The London Ambulance Service Patients Forum has listed the following questions for the public board meeting of the London Ambulance Service NHS Trust tomorrow. I am unable to attend the meeting because of work, but Malcolm Alexander, the Vice Chair of the Forum is attending in my place.
We have also issued a response to the London Ambulance Service's Quality Accounts which are going to be passed at tomorrow's meeting and will then be placed on the LAS website and made available to stakeholders. Our own website is
here and we will putting our questions there also. We have also sent our questions and the response to the Quality Account to all LINks in London.
Dear Colleagues, please find below and attached
our submission to the London Ambulance Service's Quality Account. We have also
put the following questions to LAS Board which meets on Tuesday:
1) Is the LAS in
negotiations with the directors of commissioning for North East London and City
PCT concerning the low availability of HASU (acute stroke) beds, and
if so what progress has been made?
2) In view of the
overall increase in complaints for the last quarter, and in particular the
increase in the number of complaints about delays, will the LAS ensure that
lessons are being learnt from each complaint about improvements in response
times, communication with patients about the cause of delays, and the
clinical outcome for patients?
3) Will Command Point
provide opportunities, in the near future, for 'patient specific
protocols' and their wishes about 'end of life' care to be communicated
quickly to front line staff?
4) Does the LAS have a
plan for the development of a 24/7 bariatric care service and have resources
been identified for this service?
5) Will the research
methodology for interviews with non-conveyed patients include detailed,
qualitative interviews?
6) In view of the
abnormally high current utilisation rate of the LAS (22% increase of Cat
A), does the LAS Board believe it is sufficiently funded for this level of
activity?
7) The data on performance figures given to the Patients
Forum contain some concerning figures for the East zone on Category A patients
in particular. What is the explanation for this and what is being done to
address it? We are putting this question again (having put it at the last Board
meeting) as the figures which the Forum has recently received for both the year
ending April and for the month of April from the East have given further cause
for concern. We are also aware that commissioners are concerned about this
also.
Quality Accounts 2011-12 statement
Patients’ Forum Ambulance Services (London)
Forum Officers
Company
Secretary: John Larkin
___________________________________________________________________
1) Public Involvement
a)
The LAS has a strong commitment to public involvement and the Forum plays an
active part in the following LAS committees: Patient and Public Involvement,
Equality and Diversity, Mental Health, Clinical Quality,
Safety and Effectiveness Committee, Infection Prevention & Control
Committee Meeting, Clinical Audit and Research Committee, and the Learning from
Experience Committee.
b)
Questions put the LAS by the Forum are usually responded to quickly and fully.
c)
The LAS supports the Forum by providing, information, meeting rooms,
refreshments, photocopying and presentations to meetings.
d)
The Forum has been unable to obtain a response to the issues it submitted to
the LAS for the 2011-2012.
e)
Evidence of patient experience having real influence on policy and practise in
the LAS is weak.
Recommendation: The LAS should develop a greater focus on
collecting detailed qualitative data from service users especially where they
have criticised or complemented the service. They should develop methodologies
to demonstrate how qualitative data collected from patient groups, individual
patients and the public has influenced LAS services. Evidenced
based public involvement work in which public influence on the LAS can be
demonstrated should be a priority.
2) Corporate Objectives
CO2 and CO5 – Equality and Diversity
CO2.
To improve the experience and provide more appropriate care for patients with
less serious illness and injuries
CO5.
To develop staff so they have the skills and confidence they need to deliver
high quality care to a diverse population
a)
The Forum was pleased with the decision of the LAS to hold a meeting for the
public on the Equality Delivery System (EDS) and felt this was an
important way of including the public in the developing
EDS.
b)
We have concerns about the care of patients with sickle cell disease. We have
met with the Sickle Cell Society which is committed to working with the LAS and
the Forum to improve the care of people in a sickle cell crisis. We do not
believe that the LAS gives sufficient priority to the health needs of black and
ethnic minority communities and strongly recommend that a focus on the care of
people with sickle cell disease. This would enable the LAS to demonstrate how
they are prioritising the needs of protected groups.
c)
The priority given to diabetic care by the LAS could expanded to ensure that
front line staff are trained to appreciate that some ethnic groups have higher
levels of diabetes.
d)
The LAS has been unable to attract significant numbers of staff from black and
ethnic minority communities, despite this matter having been raised by the
Forum continuously since 2003. We understand that 94% of front line clinical
staff are white. We recommend the LAS seeks expert advice to address this
problem and initiate a programme of work to transform the ethnic composition of
staff and Board members.
3) Quality Domain 5:
Clinical Outcomes
a)
The Forum welcomes progress made by the LAS in examining clinical outcomes of
LAS interventions for patients with cardiac arrest, STEMI and stroke.
b)
We would like to see this approach to quality developed by mainstreaming a
system that enables frontline LAS clinical staff to review the outcomes of
clinical care they have provided to acutely ill patients who are admitted
through A&E. This could be done on a cohort basis, or through the selection
of patients that LAS clinical staff have particular concerns about. The development
of joint clinical meetings between LAS frontline staff and A&E staff would
be an important step in meeting this important quality objective and supporting
reflective practice and annual appraisal for paramedics, technicians and
medical staff.
4) Mental Health and
Dementia Care
a)
The Forum is very pleased with the progress made by the LAS with the
development of their mental health strategy, the prioritisation of this work
over the past year and the employment of a mental health specialist.
b)
The Forum would like to see this work developed though targeted qualitative
research with patients who have been taken by the LAS to A&E departments
and Places of Safety, with a diagnosis of a severe mental illness, e.g.
sectioned under s4, s135 or s136 of the Mental Health Act.
c)
The Forum would like to see prioritisation of rapid admission to appropriate
mental health services – waits of several hours to handover patients to
appropriate mental health practitioners are appalling. Urgent negotiations are
needed with commissioners and the acute and mental health sector in London to resolve this problem.
d)
Progress with providing appropriate care for people with dementia should be a
priority. The Forum has recently met with Alzheimer’s UK, who would like to work the LAS to ensure that people with
Alzheimer’s disease receive appropriate assessments, referral to memory clinics
and mitigation of long waits in A&E.
5) Bariatric Care
a) The QA identifies appropriate care for heavy
patients as a cause of concern. The Forum is concerned about the distress
caused to these patients and their families, when staff do not have the right
equipment, and training to provide appropriate care and support.
b) We recommend the LAS ensures staff have
access to appropriate equipment and vehicles 24/7, and fully trained staff are
available to ensure heavy patients do not suffer delay in their care
or treatment.
6) Learning from Serious
Incidents and Complaints Patients Safety and Patients Complaints
a) We compliment the LAS on significant progress
made through the Learning from Experience Committee.
b) We recommend the LAS formally adopts the
Health Service Commissioner’s statement ‘Driving improvement and learning from NHS complaints information’, which provides a bridge for
learning from incidents, accidents and complaints.
c) We would like to see
details of all recommendations made following complaints investigations placed
in the public arena with evidence of enduring improvement to LAS services.
7.0
Being Open
a) We would like to initiate a joint project
with the LAS to gather evidence that people are informed when something
has gone wrong with the treatment or care provided to them by the LAS.
“Open and honest communication with patients is at
the heart of health care. Research has shown that being open when things go
wrong can help patients and staff to cope better with the after effects of a
patient safety incident.
Healthcare staff may be fearful of upsetting
the patient, saying the wrong or admitting liability. This guidance and the
associated actions outlined in the Alert, provide reassurance that Being open is the right
thing to do, and encourage NHS boards to make a public commitment to openness,
honesty and transparency”.
National Patients Safety Agency (NPSA) 2009
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