Shropshire 999 chiefs in rethink pledge over ambulance target failures

Representatives of West Midlands Ambulance Service made the remarks when they appeared before Shropshire Council's health and adult social care scrutiny committee at Shirehall in Shrewsbury.

They had been called to answer questions about the deterioration in ambulance response time in Shropshire.

The following are Shropshire CCG's figures for ambulance response times to the most serious incidents in the county during February.

For the Red One incidents the statistics are based on far fewer call-outs than the Red Two incidents, making Red Two more representative of response times.

Red One incidents are classed as 'a life threatening emergency, primarily cardiac arrest patients'. The target response time is eight minutes.

Red Two incidents classed as 'a life threatening emergency'. The target response time is eight minutes.

The percentages show how often the targets were reached, for postcodes where incidents have taken place during February.

Red One:

DY12 50%

DY14 0%

SY1 60%

SY10 100%

SY11 87.5%

SY12 0%

SY13 57.1%

SY2 77.8%

SY3 81.8%

SY4 50%

SY5 25%

SY8 60%

SY9 50%

TF11 0%

TF13 100%

TF9 50%

WR15 50%

WV15 50%

WV16 33.3%

WV7 100%

Red Two:

CW3 0%

DY12 50%

DY14 26.3%

LD7 0%

SY1 71.4%

SY10 55.6%

SY11 71.8%

SY12 33.3%

SY13 64.1%

SY15 0%

SY2 61.4%

SY21 0%

SY22 0%

SY3 85.3%

SY4 29.9%

SY5 28.9%

SY6 34.4%

SY7 68.8%

SY8 66.7%

SY9 62.5%

TF11 55.9%

TF12 47.1%

TF13 0%

TF2 0%

TF8 40%

TF9 51.1%

WR15 46.2%

WV15 57.8%

WV16 53.1%

WV5 25%

WV6 0%

WV7 43.8%

WV8 0%

With a target of reaching 75 per cent of the most serious calls - where patients are unconscious and not breathing - in eight minutes, the trust has fallen nearly 10 per cent short, with 65.6 per cent of the 1,256 Shropshire calls being answered in time.

The trust has also fallen five per cent short in the Shropshire response time for the second most serious type of incidents, where patients are breathing but are in a life- threatening condition.

Dr Julie Davies, director of strategy and service redesign at Shropshire Clinical Commissioning Group, said that a number of pilot projects are being considered in an effort to improve response times.

She said: "It is not just about being financially sustainable, it is about being sustainable in terms of quality of care delivery.

"We know it will cost us a lot more to provide an equivalent service. There are opportunities and I know elsewhere in the country they are looking at integrated responses across the emergency services."

One initiative being considered is providing firefighters with training to react to incidents as first responders when ambulance staff are not available.

Another is providing a "pre-hospital acute medicine service" delivered by GPs to help prevent people having to go into hospital.

A CCG report produced in 2014 estimated that West Midlands Ambulance Service would need to double its workforce and add 200 more paramedics just to reach Shropshire response time targets.

To reach individual postcode targets the report found that the service would need an extra 500 workers.

Mark Docherty, director of clinical commissioning and service development at West Midlands Ambulance Service, told councillors that one of the biggest problems in meeting response times is the delays faced by ambulances at hospitals.

However, Mr Docherty said it would be unrealistic to think delays could be eradicated without significant changes to health services.

He said: "The hospitals' departments were never built for the volume of patients going through there. We have to be mindful that a solution has to be built around what is practicably achievable."

The comments came after a Freedom of Information request from the Shropshire Star revealed that half of all ambulances arriving at Telford's Princess Royal Hospital and Shrewsbury Royal Hospital were facing delays.

The problem comes from increasing difficulties being caused by a continual rise in demand from patients, both through 999 calls and people attending A&E.

Chris Kowalik, of West Midlands Ambulance Service, said

: "The trust has seen an increase in delays handing patients over to both hospitals. Delays such as these mean that if ambulances have to wait to offload patients, they are then not available to respond to other 999 calls.

"The trust continues to work closely with the Shrewsbury and Telford Hospital NHS Trust to find solutions to the delays."

Simon Wright, chief executive at The Shrewsbury and Telford Hospital NHS Trust, said: "We've seen a 15 per cent increase in attendances at our A&E departments, which is a significant figure as our attendance levels over the course of a year are in excess of 100,000 people.

"With the support of our commissioners we've made improvements such as the introduction of additional nurses to accept and support patients. This is better for patients and allows ambulance crews to return to the road more quickly.

"Around 50 per cent of patients brought into our A&E departments by ambulance need to be admitted for further care. We're working to ensure the remaining patients are taken to the most appropriate place to be seen or treated rather than face an unnecessary trip to A&E."