Wednesday, 20 March 2013

Will the CQC Report on EEAS Trigger a Positive Change or Just More Excuses and Cover Ups?


Last Autumn, when I spoke to the Care Quality Commission about East of England Ambulance Service's (EEAS) failings, I was told that they could not act on my information as I was no longer an employee and therefore not a whistleblower, just a “concerned citizen”.

However the rising tide of concerns from active staff was evident – just reading through the hundreds of comments elsewhere on this blog is a sobering experience – and I'm grateful so many have shared their thoughts. But anonymous confessions on an internet blog were never going to effect a change and full credit to the many staff who were brave enough to speak out and give the CQC the information they needed to hear.

As a result, the Care Quality Commission investigated EEAS and published a report on 15 March 2013 which highlighted the need for improvement and hopefully will be the official voice which will force government ministers to re-evaluate their treatment of emergency ambulance services.

The CQC's overall view was as follows:
Our judgement
Since our last inspection the trust‘s performance in relation to its ambulance response times had deteriorated and people could not be assured they would receive care in a timely and effective manner.”
This seems like a succinct and understated version of some of the concerns that have been stated vociferously here on this blog, in the mainstream media and in crew rooms around the country. I am sure that any of the other regional ambulance Trusts put under the same scrutiny would be found wanting in similar fashion.

The Good

According to the report, EEAS operations were visited on three occasions, on 30th January 2013, 31st January 2013 and a “routine inspection” on 5th February 2013. The locations visited are not made clear in the report, but it can be inferred that the inspectors experienced some conditions out in the field as references are made to “30 interactions between ambulance staff and people using its service during our visit” and that it was a “cold and windy day”. Reference to witnessed trolley transfers and fully completed patient records suggests a visit to an Accident and Emergency department.

The report identifies that road staff are, as we already knew, doing their best providing a service which is “consistently good, with staff showing genuine concern, respect and care for people they assisted”.

The inspection team also spent some time in one of the HEOCs (Health and Emergency Operations Centre – ie. The Control Room). The report mentions two days in the Norwich HEOC, although it is unclear if one of those days was the routine inspection which took place on 5th February or if they were additional visits.

It appears that it was here that the fabled “big picture” became evident to the inspectors. It was not all bad though. The despatch system was rightly seen as effective and professionally run;
“During our time in the communications centre we spoke with managers, call takers and dispatchers. We listened to calls being taken and watched as deployment decisions were made by staff. Emergency calls were answered promptly and resources were allocated by one of five dispatchers according to the location of the call. A responding resource was allocated quickly to emergency calls as soon as the location of the incident was known. Further details concerning the call were passed to staff en route.”
The Bad

However, the CQC were forewarned of the struggle to reach many calls and back up first responders.
“Response times to emergency calls were an area of concern following our previous inspection in March 2012. We were also aware prior to this inspection, that the trust’s performance had deteriorated during 2012 and that this was particularly evident in the Norfolk area. There also continued to be a significant inequity of service between rural and urban areas of the trust. For example, although the trust achieved its response times in places like Luton and Peterborough, it regularly failed to meet them in Norfolk and Suffolk. Furthermore, we knew that the trust had not been able to reduce the length of time single paramedic responders waited for a back up vehicle to take people to hospital.”
The report goes on to examine deteriorating response times (a 4% fall in target achievement in Norfolk since Sep 2012). Reasons cited for this included a 9% increase in the past 12 months, hospital handover delays and “not enough extra staff to match the increase in calls”.

Despite this, the report states that “Managers were unable to give us sufficient explanation as to why performance had fallen.”

This is a worrying statement which not only suggests that the explanation has been missed despite clear evidence, but also seems to disingenuously finger "managers" as lacking the knowledge or competence to explain the situation. This is unfair. It is painfully, fatally apparent that the reason for ever decreasing performance is a lack of resources. That is it. No new chief executive or re-worked deployment strategy is going to squeeze any more out of resources already overstretched. Any individual arrogant enough to claim otherwise will just add to the culture of delusion that has been cultivated by the fanatical pursuit of government targets by fair means or foul.

The frontline staff are already giving more than they can sustain just trying to cover the shortfall. Experienced staff are leaving or looking for a way out as a result, further depleting a highly-skilled but shattered workforce.

I doubt the managers were “unable to give sufficient explanation”, rather they either felt it was patently obvious and already in plain view or they were unwilling to speak up due to the pointlessness of repeating themselves. No one in the ambulance service at any level is there trying to do a bad job and there is no sense searching for a scapegoat when it is a solution that is required.

The Solution

That simple solution is: MORE DEMAND REQUIRES MORE RESOURCES.

There is no sense in trying to manipulate the targets and statistics to make the demand appear less. The population is increasing, the elderly demographic especially. This means more demand for the ambulance service. Trying to split hairs because some calls might not be emergencies has only become so desperately important because REDUCTION IN GOVERNMENT FUNDING CAUSED A REDUCTION IN RESOURCES.

There is no magic deployment system, no superhuman director that will change EEAST's fortunes.  It is imperative that this is understood. The CQC report is evidence of this. Interim chief executive Andrew Morgan was powerless to do anything when the Department of Health had already dealt his cards.  Sadly, if history is anything to go by, all that will occur as a result of this report will be a few new faces at the top and another new broom to be introduced. Lord Howe's involvement might bolster board room morale, but unless he comes with a suitcase of bailout cash from his banking background then they will just be continuing to fiddle whilst Rome burns.

The CQC report quite clearly shows that THE EMERGENCY AMBULANCE SYSTEM WORKS WHEN IT IS NOT STARVED OF RESOURCES.

The only place these resources will come from is the Department of Health. Jeremy Hunt, Norman Lamb, Lord Howe et al are the people who can empower Trust staff to effect a positive change. If instead, the government ministers conduct a witch hunt and an organisational vivisection, or simply encourage The Board fudge the figures and tweak the system again, then the continued failure of East of England Ambulance Service and the blood of those whom it fails, is on their hands.

And don't for a minute think that this problem is isolated to Norfolk, or even the East of England Region. I'm sure there are a number of Ambulance Trust chief executives who are breathing a sigh of relief that East of England is getting all the heat. At least those who haven't resigned, retired or left the country in the last year or so.

This is a national problem and concerned staff from other regions should also consider contacting the CQC if things are quietly failing behind closed doors.

The time for silence is over.

18 comments:

  1. "Lions led by donkeys" according to one MP.

    He's not wrong.

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  2. I don't believe this lot, now they are blaming the staff, "due to staff sickness".

    Staff sickness is a 'result' or 'symptom', not the 'cause'. The 'result' was stress, overwork and frustration at being ignored and being unable to provide ambulances to convey patients. John Martin you deserved everything you got on Look East.

    It's an "AMBULANCE" service you need "AMBULANCES" not "CARS" to fiddle the figures, they are different words, look them up in the dictionary, they have different meanings.

    I think "Lions led by 'blind' donkeys" may be more appropriate.

    I thought the enforced rota changes were "matching the resource to the demand" (by deploying less double staffed ambulances and more cars) and along with downgrading red calls to greens if they were more than 8 minutes away was going to provide a "work smarter" solution. It hasn't worked has it? "We told you" just doesn't cut it.

    Why is our 'Director of oops' and the rest of them still there, they "couldn't see what the problem was" or what staff concerns were. It appears 'Plan B' is blame the staff and stop them being sick and going off due to stress and overwork.

    ReplyDelete
    Replies
    1. Notice how they put our 21 year old "Clinical Director" up for a grilling on Look East the other night?

      Funny how Mr Storey (Director of Operations) always manages to keep out of the limelight. Come on Neil, this is mostly your mess. Man up and face the cameras for once or would you rather let others take the flak?

      Delete
  3. Why has response got worse? Well here is Hayden Newton explaining in his own words why it had already got worse in October 2011 (BBC Look East).

    http://www.bbc.co.uk/news/uk-england-15313418

    He says "backup delays have increased since the introduction of more rapid response vehicles" (or words to that effect). So there you have it, one reason at least.

    A search of the BBC website for East of England ambulance results in the whole sorry tale of increasing delays, complaints and increasing amounts of money spent on private ambulances since at least 2010/2011 (It used to be £750,000 per year). The deterioration came about the same time they changed the call categorisation and allowed the downgrading of calls and the car to achieve the A19 minute transport time without being able to transport the patient! A search of the changeA19.org media database also results in the sorry tale of excuses ("the ambulance was diverted to more serious calls") or how everything is going to be hunky dory when we have ("worked smarter and matched the resources to the demand") and ("we are recruiting more staff").

    We need to go back to the old system and go out to almost all calls, without downgrading or diverting, it worked better for the patient. Triaging over the telephone has proved to be unsafe and the whole system is open to fiddling and abuse.

    ReplyDelete
  4. From the CQC report:

    "We noted that a high proportion of response decisions were subsequently amended once the priority of each call was determined by the call taker. We witnessed repeated examples of staff being "stood down" and/or rerouted to other calls".

    Enough said?

    ReplyDelete
  5. The Department of Health have arranged an "independent" review of East of England ambulance service by Anthony Marsh one of the "Essex Boys" as predicted by "Anonymous" on a previous thread in November copied below;



    Anonymous19 November 2012 21:56
    Don't make me laugh!

    EEAST arranging its own "independent review"?
    A bit like "News Corporation" arranging its own independent review into phone hacking.

    They will probably get one of the "Essex boys" to review it (remember the "booze run") when they removed markings and back seats on an ambulance car and a number of senior Essex managers, including Paul Leaman and Richard Lane took it untaxed and uninsured over to France to pick up alcohol for themselves and possibly other senior Essex managers. They also colluded with a company selling health service equipment and hassled colleagues to give the firm business. Paul Leaman subsequently followed Essex Chief Executive Anthony Marsh up to West Midlands along with Rob Ashford who is now Chief Executive of private ambulance provider Thames Ambulance, which EEAST gives business to. Our current director of operations Neil Storey was also an Essex Ambulance Manager and has disclosed a personal friendship with Rob Ashford (who was also an Essex Manager).

    When the fleet manager Paul Holmes reported Paul Leaman and Richard Lane he was "bullied and victimised" and after complaining unsuccessfully that no action had been taken against them (yes the ambulance service "independent" investigation was a whitewash) Paul Holmes reported them to the HPC who subsequently (2009) found them guilty of misconduct.

    The HPC stated that "the fact there was no disciplinary action taken against them (the booze cruise runners) by the ambulance Trust did not of itself show the event was not serious but may simply show a poor management culture within the Trust at the time". Anthony Marsh, Chief Executive of West Midlands Ambulance Trust and Hayden Newton Chief Executive of East of England Ambulance Trust were both character witnesses on behalf of Mr Lane and Mr Leaman.

    Paul Leaman was found guilty of misconduct, suspended from the HPC paramedic register for a year and subsequently received a caution for the following four years, he voluntarily withdrew his name from the paramedic register in 2011. Richard Lane received a caution for five years.

    Paul Leaman is currently an Associate Director for East of England Ambulance Service.

    Nice to see EEAST takes bullying, victimisation and collusion with private providers seriously.

    ReplyDelete
    Replies
    1. WTF does that mean we're stuck with Neil Storey?

      Delete
    2. Because Hayden Newton promoted him just a few months ago as he was doing such a good job!!

      Delete
  6. Chairman resigns, how many more to go?

    ReplyDelete
    Replies
    1. None probably.

      They have no shame.

      Delete
  7. Maria Ball has done the honourable thing, as was expected when the failure was on her watch. But she did not have operational responsibility she relied upon advice from her operational and clinical managers, namely Director of Operations Neil Storey and Medical Director Pam Chrispin.

    It must have been on their advice or watch that EEAST rather stupidly went against their own staff pleas and ploughed ahead with the ruinous rota changes leading to a continued reduction in double staffed ambulances, increase in response cars to fiddle the figures, increase in relief hours, reduction in trained staff, reduction in paid training, increase in downgrading of red calls and hiding of the 'recontact rate' to fiddle the target figures resulting in patients waiting hours for double staffed ambulances.

    They want us to support and believe them now? I don't think anyone is going to believe any of their bollocks or bullshit anymore. If the Francis report is implemented and NHS managers have a 'duty of candour' does this mean we can save money and get rid of all our 'spin doctors', we wont need them if we have to tell the truth all the time. Or did they actually believe their own publicity and think that the rota changes were implemented to "match the resource to the demand" and enable us to "work smarter"?

    ReplyDelete
  8. In order to help deflect from our own dire situation the Trust have obviously tipped off Look East to let them know they had to put a tent up outside the Norfolk and Norwich hospital.

    How many people used this tent? None. Zero. Zilch.

    Pointless (and probably expensive) exercise other than to shift some of the blame.

    ReplyDelete
  9. I see the cost of private ambulances has now reached £1,419,547 a month (Jan 2013)
    http://www.watfordobserver.co.uk/news/10334582.Cash_crisis_hits_ambulance_trust/

    ReplyDelete
  10. There is a rumour that Thames Ambulance has been taken over by another company (? a foreign company) and that following its failure to achieve CQC national standards (specifically "standards of staffing" - training + supervision and "standards of quality and suitability of management" its Chief Exec (Rob Ashford) is leaving?

    ReplyDelete
  11. Rob Ashford is coming to East of England as a sector leader for Essex.......

    ReplyDelete
  12. Be prepared over the coming weeks to hear in the media just how many "extra" staff the Trust is going to be employing.

    This Freedom of Information request shows a slightly different picture

    https://www.whatdotheyknow.com/request/employing_extra_staff#incoming-376718

    As you can see, the Trust are only budgeted for 44 more staff. You need ten staff to run a 24 hour a day DSA so that's 4 vehicles!

    Not sure how Mr Morgan can keep repeating the spin about 15 "extra" DSAs in that case. Don't be fooled by propaganda!

    ReplyDelete
    Replies
    1. And it's started!

      Look East have reported that the Trust are going to be employing hundreds of new staff.

      Delete
  13. and now that idiot Richard Lane is mismanaging the ambulance service in New Zealand...thanks for that guys!!! although the local paper is onto him, nothing will be done

    http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10883047

    ReplyDelete