Monday, 6 September 2010

London Ambulance Service Board meeting and news

Last week I attended the board meeting of the London Ambulance Service for the first time as Chair of the Patients Forum. Officially these meetings are open to the public - in reality the only member of the public who attends is the Chair of the Patients Forum, although other non-LAS people, such as the Commissioning Officer for the LAS, who gave a presentation, was also listed as a member of the public.

The meetings last for about 3 hours, on this occasion 3 and a half. I had been told beforehand that the most interesting papers being presented would be those by the Chief Executive and the Medical Director. Having been the Vice Chair of the Forum for two years and a member for a year before that, I am fairly up to speed with what is happening with the LAS. Pity the poor member of the public who wandered into the meeting, however, as it is riddled with jargon and 'in house' technicalities. There were several issues which drew my interest and some of these were referred to by Board members also. One was the extensive academic research being carried out by the LAS and we are basing our next Forum meeting on Monday around this, with a presentation and a question and answer session on it. In fact, I had a query from a Guardian journalist about the reseach and I was quite happy to point out just some of the areas of research, many of which have been published in serious medical academic journals. Some of the projects and publications etc are here.

SAFER 2: Care of older people who fall: an evaluation of the clinical and cost-effectiveness of new protocols for emergency ambulance personnel to assess and refer to appropriate community based care.

Investigators: Prof. H Snooks (Swansea University); Mary Halter (Kingston and St George’s University of London); Dr Rachael Donohoe (LAS), Prof. Niro Siriwardena (East Midlands Ambulance Service); Richard Whitfield (Welsh Ambulance Service).

Direct Angioplasty for Non-St-Elevation Acute Coronary Events (DANCE).
Investigators: Dr Miles Dalby (Royal Brompton & Harefield); Mark Whitbread (LAS)

Immediate Management of the Patient with aneurysm rupture: Open Versus Endovascular Repair (‘IMPROVE’).
Investigators: Prof. Janet Powell (Imperial College, London); Dr Fionna Moore (LAS).

Understanding and improving the experience of parents and carers who need advice when a child has a fever.
Externally-led research studies
Principal Investigator: Prof. Terence Stephenson (University of Nottingham)

Identifying Emergency Personnel at Risk of Post-Traumatic Stress Disorder (PTSD).
Principal Investigator; Dr Jennifer Wild (Institute of Psychiatry)


• Rea TD, Fahrenbruch C, Culley L, Donohoe RT, Hambly C, Innes J, Bloomingdale M,Subido C, Romines S & Eisenberg M (2010) Randomized trial of CPR with chest compression alone versus chest compression plus rescue breathing. New England Journal of Medicine; in press.

• Halter M, Vernon S, Snooks H, Porter A, Close J, Moore F, Porsz S. (2010) Complexityof the decision-making process of ambulance staff for assessment and referral of older people who have fallen: a qualitative study. Emerg Med J.;doi:10.1136/emj.2009.079566.

• Siriwardena, NA, Shaw D, Donohoe R, Black S & Stephenson J (2010) Development and pilot of Clinical Performance Indicators for English Ambulance Services. EmergencyMedical Journal; 27: 327-331

• Siriwardena, Donohoe R, Stephenson J & Philips P (2010) Supporting research and development in ambulance services: research for better healthcare in prehospital settings. Emergency Medical Journal; 27: 324-326

• Shah, SA; Bhopal, R; Gadd, S and Donohoe, R. (2010) Out of hospital Cardiac Arrest in South Asian and White populations in London: database evaluation of characteristics and outcome. Heart; 96: 27-29.

• Barratt H, Wilson M, Moore F, Raine R. (2010) The implications of the NICE guidelines on neurosurgical management for all severe head injuries: systematic review. Emerg Med J. 27:173-8

• Deakin CD, Clarke T, Nolan J, Zideman DA, Gwinnutt C, Moore F, Ward M, Keeble C,Blancke W. (2010) A critical reassessment of ambulance service airway management in prehospital care. Emerg Med J. 27:226-33.


Rachael T Donohoe; Jennifer Innes; Stephen M Gadd; Mark Whitbread; Fionna Moore;Douglas Chamberlain. (2010) Characteristics of out-of-hospital cardiac arrest and factors associated with survival in London: A four-year study. Annals of Emergency Medicine

The Patient Care Conference which the LAS usually holds each year in a central London location is being changed and will there will be a number of smaller events held in different parts of London to draw on the views of local communities there.

On the issue of non-emergency Patient Transport Service, it is clear that the LAS is losing more and more of the share of the contracts across London to private companies, many of which are glorified taxi firms. This has resulted in the situation where the staff of the LAS who have been working in the PTS for the South London NHS Trust are in the process of being transferred over to Savoy Cars, to whom the Trust have given the PTS contract. These staff have called for industrial action and their union , the GMB, states that Savoy Cars are not recognising the union and also are not paying Outer London weighting. There are over 50 staff in the process of being transferred under the Transfer of Undertakings procedure. I raised this issue at the board meeting and was told that the industrial action had now been dropped, that negotiations were continuing and that the transfer of staff would now happen on October 1st. However, I am determined to hear the union's side of things and am in the process of inviting a GMB rep to the Forum meeting next Monday.

I also asked why the LAS is not using the Forum's offer to involve local communities in the bidding for PTS contracts. The Forum has put together a list of basic demands for patient transport in London and not many of the companies currently being awarded the contracts are complying with them. The Financial Director replied that the LAS as a bidder could not be involved in the commissioning process but the point is that the LAS would hold many of these contracts if the London Patient Transport Commissioners were using local communities and their views in commissioning. Indeed, Malcolm Alexander, our Forum Vice Chair, has recently made this point to the commissioners and they seem to have accepted it to some extent.

There is also a plan to have a new non-emergency number in London. LAS and NHS Direct organised a meeting with the GP out of hours providers, NHS London in July to discuss the potential afforded by the development of an urgent care three digit number in London. NHS will be hosting a further meeting in October. The official Dept of Health pilot of the 111 number was launched by the North East Ambulance Service on 23rd August. LAS will be visiting the NEAS in the autumn to understand the early impact of this new approach to managing urgent care demand. Some futher detail in this article:

Finally, the issue of 'Safeguarding' is in the news a lot over the last year or so. This is the question of alerting the relevant authorities when a child or an adult who is considered vulnerable are seen as under threat from a relative or another person. The LAS has a new Safeguarding committee which I attended for some time. The latest figures presented to the board by the Medical Director indicate the league tables for London and for some reason Croydon heads the league for the LAS for the borough where there are the most safeguarding cases being reported by ambulance crews and staff. The Medical Director said that this needed more study and I put a question about this and when that study would commence and with who (the local authority?) as to why Croydon is reporting such high figures.

Our Forum meetings are very large and lively and draw health activists and members of the public from across London and even from outside. So if you want to come and discuss some of these issues and also hear about the new groundbreaking research by the LAS you are welcome to join us on Monday 13th September at LAS Headquarters, Waterloo Road, just a five minute walk from Waterloo station and down the street from the Old Vic Theater. We start at 5.30pm and finish at 7.30pm.We even provide tea and coffee and also have British Sign Language interpreters as we have several deaf members.

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