls are the largest call category and it was felt including all Red 2 calls would make IX unlikely to assist with late finishes. A small number of R2 code sets have been included in IX, along with Red 1 calls to balance patient safety with reducing late finishes for staff. We also have senior clinical oversight in the Norwich EOC for the period of this project to assist with any risk based decisions.

 How does IX work with the current end of shift agreement?

IX works alongside the current end of shift agreement.

Does IX apply to HCRT?

Yes. IX applies to all patient facing frontline staff working in A&E operations.

 How can I ask questions or give feedback during the pilot?

We have just completed a joint Trust and UNISON initial survey which went out to all staff via Need to Know, UNISON websites and social media. More than 600 staff took part in that survey. 

We will be carrying out another survey of EOC and A&E operational staff after the pilot has been running for a month. In the meantime you can comment on this page in Need to Know, which will be jointly reviewed by UNISON and the Trust, or via a dedicated e-mail address at IXfeedback@eastamb.nhs.uk.

Published 2nd August, 2016