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.