Quality Account

2009/10

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Summary 

Welcome to the East of England Ambulance Service NHS Trust Quality

Account for 2009/10. This document has been approved by the Trust Board

and reflects an accurate account of the level of quality of service provided to

patients using the service during 2009/10. In developing this set of quality

accounts the Chief Executive has set out a summary of the Trust’s values,

achievements for 2009/10 and goals for 2010/11. The Trust has drawn on

information from a range of data sources and in setting the priorities for

2010/11 it has engaged with staff and service users to identify the key clinical

areas which require its focus to further improve the quality of services to meet

patient and public expectation.

NHS Bedfordshire our lead commissioner, the Ambulance User Group, Local

Involvement Networks (LINks) and the Health Overview and Scrutiny

Committees (HOSCs) have been asked to contribute to this document.

This Quality Account will be made publically available on the NHS choices

http://www.nhs.uk/servicedirectories/pages/trust.aspx?id=ryc by 30 June 2010

and hard copies are available on demand by contacting:

East of England Ambulance Service NHS Trust

Hammond Road

Bedford

MK41 0RG

Telephone: 01234 408999

A copy of the Account will be sent to the Secretary of State.

Improving Quality is an overarching priority of the Ambulance Trust and this

report lays out plans for developing future services to improve patient care

and patient outcomes by delivering the right resource at the right time so that

we are publicly accountable for driving clinical quality higher.

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Table of contents Summary .................................................................................................................... 2

Contents ..................................................................................................................... 3

Background ............................................................................................................... 4 Introduction ............................................................................................................... 4 PART 1 – Statements on Quality ............................................................................. 5

Statement on Quality from the Chief Executive .......................................................... 5

Statement on Quality from the Director of Quality ....................................................... 8

PART 2 – Priorities for Improvement ...................................................................... 9

Priorities for coming year ............................................................................................ 9

How we developed our priorities ............................................................................... 10

Patient Safety: Priority 1 – Reducing Preventable Falls ...................................... 10

Clinical Effectiveness: Priority 2 – Increase the number of patients accessing an appropriate stroke patient care pathway ......................................................... 12

Patient Safety: Priority 3 – Improve the Quality of Patient Handovers .............. 13

Clinical Effectiveness: Priority 4 – Increase the percentage of patients accessing preferred type of end of life care ......................................................... 14

Clinical Effectiveness: Priority 5 – Improve the cleanliness of the pre-hospital environment and reduce infection ........................................................................ 15 Statements of Assurance ....................................................................................... 17

Review of Services .................................................................................................... 17

Participation in Clinical Audits ................................................................................... 19

Measuring Participation ............................................................................................. 22

Participation in Clinical Research .............................................................................. 23

Goals Agreed with Commissioners ........................................................................... 23

Care Quality Commission ......................................................................................... 24

Data Quality .............................................................................................................. 26

Information Governance Toolkit ................................................................................ 27

PART 3 – Review of Quality Performance ............................................................ 29

Patient Safety ............................................................................................................ 29

Clinical Effectiveness ................................................................................................ 31

Patient Experience .................................................................................................... 33

PART 4 – Comments from Key Stakeholders ....................................................... 40

Statement from Local Involvement Networks ............................................................ 41

Statement from Overview and Scrutiny Committees ................................................ 43

Statement from Primary Care Trusts ........................................................................ 44

Providing Feedback ................................................................................................ 46

Glossary ................................................................................................................... 47

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Background 

The East of England Ambulance Service NHS Trust covers the counties of

Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk. The

Trust is geographically the second largest ambulance service in England and

the third largest in the UK. The Trust employs over 4,000 staff and has 2,800

volunteers who support the Community First Responder Scheme.

The quality of services and the delivery of high standards of patient care is

core to the Trust’s business and strategy and central to all staff both clinical

and non clinical.

Introduction 

The National Health Service (Quality Accounts) Regulations 2010 came into

force on 1 April 2010 which requires the Trust by law to publish a set of quality

accounts by 30 June 2010. The Quality Accounts document will consist of four

parts:

(a) Part 1, containing a statement summarising the provider’s view of the

quality of NHS services provided or sub-contracted by the provider during the

reporting period and the statement referred to in regulation 6;

(b) Part 2, containing the information relevant to the quality of NHS services

provided or sub-contracted by the provider during the reporting period which

is prescribed for the purposes of section 8(1) or (3) of the 2009 Act by

paragraph (2) and the information required by regulation 7;

(c) Part 3, containing other information relevant to the quality of NHS services

provided or sub-contracted by the provider during the reporting period which

is included in the document by the provider; and

(d) Part 4, an annex containing statements or copies of the statements from

key stakeholders. (See Regulation 5).

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PART 1 – Statements on Quality 

This section outlines a statement from the Trust’s Chief Executive and

Executive Trust Board members on the quality of services delivered and

provides a commitment to the list of priorities identified for improving the

quality of services during the coming year.

Statement on Quality from the Chief Executive 

The Trust’s vision is to become the “recognised leader in emergency, urgent

and out-of-hospital care in the “East of England”. It is committed to continuing

to work closely with its patients, staff, commissioners and other key

stakeholders to ensure that it has the capacity and capability to respond

positively to the growing expectations and rising aspirations of its patient

population.

The vision acknowledges that the Trust holds a unique position in the health

economy by being the only 24/7 provider of emergency and urgent care within

the region, together with its statutory duty to provide resilience. It recognises

the ability of the Trust to contribute to the patient pathways outlined by NHS

East of England in the documents “Towards the Best, Together” and

“Improving Lives; Saving Lives” by developing and providing access to a

range of urgent and out-of-hospital care services.

The NHS Constitution also clearly sets out a duty for compliance with the

rights and pledges to patients and public. Improving quality is an overarching

priority of the Ambulance Trust and this report lays out plans for developing

future services to improve patient care and patient outcomes by delivering the

right resource at the right time so that we are publicly accountable for driving

clinical quality higher.

The Trust places patient safety and clinical quality at the heart of all its work. It

is committed to delivering high standards of clinical quality and patient care to

improve patient satisfaction and the patient experience. There are some

challenges ahead to further improve quality.

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The values of the Trust were formally adopted in November 2008 and support

the NHS Constitution, which became law in January 2009. They are reflected

in decision-making at all levels within the Trust, and are summarised as

follows:

Respect and dignity Commitment to quality of care Compassion

Improving lives Working together for patients Everyone counts

The Trust has also set out a number of key messages to promote the Trust’s

vision and values including that it will:

put patients first in all that it does;

be committed to the highest standards of patient care;

treat all patients with compassion, dignity and respect;

improve the quality of services and the patient’s experience. As a learning organisation the Trust values the contributions from its

workforce and key stakeholders, the Ambulance User Group, Local

Involvement Networks (LINks) and Health Overview and Scrutiny Committees

(HOSCs) and PCTs to provide the best possible service to meet the needs of

the patients and communities that it serves. It welcomes all forms of feedback

in order to continuously learn to improve services and to build on its

successes.

A high quality service can only be delivered if there is a focus on three key

dimensions of quality: clinical effectiveness, safety and patient experience. In

light of the significant external environmental changes and the economic

challenges which the NHS faces, the Trust has revised its previous strategic

objectives to support innovation in current clinical practice and to develop

pathways to improve clinical effectiveness, patient outcomes and experience

which are cost effective. The Trust Board will receive regular reports at its

public meetings on its achievements against the new strategic objectives.

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Strategic Objectives The Trust’s strategic objectives are:

1. Implement a new integrated operating model to improve patient

outcomes by delivering the right resource at the right time

2. Enhance management capacity and capabilities to provide leadership

and strategic direction and ensure the organisation is fit for purpose as a

Foundation Trust and meets the requirements of the NHS Constitution

3. Generate productivity and efficiency savings evidencing value for

money

4. Implement strategic and financial planning to involve stakeholders and

improve control

Statement of Accountability 

The Trust Board is accountable for quality and monitors performance on a

monthly basis. The introduction of a set of quality accounts requires renewed

focus on the development and delivery of the Trust’s clinical strategy to

ensure that it is working for the benefit of the patient population served. As

Accountable Officer and Chief Executive of this Board, I have responsibility for

maintaining the performance and standards achieved of the Trust’s services

and in supporting an environment of continuous quality improvement.

This document is the first set of Quality Accounts by the East of England

Ambulance Service NHS Trust, in line with the requirements of the Health Act

2009. The Quality Account contains details mandated by the Regulations and

also the measures that the Trust in association with our NHS and public

partners, have decided best demonstrate our work to improve the standards

and the quality of clinical care. The results of these measures in this first

report indicate that there is scope for further quality improvements to ensure

that all our patients have a positive experience in using our service. As

Accountable Officer it is also my responsibility to ensure that the data included

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in this Quality Account is accurate. I can provide this assurance based on the

Trust’s internal processes for ensuring the quality of data and the opinion of

our internal auditors who completed and delivered the annual audit

programme including an audits records management.

To the best of my knowledge the information contained within this set of

quality accounts for the East of England Ambulance Service NHS Trust is

accurate.

Signed:

Hayden Newton Chief Executive, East of England Ambulance Service

Statement on Quality from the Director of Quality 

Having taken up a new Executive appointment within the Trust as the Clinical

Director of Quality I have been struck by the commitment of staff to improving

care to patients and the examples of excellent practice I have seen and I am

therefore pleased to be able to commend our first Quality Account to you.

Patients and the care they receive, matter to us every moment of every day,

the Trust is continually striving to further improve the quality of care we deliver

to patients, often in very difficult circumstances and there are areas in which

we have some challenges to overcome. However the Trust Board and our

staff are committed to this task and my appointment is an endorsement of that

commitment. I look forward to working with patients and users, partner

organisations, regulators and of course our staff in improving further the

quality of our care and the experience that our patients receive.

Quality Innovation Prevention Productivity (QIPP)

“High Quality Care for All” Lord Darzi is about using the NHS reforms to

transform and redesign services to deliver high quality care for patients that is

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value for money and meets public expectations as well as the changing health

profiles of patients. Darzi set out an ambitious commitment for making quality

the organising principle of the NHS. His vision is that all NHS staff will

measure what they do as a basis for improving quality. He defined quality as

safe and effective care of which the patient's whole experience is positive and

stated "We can only be sure to improve what we can actually measure". This

set of quality accounts will inform you of the Trust’s clinical performance

achieved during 2009/10 through the measurement of the clinical

performance indicators which were set for that year.

Darzi argued that quality, innovation and prevention are inseparable.

Therefore the challenge for the Trust is to work with staff who play a crucial

role in delivering frontline services to patients and use their first-hand

experience and knowledge to review, redesign and innovate services to make

a difference to patients. It is important that the Trust takes this opportunity to

bring about transformational change to improve clinical quality particularly in

preparation of a predicted tighter economic climate.

 

PART 2 – Priorities for Improvement 2010/11 

A set of Quality Accounts will be produced annually which will provide the

Trust with an opportunity to look forward and identify priorities for

improvement during the following year. Priorities which the Trust achieves in

year will need to be continuously measured and maintained to ensure the

quality of service after the priority has been retired.

Priorities for the coming year The Trust has aligned two of its priorities for improvement 2010/11 with its

Commissioning for Quality and Innovation (CQUINs) schedule which has

been discussed with its lead commissioner. The CQUIN schedule and the

following priority areas for development and improvement have been selected

through building on themes from last year arising from the Trust’s complaints,

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PALS and comments system and in engaging the views of users, staff and

patients in the areas they felt the Trust should focus on.

Priority areas for development for 2010/11 include:

1) Reducing preventable falls

2) Increase the number of patients accessing an appropriate Stroke

Pathway

3) Improve the quality of patient handovers by improving the quality of

patient care records

4) Increase the percentage of patients accessing preferred type of end of

life care

5) Improve vehicle cleanliness and infection prevention and control in line

with the Hygiene Code.

How we developed our priorities In developing the priorities for 2010/11 with the Trust’s key stakeholders it has

also considered national strategic direction and the outcome of a number of

local audits which were completed over the past 12 months. All areas

identified for quality improvements link to the three domains set out in Lord

Darzi’s document and set out to improve patient safety by developing robust

mechanisms to ensure that the Trust records the quality of all care provided

as well as developing clinical practice and care to ensure a greater focus on

clinical effectiveness and the patient experience.

Patient Safety: Priority 1 – Reducing Preventable Falls

Calls categorised as a ‘fall’ account for over 18% of the Trust’s accident and

emergency patient activity. Many of these emergency calls are to older

patients who have fallen and 50% of which are treated at scene without

transfer to hospital. National statistics state that approximately 30% of

patients aged over 65 living in the community will fall each year of which 60%

are nursing home residents. Evidence suggests that up to a third of falls are

preventable if the right support systems are put in place. The Ambulance

Service has a major part to play in identifying those patients who are at risk of

falling and in ensuring that they access falls prevention services to reduce the

risk of repeat occurrences.

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Aim To work collaboratively with other healthcare providers to reduce the number

of falls and avoidable admissions and to increase identification and referral of

those patients at risk of falling and to reduce future falls.

Current status Referral to falls services across the EOE region is not consistent at present.

Currently our staff assess patients for injury but are often left without referral

options for those patients who have not sustained an injury. The Trust has a

number of pilot schemes operating across the region but this needs to be

extended across the whole Trust.

Identified areas of improvement We have recognised the need for a simple trigger tool for identifying those at

risk of falling and requiring specialist referral and have identified a need for a

simple consistent referral system across the Trust.

Current initiatives 2009/10

• The Trust operates a number of falls car(s) in some localities. These

projects are staffed by Paramedics, community nurses and social workers

• The introduction of a shared falls register. New initiatives to be implemented in 2010/11

• A regional trigger tool for all staff to use to identify patients needing

referral to a falls prevention service.

• Setting up a regional single point of contact for referral of patients 24/7

who have fallen.

• Setting up a regional register for patients who have fallen so we can

monitor trends and inform public health strategies.

• Carrying out a review of the pilot schemes.

Board Sponsor: David Donegan Implementation Lead: Clinical General Manager

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Clinical Effectiveness: Priority 2 – Increase the number of patients accessing an appropriate stroke patient care pathway

Stroke is a major cause of mortality and morbidity. Since the stroke strategy

was published in 2008 the Trust has made significant progress on the quality

markers outlined. However, there is still more that can be done to ensure that

the Trust is consistently getting the right patient to the right place for stroke

and transient ischaemic attack (TIA) services.

Aim To increase the number of patients who present with a stroke or TIA with

access to the correct treatment pathway.

Current status The Trust currently assesses all patients using the FAST system and our

clinicians are trained in the use of ABCD2 for risk identification of TIA. In

some parts of the region the Trust has access to 24/7 thrombolysis centres for

stroke patients but this is not across the whole region. Currently, TIA patients

are either transferred to hospital for treatment or referred to their GP.

Identified areas of improvement The Trust needs to develop a single patient care pathway for those patients

experiencing acute stroke and who are eligible for thrombolysis to ensure that

they reach a specialist centre offering this service. Likewise the Trust needs to

develop a TIA patient care pathway to identify high and low risk patients. In

this way high risk patients could be conveyed to hospital and low risk patients

could be referred directly to a TIA clinic within 7 days.

Current initiatives 2009/10

• An acute patient care pathway is in place

• Clinicians use the ABCD2 early warning scoring system

• The Trust has appointed two new stroke leads.

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New initiatives to be implemented in 2010/11

• Introduction of a TIA patient care pathway to identify high and low risk

patients by employing the ABCD2 system.

• Introduction of a low risk TIA referral system

• EoE regionwide access to acute thrombolysis service 24/7 for all stroke

patients.

Board Sponsor: Dr Pam Chrispin Implementation Lead: Stroke Lead Patient Safety: Priority 3 – Improve the Quality of Patient Handovers

A key component of continuing care is that the patient is effectively handed

over from one healthcare professional to another, using both verbal and

written skills. Generally this happens in the Accident and Emergency

Department, but may also occur with GPs, Nursing Teams and Social

Services. Last year the Trust set a priority for ensuring that all paper patient

care records were accurately completed and submitted. In discussion with

clinicians and staff this year the Trust will focus on improving the completion

of the paper patient care record.

Aim To improve the completion of both paper and electronic patient care records

to support effective patient handovers.

Current status A web report was run on the Trust’s CAD database for the 1 November 2009

identifying 1821 emergency responses for which 919 patient care records

were found (50.5% compliance). The accuracy of the PCRs audited ranged

from 16% to 100% for key indicators and from 0 to 14% on new form

indicators.

Identified areas of improvement The Trust needs to significantly improve the quality of the completion and

submission of its paper.

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Current initiatives 2009/10

• Guidance on completion and submission of PCRs

• Monitoring of completion and submission of PCRs

New initiatives to be implemented in 2010/11

• Improve the completion of patient care records to 90%

• Improve submission of Patient Care Records to 90%

Board Sponsor: Sheilagh Reavey Implementation Lead: Clinical General Manager Clinical Effectiveness: Priority 4 – Increase the percentage of patients accessing preferred type of end of life care

In discussion with patients and in line with national guidance the Trust will

adopt and implement the principles of the Liverpool Care Pathway to ensure

palliative care patients avoid inappropriate admission to hospital and are able

to die in a place of their choice. The majority of people would like a dignified

death and would like to remain at home. As such this year the Trust will work

in partnership with end of life care (EOLC) networks to decrease the number

of palliative care transfers to hospital and increase the number of Computer

Aided Dispatch (CAD) system flags indicating the preferred place of death for

palliative care patients.

Aim To increase the number of eligible patients accessing the right form of

treatment when they have a cardiac arrest.

Current status The implementation of a palliative care register covering some of the region

covered by the Trust.

Use of CAD flags for living wills, patient directives and do not attempt

resuscitation (DNAR) orders.

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Identified areas of improvement Whilst we have clear guidance on resuscitation we feel the area that needs

improvement is identification of those patients who are at the end of life where

resuscitation would be inappropriate. For these patients we should ensure our

practitioners have the skills to deal with end of life care.

Current initiatives 2009/10

• Full monitoring of compliance with resuscitation guidelines

• Review of CAD flags

New initiatives to be implemented in 2010/11

• Develop an end of life care training for staff

• Develop access to palliative care teams and medicines

• Flagging of patients on the palliative care register and CAD with living

wills and advanced directives re DNAR

Board Sponsor: Dr Pam Chrispin Implementation Lead: Dr Nick Morton Patient Experience: Priority 5 – Improve the cleanliness of the pre hospital environment and reduce the risk of infection

A clean environment provides the right setting for good patient care and good

infection prevention and control. This is very challenging in the pre-hospital

arena where Paramedics are required to treat and stabilise patients in a

variety of settings and environments which are often not clean. All staff play

an important role in quality improvement, in the confidence the public has, and

in reducing infection related risks. The areas that are to be cleaned in the pre-

hospital environment are divided into functional areas. Maintaining the

required standard of cleanliness is more important in some functional areas

than in others. In line with the revised National Specifications for Cleanliness

in the NHS: a Framework for Setting and Measuring Performance Outcomes

(2007) the functional areas are grouped into three levels of cleaning intensity,

based on the risks associated with inadequate cleaning in that functional area,

for example:

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1. High risk areas - includes ambulance vehicles and station sterile

storage areas, dirty utilities and toilets.

2. Significant risk areas - includes the staff kitchens, rest rooms, locker

rooms and response post rooms.

3. Low risk areas - includes administrative areas, non-sterile supply

areas, record storage and archives.

In addition Trust will adhere to the Revised Healthcare Cleaning Manual

(2009). Both documents provide comprehensive guidance on all aspects of

cleaning performance and frequency together with audit.

Aim To minimise the risk of infection to patients, staff and visitors and in response

to the inspections undertaken by the CQC the Trust has developed additional

systems and key performance indicators to monitor and improve the

cleanliness of all its risk areas listed above.

Current status

• Average vehicle cleanliness equals 38.5% (The audit tool initially

implemented was not robust and requires further development. In addition

the audit samples have been too small to be representative of the standard

being achieved)

• Average estates cleanliness equals 12.8% (small sample audits)

• Sterile stores and dirty utility facilities not adequate in some areas

• Average staff hand cleanliness equals 80%.

Identified areas of improvement

• Define routine cleaning schedules for all patient-carrying vehicles –

after patient journey, end of day, monthly and implement same

• Introduce robust cleanliness audit schedules

• Increase the sample size of all audits undertaken to meet the 95%

target set

• Trust-wide audit of estate to determine refurbishment programme of

defined clinical areas within stations/depots.

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Current initiatives 2009/10

• Monthly deep cleansing of vehicles

• Make ready depots x4 to improve cleaning performance of vehicles in

NSC

• Commence audit programme and develop tools/processes.

New initiatives to be implemented in 2010/11

• New clinical governance structure

• New continuous professional development (CPD) programme for all

staff

• Comprehensive regular vehicle cleaning schedules and audit of

cleaning programme

• Creation of new vehicle washer posts to undertake cleaning tasks

• Trust-wide new cleaning contracts to be implemented using healthcare

contractor to deliver robust cleaning programme in all Trust premises

• Standardisation of all products used for cleaning across the Trust

• Review of all patient equipment and decontamination processes to

ensure all equipment is adequately decontaminated after use.

Board Sponsor: Sheilagh Reavey Implementation Lead: Dr Scott Turner

Statements of Assurance

The Health Act 2009 requires the Trust to make a number of statements of

assurance within this set of Quality Accounts. These statements are common

to all NHS providers and will provide a benchmark against other similar

services.

Review of Services During the period 2009/10 the Trust provided and/or sub-contracted four

services:

• An accident and emergency service which covered ambulance and

rapid response provision, air ambulance, GP urgent transfers and operational

resilience

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• A special operations service which included resilience and emergency

planning, air ambulance services and the hazardous area response team

(HART) who responded to major incidents including chemical, biological,

radiological and nuclear

• Out of hours and Medicom including primary care call handling, remote

triage and face to face patient consultations and district nursing service

• Patient transport services and courier transport services.

The income generated by the NHS Services provided and reviewed during

this reporting period represents a total of £1,273,236. The Trust

subcontracted part of the out of hours service to Care UK and Take Care

Now; for 2009/10 the Trust spent £1,273,236 with Care UK and £855,884.26

Take Care Now. The total un-audited income for 2009/10 is £228,076k.

During 2009/10, the Trust attended 778,099 emergency and GP urgent calls

and transported 920,207 non-emergency patients. In addition it provided

primary care services in Norfolk, Suffolk, Cambridgeshire, Bedfordshire and

Essex.

The Trust Board received regular operational performance reports on the

quality of care provided through this service portfolio.

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Participation in Clinical Audits During 2009/10, one national clinical audit and one confidential enquiry

covered the NHS services provided by the East of England Ambulance

Service NHS Trust.

During that period East of England Ambulance Service NHS Trust participated

in all (100%) national clinical audits and all (100%) national confidential

enquiries of the national clinical audits and national confidential enquiries

which it was eligible to participate in.

The national clinical audits and national confidential enquiries that East of

England Ambulance Service NHS Trust was eligible to participate in during

2009/10 are as follows:

• National Clinical Audit: Myocardial Ischemia National Audit Project

(MINAP)

• National Confidential Enquiry: Centre for Maternal and Child Enquiries

(CMACE) Confidential Enquiry into Head Injury in Children

The national clinical audits and national confidential enquiries that the Trust

participated in, and for which data collection was completed during 2009/10,

are listed below alongside the number of cases submitted to each audit or

enquiry as a percentage of the number of registered cases required by the

terms of that audit or enquiry.

Myocardial Ischemia National Audit Project (MINAP): The Trust submits

information on specific patients conveyed to hospital at the request by acute

trusts rather than submitting a number of cases directly to the data base.

There is no system in place for direct submission of Trust data.

During 2009/10 the East of England region changed its model of care for

cardiac patients during from operating a pre hospital thrombolysis care

system to one of primary angioplasty. Professor Boyle reviewed the plans in

the Eastern region to introduce Primary Angioplasty (PPCI) after concerns

were expressed about whether the new service would offer better patient

outcomes. Professor Boyle visited the EoE area and noted the consensus of

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local opinion and shared with the local people clinical data and trials which

showed that PPCI was better than the current treatment of thrombolysis. A

PPCI service was immediately implemented alongside the treatment of

thrombolysis and the Trust was asked to monitor travel times and to transport

patients to specialist PPCI centres located at Papworth Hospital in

Cambridge, the Norfolk and Norwich University Hospital in Norfolk and the

Basildon University Hospital Cardiothoracic Centre in Essex. The Trust also

transports patients to Harefield outside the patch. There are also 9-5 services

in West Herts.

The Trust continuously monitors its performance in this new clinical practice

area.

The Trust published 10 patient related clinical audit reports during 2009/10 with the following recommendations to be actioned:

• BME Patients in Pain: Action 1. No action necessary

• Patient Care Record minimum Data Set: Action 1. PSIAM software designers should be requested to add the required missing

fields.

2. Adastra software designers should be requested to add the required

missing fields.

3. Review Trust Minimum Data Set with next review of PCR Policy

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• Stroke 1. Use ambulance services National Clinical Performance Indicators to

continue monitor further clinical performance and improvements in care

2. Feed results back to clinicians via Trust Intranet and Focus East Bulletin,

including a reminder that oxygen therapy must be recorded.

• Cannulation 1. Highlight the risks of infection through cannulation to clinicians. Publish

a Clinical Quality Memo

2. Include in CPD training

• PPCI Pathway 1. The trust should monitor the use of Clopidogrel to patients in Bedfordshire

and Hertfordshire, and support efforts to improve replenishment of the drug

from PPCI centres.

2. Trust Cardiac Lead to report to next ESCG on time performance

3. Call to leaving scene performance should continue to be monitored during

2010-11

4. Call to Balloon in less than 150 minutes and Call to Needle in less than 60

minutes should be included in the trusts Clinical Performance Indicators for

2010-11

• Private Ambulance / Voluntary Ambulance Services 1. Terms and conditions set in the contract document need to be reviewed to

ensure inclusion of sufficient clinical quality aspects of the submission and

completion of a patient care record.

2. Contractor’s performance against contract to be discussed with contractors

accordingly.

• Ambulance Support Workers (ASW) 1. Ensure systems in place to enable offline reporting of ambulance support

worker activities. (Have the grade available for selection on web reports as

well as being able to view them when a call is investigated).

2. Review deployment of ASW and associated risks

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• Drug recording 1. Pass report to Medicines Management Group for review and action

• Stroke patient survey inclusion 1. When selecting samples of a particular clinical group, only the clinical

impression field should be used for inclusion whenever possible.

• Patient Care Record (PCR) Submission 1. Continue PCR submission monitoring during 2010-11 using the Trust

CPI system

2. Feed audit results back to clinicians and improve, record submission and

completion including: child patient details and handover details.

3. Publish a Clinical Quality Memo to outline the performance of completion of

PCRs

4. Re- Audit during 2010 / 2011

Head Injury in Children: The Trust signed up to take part in the CMACE national confidential enquiry

during 2009 however to date the Trust has not been asked to submit the

ambulance data element of the enquiry. The Trust has also applied to be

included on the review committee but no committee meetings have been

scheduled yet.

The data collection process is reliant upon the collection of data from

hospitals before the ambulance service data is collected which may explain

the delay in the proceedings.

Measuring Participation National Confidential Enquiry into Patient Outcomes and Death (NCEPOD)

appears not to include the participation of ambulance services.

Centre for Maternal and Child Enquiries (CMACE): The Trust is registered to

participate with this project and is waiting for the Acute Hospital data phase to

be completed before receiving the ambulance service data request.

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National Confidential Inquiry (NCI) into Suicide and Homicide by People with

Mental Illness (NCI/NCISH): This project reviews psychiatric reports and does

not include ambulance services.

Participation in Clinical Research The number of patients receiving NHS services provided or sub-contracted by

East of England Ambulance Service NHS Trust in 2009/10 that were recruited

during that period to participate in research approved by a research ethics

committee was 18.

The 2009/10 reporting period represented the baseline year for the Trust with

regard to the hosting of and accrual to the National Institute for Health

Research portfolio activity. Three such projects were given approval to

proceed during this timeframe; one of which was subsequently completed and

two remain on-going.

Participation in clinical research activity demonstrates the Trust’s commitment

to improving the quality of care we offer and to making our contribution to

wider health improvement.

Goals Agreed with Commissioners Commissioning for Quality and Innovation (CQUIN) is a system that aims to

support a cultural shift towards making quality the organising principle of NHS

services. It does this by setting areas for development across the year and

only receiving payment when the quality and innovation has been achieved.

A proportion of the income received by the Trust during 2009/10 was

conditional on achieving quality improvements as described in agreement for

the provision of emergency and urgent ambulance services CQUINs

schedule.

The CQUIN schedule incorporated the following metrics:

• Patient report form completion

• Effect of Implementing Hygiene Code

24

• Safeguarding Children: Ensure regional, local and internal pathways

are developed to ensure best practice in line with national and local guidelines

• MINAP data flow

• 100% of stroke patient destination recorded

• Data flow for resuscitation rates

• Increase patient satisfaction and patient experience

• End of life Care and DNAR pathway

• AMPDS repeat callers’ activity data

• Implementation of National Patient Safety Agency recommendations

Further details of the agreed CQUIN schedule for 2009/10 and for the

following 12 month period are available on request. Please see page 2 for

contact details.

Significant financial consequences are attached to the CQUIN schedule for

2010/11 as this equates to 1.5% of the total contract value. Regular reports

on milestone achievements against the stretch targets will be provided to the

Trust Board and sub committees of the Board.

Care Quality Commission The Trust is required to register with the Care Quality Commission and

submitted its application for registration on 29 January 2010 and applied to be

registered against three regulatory activities to cover the services provided by

contracts and service level agreements. The Trust declared non compliance

to four regulations namely Regulation 14 Outcome 5 Meeting nutritional

needs, (not applicable to Ambulance Trusts) Regulation 13 Outcome 9

Management of medicines, Regulation 11 Outcome 7 Safeguarding and

Regulation 12 Outcome Cleanliness and infection control. Action plans were

submitted and the medicines management plan has now been completed so

that the Trust is compliant to Regulation 13. Work is continuing to achieve

specified actions in the remaining two plans.

On 23 March 2010 the Trust was awarded registration for each of the three

regulated activities for which it applied without conditions. The Trust will

25

therefore be required to submit payment to the CQC for its registration and

will be subject to periodic reviews in the near future.

The Trust has not participated in any special reviews or investigations

conducted by the Care Quality Commission however it did carry out two

unannounced visits, one in August and one in November 2009 relating to the

Hygiene Code. This resulted in two improvement notices being served in

relation to the breach of 3 of the duties.

The Trust has implemented a comprehensive action plan following these visits

which has been monitored by the Trust Board. It has taken the following

action to address the conclusions/requirements by the CQC:

A detailed analysis of the Trust’s position against every section of the Hygiene

Code was completed. This has been reviewed recently in line with the

updated Health and Social Care Act 2008 Code of practice for health and

adult social care on the prevention and control of infections and related

guidance.

For the first time the Trust has started to collect information on the cleanliness

of its vehicles, buildings and staff. This has proved complex to achieve taking

into account the geographical spread of properties and vehicles. The public

LINks group is starting to get involved in this process of quality assurance and

the Trust is also inviting PCTs to review ambulance cleanliness and feedback

results. Whilst the system is in its infancy it is already producing interesting

results. It is accepted that the initial results have been based on small

samples and that significantly more effort and resource will have to be put in

to ensure validity of the data. The aim in the coming months is to make the

system far more robust and with the ability to give information back to staff

and managers on what they are doing well and where they may need to be a

focus of increased effort.

The audit of policy and practice will be key in ensuring quality and

compliance. An internal review of the Trust’s audit structure and plan is

currently underway.

26

A number of very detailed reviews have already been done or are in progress

to show us organisationally where we need to focus in the coming year. As a

Trust we have enlisted the help of a private external organisation with

expertise in IP&C to ensure that we do achieve compliance against all areas

of the hygiene code. This working relationship is likely to persist for some time

to come. Key focuses already identified will be audit, training and policy.

Significant work has already been done with our make ready teams and

depots. Continued Professional Development (CPD) for the coming year has

been designed to take forwards some of the critical issues that have come out

of the last year. However CPD on its own will not be enough on its own to

ensure continued compliance and success in this area. Continued

engagement with staff and managers will be vital.

The Trust uniform policy has been reviewed and will be reissued and “Bare

below the elbows will be expected.

All ambulance sites will be audited to identify required improvements; cleaning

contracts will be enhanced and a programme of regular cleaning implemented

against an agreed specification.

The new Director of Clinical Quality has taken on the mantle of Director of

Infection Prevention and Control (DIPC) and has a background in this field.

Her expertise will focus the Board on infection prevention and control issues

in coming months to ensure that the Trust works towards closing all

weaknesses in this area.

Data Quality Good quality information underpins the effective delivery of patient care and is

essential if improvements in quality of care are to be made. Lord Darzi stated

that “We can only be sure to improve what we can actually measure”.

Improving data quality which includes the quality of ethnicity and other

equality data will assist in improving the quality of patient care. The Trust has

implemented a three year IM&T strategy to improve the quality reliability and

accuracy of the Trust’s data processes.

27

The Trust did not submit records during 2009/10 to the Secondary Uses

service for inclusion in the Hospital Episode Statistics.

Information Governance Toolkit To improve the level of risk associated with the use of information the Trust is

required to work within the parameters of an information governance

framework. Information governance is an umbrella term used within the NHS

to inform all stakeholders that there is a set of standards, processes and

procedures to be used when using information which the Trust is required to

achieve and to remain compliant. The level of compliance attained will

provide the level of assurance to the Executive Management Team and to the

Trust Board that all information created and used by the Trust is kept

confidential and secure and that all records held by the Trust meet the NHS

Code of Practice which is based on current legal requirements and

professional best practice. It encompasses legal requirements, central

guidance and best practice in information handling and includes:

• The common law duty of confidentiality

• Data Protection Act 1998

• Information Security

• Information Quality

• Records Management

• Freedom of Information Act 2000

To measure the Trust’s compliance across a broad spectrum of information

initiatives the Trust is required to complete a self assessment using the

information governance toolkit. This toolkit contains a set of six work areas

covering:

• Information Governance Management

• Confidentiality and Data Protection Assurance

• Information Security Assurance

• Clinical Information Assurance

• Secondary Uses Assurance

• Corporate Information Assurance

28

The Information Governance toolkit is monitored and audited externally and

has been approved by Health Ministers, the Review of Central Returns

(ROCR) team and Monitor. Final assessments are submitted on 31 March

each year and are shared with the Care Quality Commission, the Audit

Commission, Monitor and the National Information Governance Board. The

toolkit is the principal method of assessing the Trust’s Information

Governance framework and its performance during the year and is a key

element of the NHS Information Governance Assurance Framework.

The Trust met the deadlines for the three scheduled returns for 2009/10 as

follows: 1. Baseline assessment by 31 July 2009 - 56%

2. Performance update by 31 October 2009 – 65%

3. Final submission by 31 March 2010 – 70%

The final self assessment using the information governance toolkit was

submitted on line on 31st March 2009 with scores recorded against each of

the six work areas. Within each work area there are a number of criteria - 47

in total for the Ambulance Service Trust 2008/09 toolkit. Each criterion is

scored as nil if nothing is in place, as 1 if policies/strategies exist; as 2 if the

process can be evidenced as being implemented and embedded within the

Trust and as 3 if the process is mature with regular audits and reviews being

undertaken. The scoring thresholds are Red - below 40%, Amber - 40% to

69% and Green - 70% and above. The Trust reported a green RAG rating

scoring 70% compliance having been at an amber rating for the past two

years.

In respect of the criteria relating to standards 401, 403, 405, 408, 601, 602

which scores a maximum of 18 the Trust scored 12 out 0f 18 which was an

achievement of 66.67%.

The East of England Ambulance Service NHS Trust was not subject to the

Payment by Results clinical coding audit during 2009/10 by the Audit

Commission as it is not applicable to the organisation and its service portfolio.

29

PART 3 – Review of Quality Performance 

The aim of Quality Accounts is to enhance public accountability to improve

patient safety, clinical effectiveness and patient experience and to inform the

public about the quality of the services that are being delivered. The Health

Act 2009 has now placed a statutory requirement on the Trust to produce a

quality account from April 2010.

The Trust reviewed its performance during 2009/10 and took into account a

number of internal self assessments and dashboard data sources as well as

external audit reports and regulator inspection reports to identify its quality

indicators for improvement. The priorities for 2009/10 consisted of the

following metrics:

Patient safety 

Vehicle cleanliness

In response to the CQC rating for C4a, the Trust has developed additional

systems and key performance indicators to monitor the cleanliness of the

vehicle fleet. Initial reports demonstrated an improvement in both hand

hygeine scores, estate cleanliness and vehicle cleanliness scores. However,

the vehicle cleanliness has shown a decline during the winter periods

although it is fair to say that these scores are still being obtained from a small

sample of the total vehicle fleet which must be improved upon during 2010/11.

Which is why this still needs to be one of our priority areas

30

Sector Indicator Target Current

ytd (b)

Current month result

No. (c)

% (d)

Ambulance vehicles

1.1 Number and percentage of vehicles audited for this report

95% 702 198 69.2%

1.2 Number and percentage reported as completely clean

Target to be set after bench marking in QTR1

236 110 38.5%

1.3 Average vehicle cleanliness

95% 95% Not applicable 96.9%

Estates

2.1 Number and percentage of buildings audited for this report

95% 147 48 36.1%

2.2 Number and percentage reported as completely clean

To be confirmed 56 28 21.1%

2.3 Average estates cleanliness

95% 92.3% Not applicable 97.2%

Staff

3.1 Number and percentage of staff hands audited for this report

Target to be set after bench marking in QTR1

289 74 76.3%

3.2 Number and percentage reported as completely clean

Target to be set after bench marking in QTR1

282 97 87.7%

3.3 Average staff hands cleanliness 95% 82.7% Not

applicable 83.3%

31

Number of patient care record submissions (PCRs) In response to the CQC rating for C9, the Trust will develop key performance

indicators to monitor the number of PCR submissions versus the number of

responses and as a priority for 2010/11 monitor their completion to improve

handovers.

Quality & Accuracy of Information collected on PCR, using a snapshot of 50

records for operational areas (Apr 2009-Mar 2010)

Clinical Effectiveness: Asthma

In response to the CQC report on the standards of care, the Trust has

continued to contribute to the national audit on the management of asthma by

examining up to 300 records (or up to 300 if there were fewer than this) with a

clinical diagnosis of asthma. The Trust’s performance has been analysed and

compared using funnel plots which have the advantage of avoiding

inappropriate ranking against the other 11 ambulance services in England but

which identifies outliers above and below the mean. Criterion A2 below relates

to the taking of a peak flow reading prior to treatment. Current JRCALC

guidelines (2006) advise staff to check peak flow if practical’ but this is open

to interpretation as it gives no further clarification as to what constitutes

‘practical’ or ‘not practical’. The Trust (number 8) on the graph below which

demonstrates that it is above the mean and just below the upper control limit

and expects to continue to improve its performance during 2010/11.

Apr 09

May 09

Jun 09

Q1 09/ 10

Jul 09

Aug 09

Sep 09

Q2 09/ 10

Oct 09

Nov 09

Dec 09

Q3 09/ 10

Jan 10

Feb 10

Mar 10

Q4 09/ 10

83.0%

82.0%

81.8%

82.3%

82.0%

79.2%

79.1%

81.2%

78.1%

73.5%

73.7%

79.2%

74.8%

76.0%

77.4%

78.4%

32

EEAST Total Sample Size

Performance Cycle 3 (%)

Performance Cycle 2 (%)

Performance Cycle 1 (%)

791 37.06% 29.11% 28.92%

Cardiac arrest In response to the CQC report on the standards of care, the Trust decided to

re-audit and to continue to contribute to the national audit on the management

of cardiac arrest. During the year the definition of ‘return of spontaneous

circulation’ at the hospital, has been further clarified. The CPI sub committee

recommended that criterion C1 ROSC on arrival at hospital be revised to look

at cases of ROSC at hospital where the initial rhythm had been shockable or

VF/VT. This would bring it into line with Utstein criteria. The Trust has

demonstrated a 2% improvement to its ROSC standard however this needs to

be improved further and will continue to be monitored during 2010/11.

33

EEAST Total Sample Size

Performance Cycle 3 (%)

Performance Cycle 2 (%)

Performance Cycle 1 (%)

534 18.49 9.88 16.28

Patient Experience Clinical Audit and Patient satisfaction It is both a national and Trust priority to receive feedback from patients and

users to improve the service provided.

34

Patient Satisfaction for Emergency Services (April 09-Dec 09)

April 09 May 09 June 09 Q1

total Jul 09 Aug 09 Sept 09

Q2 total

Oct 09 Nov 09 Dec 09 Q3

total

Ninemonth total

52,278 55,197 54,263 161,738 57,384 54,918 52,918 165,220 61,300 56,050 61,216 178,566 505,524

Number of

emergency

and urgent

responses

69 53 88 210 88 76 138 302 113 114 125 352 864 Number of

patients giving

feedback

95.8% 96.4% 95.7% 95.9% 95.9% 96.2% 98.6% 97.1% 97.4% 98.3% 99.2% 98.3% 97.3%

Percentage of

patient’s

responses

recorded

overall

‘Satisfied’ or

‘Very Satisfied’

As part of the clinical audit annual programme and the need to continuously

improve patient services the Trust planned and conducted a number of patient

surveys and interviews. This was to actively seek user feedback on

experiences including comments on staff attitude, cleanliness and comfort of

vehicles and whether users are treated with dignity and respect. Part of the

annual audit programme has been carried out in partnership with other NHS

providers to improve the overall effectiveness survey activity. The Trust’s

PPI&E managers have worked with the Ambulance User Group consisting of

volunteer public and patients, and works with a variety of external patient

groups. Patients’ overall satisfaction remains high (Emergency Services 97%,

Out Of Hours services 88%, Patient Transport Services 91%).

Recent developments During 2009 a range of developments took place; the roles of existing clinical

directorate staff were changed to allow an increase of staff resource for the

purpose of gaining patient feedback.

The surveying of users of the Out of Hours service went through changes to a

telephone type survey and was altered so all Trust areas undertake the same

activity allowing for better internal comparisons.

35

A continuous postal survey of ES patients commenced, increasing the

number of responses from patients in accordance with the new ES CQUIN

requirement; such continuous survey allowed the Trust to report performance

each month. A system of interviewing patients was introduced for ES patients

with interviewers consisting of a Trust staff member and a Patient User Group

volunteer.

A new team has been set up to manage patient engagement. This team

worked with the Trust User Group and external groups such as Local

Involvement Networks (LINks). This activity was planned to be a part of the

Trust Communications & Engagement Department (Associate Director and

Director yet to be appointed).

Current programme and performance The agreed programme for patient feedback activity was split into the three

service areas:

1. Emergency Services

A continuous postal survey was started during 2009-10 and seven topic

specific projects were programmed: BME patients, patients suffering a stroke

x 2, patients suffering hypoglycaemia, patients using the PPCI pathway,

patients treated by private and voluntary ambulance services and mental

health. The number of patients expected to receive feedback from during

2009-10 was approximately 2500. Overall patient satisfaction for ES was

around 96%.

2. Primary Care Services

The continuous survey was continued for 2009-10, moving from postal to

telephone method part way through the year. The number of patients

expected to receive feedback from during 2009-10 was approximately 2800.

Overall patient satisfaction for PCS tended to be around 86%.

3. Non-Emergency Services

Three topic specific surveys were programmed: patients travelling in Essex,

West Suffolk and NNUH. The number of patients expected to be surveyed

36

during 2009-10 was approximately 600. Overall patient satisfaction for NES

tended to be around 91%.

In the future the Trust wishes to develop the work carried out around patient

interviews and improve the direct feedback to staff.

Patient Experience via Complaints Monitoring The Trust is committed to improving the service it provides to the people it

serves and is continually working towards a culture that seeks and then uses

patients’ experiences of care to improve and shape services. Staff work very

hard to meet patient and public expectations however in a busy public service

organisation mistakes can occur which need to be resolved and systems put

in place to ensure that services are improved.

All patient related complaints, queries and concerns about the Trust are

managed through two main departments located in Norwich and Bedford.

Each department has a dedicated team of staff whose aim is to forge a link

with the patient or member of the public so that there is a clear understanding

of the issues being raised and how best they can be resolved.

Complaints are relatively small in number compared to the volume of patient

activity undertaken by the Trust. However we believe that any comments

received or any bad experiences felt by patients and brought to our attention

must be fed back into the organisation to enable learning to take place to

continually improve our patients’ experience of using our services and to also

support our staff in delivering high quality care to all our patients.

During the period April 2009 to March 2010 the Trust registered 452

complaints compared to 389 for the previous year. 98% of all complaints

received were acknowledged by the patient experience teams and were all

handled in accordance with the new Local Authority Social Services and

National Health Service Complaints (England) Regulations 2009. Joint

working with other social services and health organisations has also been

established to improve the complaints process when the complaint extends

beyond organisational boundaries and involves more than one organisation.

37

In terms of comparing activity with complaints received for the period, for

every one complaint that the Trust received it responded to and managed

1768 patient episodes satisfactorily.

The majority of complaints have been resolved locally however 12 went on to

independent review with the Health Service Ombudsman. Six of these were

closed with no further action required, two required some additional work and

four are still currently under review by the Ombudsman.

Patient Advice & Liaison Service (PALS) The PALS service is an integral part of our patient experience departments

dealing with up to 961 enquires ranging from feedback on how to improve

services, giving advice on any NHS matter and helping to find misplaced

personal belongings.

Lessons Learned For every registered complaint or concern raised by the public the Trust seeks

to learn from this positive feedback. The majority of lessons learned have

been managed at local level by the management teams and Clinical

Operation Managers through direct feedback to those staff involved. Where

complaints have had a wider implication for the Trust then lessons learned

and changes to practice have been published via bulletins so that learning

can be shared across the whole organisation. For example as a result of

complaints and concerns received there have been bulletins issued to staff on

the management of paediatrics, swine flu, clarification on seeking clinical

advice and support, operational guidelines on procedures, good practice

guidelines in the non emergency setting and the introduction of a trial scheme

to transport patients’ medication safely to name a few.

Compliments The Trust is also proud of the many compliments and thank you letters sent to

our staff. This year over 1390 staff received a “thank you” in recognition of

their hard work, dedication and professionalism. For every “thank you”

38

received by the Trust each member of staff has received a copy of the letter

and their names have been published in our Trust bulletin.

Complaints are categorised into the following areas to assist the Trust to

identify any relevant trends which require changes to training programmes,

equipment and/or services to improve the patient experience. The number of

complaints during 2009/10 has increased by 60 compared to 2008/09 but this

should analysed in the context of an additional 6% increase in patient activity.

What is pleasing is to see the number of complaints relating to attitude

decrease although there is further work needed to reduce these types of

complaints to an acceptable level. Patient care complaints have increased

and further analysis will be undertaken to identify the root cause of the

increase.

39

Comparative Complaints Data 2008/09 and 2009/10

Area of Complaint

Apr 08

May 08

Jun 08

Jul 08

Aug 08

Sep 08

Oct 08

Nov 08

Dec 08

Jan 09

Feb 09

Mar 09 TOTAL

Attitude of staff 7 12 20 13 9 11 15 10 8 22 6 11 144

Patient Care 8 4 14 15 14 11 7 8 10 9 13 15 128

Call handling 0 1 0 0 0 1 1 1 1 0 1 0 6

Driving Actions 0 0 1 2 0 2 0 0 1 0 0 0 6

Delay to

attend/arrive 6 3 4 4 4 6 5 10 8 10 7 5 72

Infection 3 1 0 0 0 0 0 0 0 0 0 1 5

Hospital

Transport 2 3 1 2 2 2 2 2 2 3 3 0 24

Equipment 0 0 0 0 0 0 0 0 0 0 0 0 0

Other non

specific 1 0 0 0 0 0 1 0 0 1 0 0 3

Medication

Error 0 1 0 0 0 0 0 0 0 0 0 0 1

Total 27 25 40 36 29 33 31 31 30 45 30 32 389

Area of Complaint

Apr 09

May 09

Jun 09

Jul 09

Aug 09

Sep 09

Oct 09

Nov 09

Dec 09

Jan 10

Feb 10

Mar 10 TOTAL

Attitude of staff 7 10 3 15 13 9 11 14 13 15 11 13 134

Patient Care 12 6 21 18 13 12 22 11 10 15 20 18 178

Call handling 4 1 2 2 2 7 5 3 2 6 3 6 43

Driving Actions 1 0 0 2 0 2 0 0 2 3 4 0 14

Delay to

attend/arrive 4 3 4 4 4 7 6 5 2 3 2 5 49

Infection 0

1 0 1 0 0 0 0 0 0 0 0 2

Hospital

Transport 0 1 4 2 0 0 1 1 1 0 1 1 12

Equipment 1 0 0 0 0 0 0 0 0 0 0 0 1

Other non

specific 0 0 0 0 3 2 1 5 3 0 2 2 18

Medication

Error 0 0 0 0 0 0 0 0 1 0 0 0 1

Total 29 22 34 44 35 39 46 39 34 42 43 45 452

40

 

PART 4: Comments from key stakeholders 

If the aim of improving public accountability is to be achieved, the Trust has

asked for the views of its local communities to ensure that the Quality

Accounts are accessible and informative. A glossary has been developed

having taken the advice of the chair of the Trust’s ambulance user group.

Copies of the quality account have been circulated to all members of the

Ambulance User group and Local Involvement Networks (LINks) and Health

Overview and Scrutiny Committees (HOSCs) to develop the Quality Account

further and to ask for comments on the priorities identified for improvement

with regards to quality of care for 2010/11.

Comments have been received from the stakeholders:

Statement from Ambulance User Group 

The Trust User Group (TUG) were very pleased to receive and note the

Quality Accounts for the East of England Ambulance Service Trust.

41

The Group are pleased with the progress on last year’s initiatives and the

improvements on those initiatives planned for 2010/11.

They also especially welcome the planned improvement for patients

accessing preferred type of end of life care. They would like to see training

for all staff to the level of the Trusts ECPs in this area to ensure that these

patients receive the very best of care at all levels without any delays.

The TUG are committed to helping the Trust improve its vehicle and station

cleanliness by carrying out impartial cleanliness audits throughout the year

and feeding back to the Clinical Quality team its findings and comments for

action. They look forward to working with the Trust on appropriate use of the

ambulance service through public awareness.

They are happy with what you have written. The statement is just the length it

should be. They would have liked to see something about the falls project at

Hemel which has had a good outcome and could save a great deal of money

for the NHS. Hertfordshire Link has put a short paragraph in its response as it

was funded by the County Council and Ambulance Trust. Herts OSC may

also mention it as they have been asked to do look at it at a meeting

today. Perhaps it could be mentioned next year.

Statement from Local Involvement Networks 

Bedfordshire LINk welcomes the opportunity to comment on the Quality

Accounts for the East of England Ambulance Trust. We would like to acknowledge the input of the PPI Lead for the Trust, Gina

Pryor at Bedfordshire LINk Board meetings, which has allowed for two-way

communication and speedy responses to questions. We have also been

fortunate to have a member of the Trust’s Ambulance Patient User Group in

the LINk, which has meant that when the issue of ambulance crew attendance

at homes of the visually impaired/blind patients or carers caused some

concern, it resulted in the Trust implementing changes to the crew ID cards to

include Braille and a revision to the crew induction process. The LINk

membership including the Central Bedfordshire Access Group, where the

issue was raised, welcome these changes.

42

Luton LINk has representation on the Trusts User Group and has maintained

a close interest in the services provided in the town. It is pleasing to note the

very low level of complaints originating from patients in the area. Active

participation has been given to the Turnaround, Patient Interview and

Cleanliness projects as a contribution to the Trust’s service improvement

programme.

Thank you.

Rutland LINk has no comments

Thank you for asking Cambridgeshire LINk to comment on the 2009/10 Draft

Quality Accounts.

We would firstly like to comment on the restricted timescale that the LINk has

been given to respond to this document. The draft document was only

received by our facilitator on 6th May 2010 with an e-mail asking for us to

respond by 20th May 2010. This has only given us 14 days to respond and

not the 30 working days as recommended in the DoH letter dated 14.01.10,

Annex 1 (Gateway No: 13393) QUALITY ACCOUNTS: Roles of

Commissioning PCT’s, Local Involvement Networks (LINks) and local

authority Overview and Scrutiny Committees (OSCs). As a result of this we

shall only be able to comment at a local level as we have not had time to

discuss this with our counterparts across the Region.

The group applaud the priorities that you have identified for the forthcoming

year at the same time recognising that performance against category A, B and

C response times is measured Trust wide. The group have shown concern

during the year that there is a huge local variation between response times,

especially rural versus urban and would suggest that this is monitored very

closely. We have strongly made the same suggestion to NHS

Cambridgeshire.

Hertfordshire LINk strongly supports the values and priorities for quality

improvement set out in the East of England Ambulance Service NHS Trust’s

43

Quality Account. Priorities are set out with clear aims and objectives and lead

responsible.

For ‘Priority 1 – Reducing Preventable Falls’, Hertfordshire LINk commends

the six month Fall Prevention project run by Hertfordshire County Council and

the East of England Ambulance Service NHS Trust which aimed to help older

people avoid unnecessary trips to A&E and promoted joint working. LINk

would like to see this good practice rolled out and further collaborative

working with healthcare providers.

A key concern of Hertfordshire LINk is the care of the very vulnerable

(children and adults) in hospital and in the community. There is a need for

patient surveys and possibly clinical audits to identify the level of patient

satisfaction and care outcomes for the very vulnerable. The very vulnerable

are defined as those with severe sensory or physical disabilities, learning

disabilities, Autism, Dementia and complex mental as well as physical health

problems.

Staff are involved with quality improvement through the Compliments and

Complaints system and as patient surveys include dignity and respect, could

be encouraged to become Dignity Champions.

Hertfordshire LINk looks forward to working with the East of England

Ambulance NHS Trust to support quality improvement.

Statement from Health Overview and Scrutiny Committees 

This is to give feedback from Cambridgeshire County Council Health and Adult Social Care Scrutiny Committee on the EEAS Quality Account, as

follows:

The Committee thanks the East of England Ambulance Service for the

opportunity to comment on the Quality Account. We are concerned that the

Cat A 8 minute ambulance response time target is not being achieved in the

Cambridgeshire PCT area outside Cambridge City, ie East Cambridgeshire,

Fenland, Huntingdonshire, and South Cambridgeshire. We therefore suggest

that the Quality Account include as one of its priority areas for development

improvements in Cat A ambulance response times for those localities within

44

PCT areas which are underperforming, with targets set for each locality, in

discussion with the commissioners.

We particularly welcome the priorities being given to: increasing the number

of patients who have suffered a stroke going to the most appropriate clinical

setting as this should result in improved outcomes improving the quality of

patient handovers, which should lead to a more effective use of resources as

well as impacting on patient safety.

The Suffolk Health Scrutiny Committee Many thanks for the opportunity to comment on the East of England

Ambulance Service NHS Trust’s Quality Accounts publication. The following

statement is the Health Scrutiny Committee’s formal response:

The Suffolk Health Scrutiny Committee has decided not to comment on any of

the Suffolk provider NHS Trust's Quality Accounts for 2009/10 and would like

to stress that this should in no way be taken as a negative comment. The

Committee has taken the view that it is appropriate for Suffolk’s Local

Involvement Network to consider the Quality Account and comment

accordingly.

Please note, this decision was taken on the on the basis that the Health

Scrutiny Committee feels that Suffolk LINk is better placed to comment from

the public / patient point of view.

Statement from Primary Care Trusts 

NHS Bedfordshire as the Lead Commissioning Primary Care Trust for East of

England Ambulance Service NHS Trust has a duty under the National Health

Service Act 2006, to confirm that this Quality Account contains accurate and

relevant information in relation to the NHS services provided. Reasonable

steps have been taken to ensure the data has been checked for accuracy

against data supplied during the year. This process is part of the contractual

quality monitoring systems.

45

A description of services provided has been identified. The CEO statement

confirms that internal quality assurance process including data is scrutinised

and can be evidenced. NHS Bedfordshire supports the plan to provide regular

reports to the Public Trust Board meetings on the achievements against new

strategic objectives. Board sponsors and implementation leads are clearly

identified demonstrating Executive ownership and commitment to this agenda.

Clinical Performance indicators for 2009/10 are utilised to set targets for this

year, it is acknowledged that these have not been nationally benchmarked but

due to the nature of the organisation this has been done within the East of

England.

The five priority areas for 2010/11 have been identified from various sources

and the new initiatives when achieved will enhance the quality of service and

outcomes for the patient. Progress on achievement will be monitored via the

existing quality monitoring processes.

NHS Bedfordshire notes and confirms the position in relation to the hygiene

code. The detailed review of work and progress will be monitored closely, it is

noted that there is a new Director of Infection Prevention and Control who has

been appointed and is named as championing this agenda at the Board.

A detailed list of involvement in clinical audit both National and local is clearly

illustrated and the findings and actions required identified. The service

changes are described and NHS Bedfordshire will continue to review impact

and patient outcome measures.

NHS Bedfordshire is satisfied with the challenge of identified CQUIN

(Commissioning for Quality and Innovation) indicators and looks forward to

the improved patient experience and the impact on patient care outcomes and

the impact on demand management.

NHS Bedfordshire acknowledges that the East of England Ambulance Service

NHS Trust has been registered unconditionally, with the Care Quality

Commission from 23 March 2010 for its three regulated activities.

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NHS Bedfordshire can confirm that the Quality Account provided for 2009/10

contains accurate information and reflects the quality of current service

provision. The account contains the challenges for continued improvement

and monitoring of effective patient outcomes which NHS Bedfordshire will

continue to review and validate in year.

Yours Sincerely

Andrew Morgan Chief Executive Providing Feedback

If you would like to provide comments and feedback on our quality account

you can write to:

Sheilagh Reavey

Director of Clinical Quality

East of England Ambulance Service NHS Trust

Hammond Road

Bedford

MK41 0RG.

Or Telephone: 01234 408999

Or email: qualityaccount@eastamb.nhs.uk

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Glossary

Term Acronym Description

ABCD2 Algorithm ABCD2 A simple score (ABCD2) to identify individuals at high early risk of

stroke after a transient ischemic attack

Advanced Directive AD

Also known as living wills, advance directives, or advance decisions, are instructions given by individuals specifying what

actions should be taken for their health in the event that they are no

longer able to make decisions due to illness or incapacity.

Advanced Medical Priority

Dispatch System AMPDS

Licensed software to clinically triage the category of emergency

calls.

Ambulance support

worker ASW

A new support worker introduced to work on urgent tier vehicles

and or teamed up with a Paramedic to enable them to concentrate

on delivering clinical care and treatment to patients.

Auditors’ Local Evaluation ALE

External auditor assessment of how well NHS organisations

manage and use their financial resources. Highlights areas for

improvement

Care Quality Commission CQC

The independent watchdog for healthcare in England. It assesses

and reports on the quality and safety of services provided by the

NHS and the independent healthcare sector, and works to improve

services for patients and the public

Clinical, biological,

radiological, nuclear CBRN

Term in common use worldwide, to refer to incidents in which any

of these four hazards have presented themselves

Clinical performance

indicator CPI

A performance indicator designed to monitor important aspects of

clinical which require either monitoring or improvement

Clinical support desk CSD

Clinically trained individuals providing telephonic support following

an emergency call. Generally utilised for lower acuity calls not

necessarily requiring attendance at scene or a transportable

response

Commissioning

The processes which local authorities and PCTs undertake to make

sure that services funded by them meet the needs of the patient

with the financial envelope

Commissioning for

Quality and Innovation CQUIN

The incorporation of quality metrics within three-year contracts. Full

reimbursement of activity is made upon delivery of quality initiatives

Community first

responders CFR

Teams of volunteers who are trained by the ambulance service to a

nationally recognised level and provide life saving treatment to

people in their local communities

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Computer aided dispatch

system CAD

Computer hardware used to record all patient calls and patient

activity.

Continuous professional

development CPD

An updating of professional knowledge and the improvement of

professional competence throughout a person's working life. It is a

commitment to being professional, keeping up to date and

continuously seeking to improve.

Courier transport service CTS Transports medical freight, mail and supplies

Directory of service DoS A live list of available health and social care provision

Do not attempt

Resuscitation DNAR

A patient with capacity has the right to refuse CPR and agrees to

an advance decision refusing CPR, this should be respected. A Do

Not Attempt Resuscitation (DNAR) decision does not override

clinical judgement in the unlikely event of a reversible cause of the

patient’s respiratory or cardiac arrest that does not match the

circumstances envisaged. DNAR decisions apply only to CPR and

not to any other aspects of treatment.

Emergency operations

centre EOC

Control centre for managing call receipt, triage and dispatch

functions

Emergency service ES 999 ambulance service providing patient care, treatment and

transport to acute hospitals

End of life care EOLC

A DH programme, to improve the quality of care at the end of life

for all patients and enable more patients to live and die in the place

of their choice.

Foundation Trust FT

A type of trust created to devolve decision-making from central

government control to local organisations and communities so they

are more responsive to the needs and wishes of their local people

Hazardous Area

Response Teams HART

Specially trained personnel who provide the ambulance response

to major incidents

Health Overview and

Scrutiny Committee HOSC

The Committee provides external assessment of any NHS

consultation process giving local assurance that the businesss

case for any future NHS developments are robust

Inpatient quality indicators IQI IQIs are a set of measures that provide a perspective on the

quality of care given to patients

Joint Royal Colleges

Ambulance Liaison

Committee

JRCALC

A committee that provides robust clinical speciality advice to

ambulance services and is well known for the development and the

production the UK Ambulance Service Clinical Practice Guidelines.

JRCALC Works closely alongside the Directors of Clinical Care of

all UK ambulance services, local Ambulance Paramedic Steering

Committees, the British Paramedic Association and other

interested groups it effectively fulfils the liaison role of its title.

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Knowledge and skills

framework KSF

The NHS KSF process involves managers working with individual

members of staff to plan their training and development

Local involvement

networks LINks

Run by local individuals and groups and independently supported.

The role of LINks is to find out what people want, monitor local

services and to use their powers to hold them to account

Metrics Set of ways of quantitatively and periodically measuring

performance.

Myocardial Infarction

National Audit Project MINAP

The Myocardial Infarction National Audit Project (MINAP) was

established in 1999, in response to the national service framework

(NSF) for coronary heart disease, to examine the quality of

management of heart attacks in England and Wales. The project

uses a highly secure electronic system of data entry, transmission

and analysis developed by the Central Cardiac Audit Database

(CCAD). This system uses encryption of patient identifiers to allow

secure transfer of data between hospitals and central servers and

allows linkage with the Office of National Statistics for tracking of

mortality.

NHS East of England NHS EoE Strategic health authority (SHA) in the East of England

Quality Innovation

Prevention Productivity QIPP

Lord Darzi argued in High Quality Care for All that quality,

innovation and prevention are inseparable. QIPP is a concept for

delivering quality services through a period of tighter financial

challenge.

Patient and public

involvement PPI

Involving the public in shaping a care system’s development, and

keeping patients well informed of clinical processes and decisions

Patient public involvement

& engagement PPI&E

The NHS fully supports engaging people in the design and delivery

of services. They are routinely asked for their views, about their

experience of services, to contribute to staff training and to be

members of NHS foundation trusts.

Patient care record PCR All NHS providers are required to record the care given to a patient

on a patient care record

Patient transport service PTS Provides transport to and from premises providing NHS healthcare

and between NHS healthcare providers

Primary and urgent care P&UC The term for out-of-hospital health services that play a central role

in the local community

Primary care operations

Comprises the patient transport service (PTS) and courier transport

services (CTS)

Primary care trust PCT NHS bodies with responsibility for delivering health care services

and health improvements to their local areas

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Primary percutaneous

coronary intervention PPCI

Commonly known as coronary angioplasty or simply angioplasty, is

a therapeutic procedure to treat the narrowed coronary arteries of

the heart found in coronary heart disease

Return of spontaneous

circulation ROSC A palpable pulse is present after clinically documented asystole

Service user Anyone who uses, requests, applies for or benefits from health or

local authority services

Single point of contact SPoC

A single telephone number which will facilitate patient navigation to

a range of health and social care services around the clock and

prevent unnecessary admission

Stroke TIA

A stroke happens when the blood supply to the brain is disturbed.

Transient ischaemic attack (TIA) or 'mini-stroke' has similar

symptoms to stroke but these symptoms are resolved faster and

the person usually will get better within 24 hours. The TIA may be a

warning sign of a more serious stroke and always requires further

immediate medical attention.

Stakeholders

Anyone with an interest in the way services are delivered including

service users, carers, patients, service providers, staff, health

professionals and partner organisations, councils and other

community or voluntary groups

Strategic health authority SHA

Regional NHS headquarters, responsible for ensuring national

priorities are integrated into local plans and PCTs are performing

well

Telehealth The delivery of health-related services and information via

telecommunications technologies

Voluntary and community

sector

Groups set up for public or community benefit such as registered

charities, and non charitable non-profit organisations and

associations