EEAST Annual Quality Account 2023-2024

• Foreword and statement on quality from the Board
• Welcome to the East of England Ambulance Service NHS Trust
• Introducing the East of England Service NHS Trust (EEAST) quality account
• What is a quality account and what does it mean to EEAST and the public we serve
• Our current quality position
• Care Quality Commission
• Department of Health quality indicators
• NHS number and General Medical Practice Code validity
• Clinical coding error rate
• Data Security Protection Toolkit
• Statement of accountability: Chief Executive Officer, Tom Abell

At the East of England Ambulance Service NHS Trust (EEAST), our unwavering commitment to patient care and the wellbeing of our people drives every aspect of our operations. As we reflect on the past year, we recognise the challenges we've faced and our improved approach to advancing our strategic objectives through connected planning.

Our regulators have recognised our ongoing efforts by moving the Trust from NHS Oversight Framework (NOF) Segment (NOF 4) to NOF 3. Furthermore, significant progress has been made in addressing Care Quality Commission (CQC) conditions, with only two remaining open, expected to close by the end of the financial year. These advancements underscore our commitment to upholding the highest standards of quality and safety and reflect the hard work of our people. Although we recognise there is much more still to do and we continue to work closely with NHS England.

We continue to work on reducing our C2 response times and have established an Organisational Performance Improvement Plan to measure and monitor the deliverables required to improve response times. Collaborating closely with our six Integrated Care Systems (ICS), we have implemented robust strategies to improve the navigation of 999 calls with Urgent Care Hubs, ultimately enhancing patient outcomes. This collaborative approach ensures seamless coordination across the healthcare environment, from emergency response to ongoing care and support. We have also increased the number of schemes developed in partnership with Fire Service colleagues to improve response times in our harder to reach areas.

We have also taken a number of actions to drive culture change and improve the wellbeing of our people:

• Time to Lead: This has now been completed for many of senior leaders and has commenced for our duty operational mangers. This next stage is in progress and will improve our spans of control and therefore the support available for our people.
• Leadership Development Framework: A comprehensive leadership development framework has been developed and prioritised for all operational leaders, empowering them with the skills and knowledge to drive positive change and foster a culture of excellence.
• Recruitment of Resuscitation Officers: The recruitment of resuscitation officers will improve patient outcomes but also provides valuable learning opportunities for our staff, strengthening our overall capabilities in emergency patient care.
• Expansion of Education Team: In line with our commitment to continuous learning and development, we have expanded our Education team to support clinical, leadership, and mentorship learning, equipping our staff with the knowledge and skills needed to excel in their roles.
• Fleet Provision Enhancement: Significant investments have been made to increase fleet provision, including the introduction of Electric response vehicles, with ambitious plans for further enhancements in the new financial year.
• We are pleased to note that more of our staff have felt empowered to speak up, as evidenced in staff survey results and continued high numbers of reported cases. This reflects our ongoing commitment to fostering a culture of openness, transparency, and accountability within the organisation.

In conclusion, as we look ahead, we remain steadfast in our commitment to driving positive change, enhancing patient care, and fostering a culture of wellbeing and quality at EEAST. We are grateful for the dedication of our people and volunteers, the support of our partners, and the trust placed in us by the communities we serve. Together, we will continue to strive for excellence in all that we do, ensuring the highest standards of care for those who rely on our services.

Tom Abell

Chief Executive Officer

Welcome to the East of England Ambulance Service NHS Trust Quality Account for 2023/24. This document has been approved by the Trust Board and is an accurate account of the level of quality of service provided to patients. In developing this Quality Account, we have set out a summary of achievements for 2023/24 and goals for 2024/25 as mandated within the regulatory guidance.

Improving quality is an overarching priority of the Trust and this report lays out plans for developing future services to improve the quality and safety of patient care and patient outcomes.

In order to help do this, the Quality Account is based on data from a range of sources.

Further information about us and our achievements can be found in our Annual Report.

Assurance for quality and safety is given to the Trust Board by the Quality Governance Committee which is in turn informed by our Compliance and Risk Group.
Underpinning the Compliance and Risk Group are a number of groups which cover the multiple aspects of our service including; risk management, patient safety, medicines management, safeguarding, infection prevention and control, medical devices and patient experience.

Information on all groups and how other factors contribute to this such as Healthwatch, internal audit and regulatory inspections can be found on page 59.

Contributions to this document

All Integrated Care Boards (ICB) including Ipswich and East Suffolk ICB (the lead commissioner), HealthWatch groups and the region’s health overview and scrutiny committees (HOSCs) have been invited to provide a commentary on the provision of our quality and care to include within this document. Those received can be found from page 60.

Where can you get hold of this document?

This Quality Account is available on the Trust website or write to:

East of England Ambulance Service NHS Trust Headquarters, Whiting Way, Melbourn, Cambridgeshire SG8 6EN

If you require this document in another format or language, please contact our Patient Advice Liaison Service (PALS) on 0800 028 3382 or by emailing feedback@eastamb.nhs.uk

Other sources of information

We publish a number of other documents which you may find useful, these include; Trust Annual Report, Safeguarding Annual Report and the Infection Prevention and Control Annual Report. These, and other information about us, can be found on the Trust website under Publication Scheme

Our Trust provides emergency and urgent care services throughout Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk.

During 2023/24 we also provided non-emergency patient transport services for patients needing non-emergency transport to and from hospital, treatment centres and other similar facilities within Cambridgeshire, parts of Essex, Bedfordshire and Hertfordshire. We work with six Integrated Care Systems (ICS) covering an area of approximately 7,500 square miles with a resident population of around 6.3 million people.

We employ more than 5,000 staff operating from over 120 sites and are supported by more than 1,000 dedicated volunteers working in a variety of roles including: Community First Responders; volunteer car drivers; BASICS doctors; chaplains and our community engagement group.

The Trust Headquarters is in Melbourn, Cambridgeshire and there are ambulance emergency operations centres (EOC) at each of the three locality offices in Bedford, Chelmsford and Norwich which receive over 1.3 million emergency calls from across the region each year as well as calls for patients booking non-emergency transport.

The east of England is made up of both urban and rural areas with a diverse population. As well as a resident population of about 6.3 million people, several thousand more tourists enjoy visiting our area in peak seasons each year. Our area also contains several airports including London-Luton and London-Stansted as well as major transport routes which increase the number of people in our region on a daily basis.

We have four areas of service provision:

Response to 999 calls as an emergency and urgent care service

In 2023/24, our emergency operations centre (EOC) received 1,384,547 emergency contacts from the public.

On average, over 2,750 emergency 999 calls came into the ambulance service every day.

Call handlers record information about the nature of the patient’s illness or injury using sophisticated software to make sure they get the right kind of medical help. This is known as triaging, and allows us to ensure that the most seriously ill patients can be prioritised and get the fastest and most appropriate response.

More information on how we manage these calls can be found within the Response Times section (page 22) of this report.

Special and partnership operations

The Trust operates two hazardous area response teams (HART) and has a resilience and emergency planning department who work closely with critical care charities and community volunteers to respond to a variety of emergency situations.

Scheduled Care Service – Patient Transport Service

We operate a quality Non-Emergency Patient Transport Service (NEPTS), working in collaboration with hospitals and treatment centres, transporting and caring for a variety of patients, including elderly and vulnerable people, and those with mental ill health, to and from outpatient clinics, day-care centres, and other treatment facilities.

Staff are trained to lift and manoeuvre patients in and out of vehicles, ensuring patients are safe and comfortable during the journey and arrive on time for appointments. Staff are also trained to administer first aid or life saving techniques should this be necessary. Other duties include making sure vehicles are clean and tidy, in line with infection and prevention guidelines and keeping accurate records of journeys. During 2023/24 we undertook 437,647 patient journeys and 41,728 escort journeys – a total of 479,375 NEPTS journeys.

Commercial services

We operate a number of commercial services that generate income for the trust, as well as providing organisational resilience.

CallEEAST, our non-emergency and commercial contact centre, offers an array of contact centre solutions to commercial organisations and NHS Trusts. The team supports 80 separate contracts handling in excess of 850,000 calls every year.

The National Performance Advisory Group (NPAG) brings people together nationally to share best practice and showcase industry developments across the NHS enabling innovation and efficiency.

TrainEEAST, the Trust’s commercial training department offers a wide range of first aid and emergency care training courses for businesses, organisations, individuals and our own people.

A Quality Account is a mandatory report about the quality of services an NHS healthcare trust provides and is required to be completed in line with the Health and Social Care Act 2012.

Quality reports and accounts are set against the framework of three overlapping key themes, patient safety, clinical effectiveness and patient experience, which can be used to define quality of care.

The content is defined by NHS England and includes outcome results against specific indicators under five headings:

1. Preventing people from dying prematurely.
2. Enhancing quality of life for people with long term conditions.
3. Helping people to recover from episodes of ill health or following injury.
4. Ensuring that people have a positive experience of care.
5. Treating and caring for people in a safe environment and protecting them from avoidable harm.

Over the past 12 months I am proud to see that the Trust has maintained its ambulance care quality indicators well above the national average, seen an improvement on all ambulance responses, particularly in relation to our response to category 2 calls (average 22 minutes reduction ) and our category 3 calls (average 2 ½ hour reduction). We have continued to work closely with the healthcare systems; an example being the establishment of Unscheduled Care Hubs across all areas of the Trust and exploring how artificial intelligence can assist with health efficiency within our Emergency Operational Centres. Both the Board and I remain committed to drive and focus on quality and safety with the aim of improving pre-hospital clinical outcomes and the overall experience of our patients. The Trust, our staff, and volunteers along with our system partners remain dedicated to delivering the service our communities deserve whilst balancing the immense pressure the national health service is facing.

At the time of writing this statement the Trust has been successful in its application to move to Level 3 of the National Operating Framework in recognition of the improvements made around its leadership, responsiveness and support provided to staff and communities it serves. The Trust remains to be inspected by the Care Quality Commission (CQC); this is a follow up to the inspection in April 2022, when the Trust was rated as ‘Requires Improvement’. The Trust continues to work hard with all system partners and regulators to ensure all our required actions are met and over two thirds of the must dos and should dos from the 2022 report have been closed – an overview can be found on page 11 of this report.

Furthermore, since the April 2022 inspection visit and the movement to NOF level 3, I am pleased to report that the CQC has now removed four of the improvement conditions and at the time of this report, we are waiting for the outcome of a fifth. The remaining two conditions are currently being drafted for consideration to release by Summer 2024.

I am confident that the lifting of these conditions by the CQC came about because of the overhaul of our policies and processes to ensure both quality and safety and robust monitoring and audit as well as the commitment of our staff and focus on improving quality and safety. It was especially pleasing to note that the Clinical Audit Department received Substantial Assurance, the highest assurance level by an Independent Internal Auditor.

During 24/25 the Trust intend to undertake a true staff and stakeholder collaboration approach to reshaping the clinical strategic vision and have utilised the Quality Improvement Innovation links to partner with Clever Together, a company with a successful record of improvement stakeholder engagement across many healthcare providers promoting further quality improvements.

Reviewing performance against the priorities for 23/24, it is heartening to see how much progress has been made. Clinical supervision for all staff has been established and continued learning from complaints, clinical incidents, patient, staff, and community experiences helps provide constructive feedback to continue to develop our services for the better.

The Trust are currently piloting the first artificial intelligence ‘bot’ within the Emergency Operation Centres by automatically identifying and diverting low acuity falls to community services.
For the fourth year running, we have exceeded the national ambulance average for our quality indicators; heart attack, stroke, and cardiac arrest survival to discharge for those patients where the arrest was bystander witnessed and the initial heart rhythm was ventricular fibrillation or ventricular tachycardia (Utstein comparator).

In summary the Trust has strived to continue to make improvements within the quality and safety portfolio as well as our operational performance. However, I do not underestimate the work we have ahead of us to ensure continuous sustainable improvement. A focus remains on improving timely response to our communities, supporting an inclusive and safe culture to provide the best optimal care and develop further stakeholder and system partnerships to deliver the best and required healthcare as an ambulance service. I remain committed and proud to lead on ensuring the quality and safety of our community and developing the professional workforce of the future to tackle the future challenges the NHS faces.

Simon Chase, Chief Paramedic (Allied Health Professional) & Director of Quality

The Care Quality Commission (CQC), England’s independent regulator of health and social care ensures fundamental standards of quality and safety are met and sets out what good and outstanding care looks like. Then, through inspections, ratings and published reports, it encourages care services to meet those standards. The CQC inspect organisations through five Key Lines of Enquiry (KLoE) to determine whether:

• we are safe
• we are effective
• we are caring
• we are responsive to people’s needs
• we are well led.

EEAST was last inspected in 2022 which involved a comprehensive short notice announced inspection of emergency and urgent care (EUC) and emergency operations centre (EOC) core services as well as a focused inspection of the well-led key question for the Trust overall.

Whilst the CQC recognised that significant improvements had been made in the Trust, the overall rating remained as ‘Requires Improvement’, with the recommendation that the Trust remain in the Recovery Support Programme to ensure continued relevant support to make the changes identified during their inspection.

These changes were required to bring the service in line with legal requirements relating to the core services of Emergency and Urgent Care and Emergency Operations Centre with nine ‘must dos’ identified across these two services. Areas for improvement included; provision of mandatory training and appraisals to all appropriate staff, adequate staffing levels, continued development of staff engagement processes, response times and facilities/premises improvements.

In addition, there were seven actions the Trust ‘should’ take because it was not doing something required by a regulation, but it would be disproportionate to find a breach of the regulation overall, to prevent it failing to comply with legal requirements in future, or to improve services. The full report can be found at www.cqc.org.uk/provider/RYC

Sixty seven deliverable actions were identified , and together with two long term actions from the previous plan, work began on completion.

To date, two-thirds of these actions (46/69:66.7%) have been closed with the remaining actions being those contained within our much longer-term priorities regarding workforce development and the Trust’s cultural journey.

From a previous inspection in 2020, the Trust was also given notice under Section 31 of the Health and Social Care Act with seven conditions relating to; safeguarding, staff allegations, recruitment checks, Disclosure and Barring Service (DBS), contracted private ambulance service provision, sexual harassment and processes to manage concerns, grievances and disciplinaries.

To date four of these conditions have been lifted, and at the time of this report, we are waiting for the outcome of a fifth relating to how we manage concerns, grievances and disciplinaries. Applications for the remaining two, sexual harassment and contracted private ambulance service provision, are being collated and will be submitted this spring.

The hard work we have undertaken regarding the closure of actions, lifting of conditions and other improvements has been recognised by the NHSE resulting in the Trust moving from level 4 to level 3 within the NHS Oversight Framework (NOF) and coming out of the Recovery Support Programme in January 2024.

Next steps Work will continue embedding the actions already implemented and closure of those still ongoing, and we are currently establishing what will be needed to move to achieve level 2 of the NHS Oversight Framework.

The CQC have started to implement their new assessment process and have published guidance relating to;

• how often they will carry out assessments and calculate ratings,
• their single assessment framework, and
• evidence categories.

The new framework retains the 5 key questions; Safe, Effective, Caring, Responsive and Well-Led but these will be assessed through quality statements which are replacing the KLoE prompts.

These statements will give organisations an opportunity to express the commitments that they will live up to, showing how services and providers will work together to plan and deliver high quality care.

Statement topics to be completed are provided in the table.

Safe

• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Effective

• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Caring

• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people's immediate needs
• Workforce wellbeing and enablement

Responsive

• Person-centred care
• Care provision, integration, and continuity
• Providing information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Well-led

• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation
• Environmental sustainability – sustainable development

Work will commence on publishing our statements in quarter one which will be supported by data outcomes as well as patient and staff stories and will link to our ambition to move to NOF2.

All NHS organisations are required to report against a set of Core Quality Indicators (CQIs) relevant to their type of organisation. For ambulance trusts, both performance and clinical indicators are set as well as indicators relating to patient safety and experience. Where information is publicly available, organisations are also required to demonstrate their performance against other ambulance services within the year.

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Ambulance trusts are excluded from this requirement therefore no records were submitted during 2023/24 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics.

As an ambulance service, EEAST was not subject to the Payment by Results clinical coding audit during 2023/24 by the Audit Commission.

The Digital Services organisation within the Trust provides technology to support the operational activities and corporate service areas, digital transformation technology programmes, information repositories and data services. NHS England benchmarked all English Trusts in the year and EEAST were considered to be in the top quartile in the ambulance services category and at the national average for all trusts.

The Trust Electronic Record Platform has now achieved the benchmark of over 95% digital utilisation for all patient interactions which the Trust will target to get to 100% in the years to come, the Trust mobile clinicians also have access to the National Care Records Service to enable access to longitudinal records.

The core clinical platforms maintained very high availability in 2023/24, which no major disruption. The organisation’s digital services through the year maintained the continued service to the wider Trust staff with a continued reduction in time to resolution despite a significant increase in the demand for new services. During the year further new technology has been deployed in support of National guidelines to protect the organisation against the continual cyber challenges, this work never ends, and we will continue this into the coming years.

The digital services team continued to deliver the Trust’s five-year Digital Strategy with a move from physical environments to virtualised external data centres and cloud based technology in line with NHS best practice. The strategy was reviewed and has been adjusted to support the core Trust strategies.

As a Trust we receive over two and half million emails per year and send an average of three hundred and seventy thousand emails every month internally and externally, this shows a near 25% increase on the previous years. The Trust has over seven thousand end user devices all with connection to the internet. Through the year, whilst we saw daily unauthorised attempts to access our systems including multiple brute force attacks, the integrity of all our digital systems and assets were protected and maintained.

The Trust has several processes in place to ensure that data included within the Quality Account is accurate and provides a balanced view. These include:

Clinical data and outcomes

• Checked and verified by the Clinical Audit Manager prior to submission to the national audit programmes,
• Monthly checks of the Department of Health statistical reports to ensure latest comparative data is included,
• Digital Data Quality Checks are automated with tooling with exceptions identified for the resolving process,
• Assurance through internal governance processes to Board Level via the Integrated Board Report.

Data Security Protection Toolkit

• Assurance provided through Information Governance Group to Trust Board via the Audit Committee.

Regular scrutiny of processes and information through:

• Quality Governance Committee,
• Digital Strategy,
• Data Quality and Security Groups,
• Clinical Commissioning Groups contracting requirements,
• Data Quality Committee.

Data Security Protection Toolkit (DSPT) is an online self-assessment tool that allows organisations to measure their performance against the National Data Guardian’s ten data security standards. All organisations that have access to NHS patient data and systems must use this toolkit to provide assurance that they are practising good data security and that personal information is handled correctly. The DSPT also provides the Trust with a means of reporting data breaches and data security incidents.

Following the delayed national submissions in previous years, the 2023/24 assessment submissions continued to have the deadlines of February 2024 for the baseline submission and June 2024 for the final submission.

The Trust submitted the baseline assessment on the 29 February 2024 where 88 of the mandatory evidence items were met, this included a mandatory item which NHS England requested an update on. The Information Governance team hold frequent meetings which concentrate on gaps where evidence is needed to complete a mandatory item.

The Trust has currently completed 91 of the 108 mandatory evidence items, with 7 out of 34 assertions confirmed and are working towards completing the final standards by the 30 June submission. Progress against these outstanding areas will be monitored through our Information Governance Group and assurance provided to the Trust Board through our Audit Committee. The Trust will strive to meet all the mandatory items to be assessed as Standards Met, which was achieved last year for the 2022/23 toolkit.

For the 2024/25 toolkit, NHS England have announced the DSPT will be aligned with the Cyber Assessment Framework (CAF), where there will be 47 contributing outcomes, which the Trust will need to provide evidence and provide answers of “not achieved,” “partially achieved” and “achieved”. Profiles for organisations have been built with a minimum requirement set for organisations to work towards and achieve Standards Met. This will be released in September 2024.

As Accountable Officer and Chief Executive of the Trust, I have responsibility for maintaining the performance and standards achieved within our services, and to support an environment of continuous quality improvement.

This is the 17th Quality Account produced by the East of England Ambulance Service NHS Trust, in line with the requirements of the Health and Social Care Act 2012. The Quality Account contains details mandated by the regulations alongside the measures that the Trust, in association with our NHS and public partners, has decided will best demonstrate the work that has been done to maintain and improve the standard and quality of care we provide to our communities.

This account sets out the work has been undertaken this year to improve the quality of care to patients and outlines where we want to improve to ensure all patients have a positive experience and the standard of care that we want.

As Accountable Officer, it is also my responsibility to ensure both the quality and accuracy of the data within this Quality Account and to confirm that it presents a balanced picture of the Trust’s performance. Therefore, to the best of my knowledge the information contained within this Quality Account for the East of England Ambulance Service NHS Trust is a true and accurate record.

Tom Abell, Chief Executive Officer

• How have we prioritised our quality improvement initiatives
• Priority One - Patient safety
• Priority Two - Clinical effectiveness
• Priority Three - Patient experience

The Quality Account for 2024/25 will continue to focus on the core priorities which match the mandatory indicators for ambulance trusts set by the Department of Health and Social Care (DHSC) as outlined in Part 1 as well as local priorities to improve the quality of care delivered by our staff.

The National Quality Board (NQB) has currently paused its review of the required content for quality accounts so this report has been compiled in line with current published guidance.

How we will monitor progress: Monthly Board reports detailing Learning from Deaths data and through the Patient Safety and Experience Group with progress reported bi-monthly to the Quality Governance Committee

Responsible Lead: Dr Simon Walsh, Medical Director

Date of completion: 31 March 2025

How we will monitor progress: Reported bi-monthly to the Quality Governance Committee via the Clinical Best Practice Group and to the Trust Board via the Integrated Performance Report.

Responsible Lead: Simon Chase, Chief Paramedic and Director of Quality

Date of completion: 31 March 2025

How we will monitor progress: Progress reported bi-monthly to the Quality Governance Committee and through the Patient Safety and Experience Group

Responsible Lead: Simon Chase, Chief Paramedic and Director of Quality

Date of completion: 31 March 2025

• Progress on the quality account priorities 2023/2024
• Performance of the Trust against mandated quality metrics
• Achievements against local priorities for 2023/24
• Clinical audit
• Patient safety incidents
• Serious incidents
• When things go wrong
• Duty of Candour
• National patient safety alerts
• Patient experience and feedback
• You said, we did
• Patient and public involvement (PPI)
• Raising concerns and Freedom to Speak Up
• Working with our local communities
• Commissioning for Quality and Innovation (CQuIN)
• Quality successes throughout the year
• Quality Governance Committee Assurance
• Statements from stakeholders
• Glossary

The following section provides feedback and evidence on the progress of last year’s work on our key quality priorities and our performance.

The content is defined by NHS England and includes outcome results against specific indicators under five headings:

1. Preventing people from dying prematurely
2. Enhancing quality of life for people with long-term conditions
3. Helping people to recover from episodes of ill-health or following injury
4. Ensuring that people have a positive experience of care
5. Treating and caring for people in a safe environment and protecting them from avoidable harm

Except for the time standards to our calls, no thresholds are set by the Department of Health for the Ambulance Clinical Quality Indicators.

Response Times

Ambulance services are monitored against response times for a Category 1 – 4 system (determined by clinical condition/emergency), with varying response times for each category. The table below summarises the Trust’s performance against the national response time standards for 2023/24 and shows that there was improvement in all categories when compared to the previous year.

Published further information for all ambulance services can be found here: www.england.nhs.uk/statistics and more detailed information relating to EEAST can be found within our Annual Report.

In September 2023, EEAST implemented the national principles of C2 segmentation. This is to ensure that we classify the risk within the C2 category that accounts for over 60% of ambulance workload we receive. EEAST has managed C2 calls via Hear and Treat for many years, so the focus has been on increasing staffing and improving processes. Since the process went live, EEAST has increased the number of C2s receiving an appropriate Hear and Treat outcome from 4% to 6%. The impact of C2 response times is still being evaluated.

The increased demand on our services and the handover delays experienced at hospitals within the year has also contributed to the delays seen in attending our patients. To improve our performance, we have worked hard with our system partners and implemented a number of actions such as, co-horting of patients at hospitals to release ambulance clinicians back into the community, alongside moving calls to community providers via the Access to Stack process which is now embedded and consistent. The Trust routinely moves across 4000 calls a month of which 70% are accepted by the community providers. This allows the patient to receive the most appropriate service when they have dialled 999. There is continued work with establishing the six Unscheduled Care Coordination Hubs to deliver the appropriate care to patients.

All calls (with some specific exceptions) now go into the Trust’s Clinical Assessment Service (CAS) stack once received. This ensures that we can optimize the potential to manage the patient in a different way therefore protecting the response to our most ill patients.

The CAS team has been expanded and there are currently 24 validators who have moved to remote working from our Emergency Operations Centres (EOCs) as well as another five who are requesting a hybrid arrangement and are awaiting hardware. We have successfully recruited our first trained and qualified externally recruited validator with a further five due to be inducted and signed off during April. We plan for another five externally recruited staff to be trained during May.

We have also successfully recruited five new clinical workforce managers who are progressing through recruitment processes with an aim to interview four more before the end of quarter 1.

This new key role has been implemented to provide and embed a supportive, motivational, and compassionate leadership culture across the EOC, leading and supporting the CAS teams to deliver the best possible patient care.

The anticipation is that we can become more robust with individual performance and offer a more supportive approach to improving our compliance with clinical targets.

The Trust have introduced the first digital solution using artificial intelligence (AI) to help with identifying and automating a direct referral to community services concerning low acuity falls.

Currently, the Trust, through clinical navigation, manually identify and transfer calls to other health care providers, a system known as ‘access to the stack’. With oversight of the Trust Medical Director and the Senior Clinical Managers within the Emergency Operations Centre, the digital team have successfully created and currently piloting using an automated AI bot to identify, select and transfer low acuity falls responses after the call has passed through the call handling process. The pilot is being monitored with clinical oversight and if successful, the Trust are looking at expanding the call identification to other low acuity code sets.

Heart attack care

Heart disease continues to be one of the UK’s leading causes of death and is the most common cause of premature death, responsible for around 66,000 deaths in the UK each year.

As many as 100,000 hospital admissions each year are due to heart attacks. Because of the life-threatening risk with a heart attack, providing patients with a pre-hospital assessment for a STEMI and administering an appropriate care bundle means a significant improvement on patient outcomes, thereby supporting the NHS to reduce the number of patients dying prematurely and to help people to recover from episodes of ill-health or following injury.

STEMI care bundle

The mandatory quality indicator for ambulance services relating to this topic is the provision of an appropriate care bundle; recording of two pain scores, giving aspirin to break down the clot, giving glyceryl trinitrate (GTN) to dilate the coronary arteries and providing pain relief. The patient care record is audited against all of these criteria and deemed to be either compliant or non-complaint.

The data is reported on quarterly within the year and the table below shows our result against the national average and the best and worst scores achieved by ambulance services within England.

To provide a robust comparison, the table shows our achievement against the average and upper and lower compliance levels for ambulance trusts that have been published to date (April - October 2023). The graph demonstrates our performance against the national average for each quarter (April - November 2023), both demonstrating that the Trust is well above the national average for each quarter within the year.

National data (April to October 2023)

EEAST was the second highest performing Trust for this care bundle achieving 16.2% above the national average for this period. April - October 2023

Patients conveyed to a Primary Percutaneous Coronary Intervention (PPCI) Centre

Although the time it takes to transport a STEMI patient to a specialist Primary Percutaneous Coronary Intervention (PPCI) treatment centre is not a quality metric for the Quality Account, we report our achievement on a month-by-month basis to both NHSE and our commissioners.

This ACQI contains two joint indicators for ambulance trusts and these centres both of which are measured in hours and minutes.

The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April - November 2023). It should be noted that the lower score is the best performing score within these outcomes.

Latest data available April - November 2023 (hh:mm)

Although meeting the national average for the 90th centile, EEAST performed just outside the national average for the mean.

However as demonstrated in the previous section, all patients received excellent care, with EEAST consistently achieving high compliance for the STEMI care bundle and being the second highest performing trust within the year.

Next steps:

As well as continually being monitored through the national ACQI programme, one of the Trust’s priorities for the year ahead is to reduce our response times to Category 2 calls which includes STEMI patients. This will be supplemented by a local priority for reducing the time spent on scene with these patients which will be monitored through a quarterly audit.

Stroke care

Stroke is a type of cerebrovascular disease, which is one of the leading causes of death in the UK accounting for approximately 75% of deaths from cerebrovascular diseases.

Face-arms-speech-time (FAST) is a simple test to help people recognise the signs of stroke and understand the importance of emergency treatment. The faster a stroke patient receives treatment (the care bundle), the better the chances are of surviving and reducing long-term disability.

Stroke diagnosis bundle

This quality metric relates to the percentage of suspected stroke patients (assessed face to face) who receive an appropriate assessment; recording of blood pressure (BP), FAST test and blood sugar levels (BM) the outcomes of which can be used to diagnose a possible stroke. As for heart attacks, the patient care record is audited against all of these criteria and must meet them all for the overall bundle to be compliant.

The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April – November 2023).

National data – April - November 2023

EEAST was the second highest performing trust for this bundle achieving 100% in 2 out of the three reporting months. April - November 2023

Next steps:

In May 2024, NHS England advised ambulance trusts that this ACQI was being removed from the annual programme with immediate effect. However data will still be collected and reported on in relation to stroke timeliness (please see next page).

Stroke Timeliness

Patients who are cared for in a defined stroke unit with organised stroke services are more likely to survive, have fewer complications, and return home and regain independence quicker than patients on a general medical ward.

Although the time it takes to convey a stroke patient to hospital is not a quality metric for the Quality Account, we report our achievement on a month-by-month basis to both NHSE and our commissioners. Our performance is assessed monthly against three indicators for this ACQI: the mean average, median and 90th centile times from call to hospital arrival.

The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April – November 2023). The Lower level relates to the best performing trust for this outcome.

It should be noted that not all strokes are identified at the time of call due to the information provided to the call taker, or the patient may deteriorate before or after the crew arrive.

National data – April – November 2023 (hh:mm)

Although on average EEAST performed just outside the national average for the median indicator for this time period, it matched against the mean and performed better in relation to the 90th centile.

However as demonstrated in the previous section and as per the STEMI ACQI, all patients received excellent care, with EEAST consistently achieving high compliance for this ACQI and being the second highest performing trust within the year.

Next steps:

As well as continuing to be monitored through the national ACQI programme, one of the Trust’s priorities for the year ahead is to reduce our response times to Category 2 calls which includes stroke patients. This will be supplemented by a local priority for reducing the time spent on scene with these patients which will be monitored through a quarterly audit.

Cardiac arrest care

A cardiac arrest occurs when the heart suddenly stops pumping blood around the body. Someone who is having a cardiac arrest will suddenly lose consciousness and will stop breathing or stop breathing normally. Unless immediately treated by cardio-pulmonary resuscitation (CPR) and early defibrillation, this always leads to death within minutes. It is, however, possible to survive and recover from a cardiac arrest if you get the right treatment quickly. Around two-thirds of cardiac arrests outside of hospital happen in the home, but nearly half of those that occur in public are witnessed by bystanders. With each minute that passes in cardiac arrest before defibrillation, chances of survival are reduced by about 10%.

This year we set out to improve the Trust’s outcomes from cardiac arrest and work towards an increase in Return of Spontaneous Circulation (ROSC) and ‘survival to discharge’ figures.

Although the indicators displayed in the table below are not quality metrics for the Quality Account, we report our achievement on a month-by-month basis to both NHS England and our commissioners, the exception being the post-ROSC care bundle which is a quarterly requirement.

The post-ROSC care bundle contains six components, the recording and administration of: 12 lead ECG; blood glucose; end tidal CO2; oxygen; systolic blood pressure, and saline fluids for all patients who achieve a ROSC on scene which continues to hospital. Patients who had suffered a traumatic cardiac arrest, were successfully resuscitated before the arrival of ambulance staff or were aged less than 18 years are not included.

The table below shows our result against the national average and the upper and lower levels achieved by ambulance services within England for data published to date (April – November 2023).

National data, April - November 2023

With the exception of 30-day survival (all patients group), EEAST is performing above the national average for all cardiac arrest related indicators. It was also the second highest performing average compliance for the Post-ROSC care bundle and 19.3% better than the national average for the time period.

It should be noted that not all ambulance trusts submitted full data, so these outcomes must be used with caution.

Next steps:

This will continue to be monitored through the national ACQI programme. Successful outcomes from cardiac arrests are, in part, due to actions taken by acute organisations following arrival at hospital as well as early access to treatment and intervention as well. As our response times improve, so should our rates of ROSC and survival.

Priority One: Patient Safety

Embedding the Learning from Deaths programme.

For many people, death under the care of the NHS is an inevitable outcome and they experience excellent care from the NHS in the months or years leading up to their death. However some patients experience poor quality provision resulting from multiple contributory factors, which often include poor leadership and system-wide failures. NHS staff work tirelessly under increasing pressures to deliver safe, high-quality healthcare. When mistakes happen, providers working with their partners need to do more to understand the causes. The purpose of reviews and investigations of deaths which problems in care might have contributed to is to learn in order to prevent recurrence (National Quality Board:2018).

Following the adoption of the Learning from Deaths (LfD) programme in 2022/23, our aim for the year was to embed the process to improve the quality of care delivered to service users, both when things go well, and when things could have been done differently. Part of this included the implementation of a robust review process to ensure improvements in the delivery of care and a reduction in harm to patients.

In quarter 4, facilitated training courses in relation to the Shared Judgement Review (SJR) process were delivered to a selected number of our clinicians. In total 19 were trained by the end of the year with a further course planned in April. This will allow us to undertake a minimum of 40 SJRs per month, increasing the volume of the data reviewed, to further learn from excellence as well as highlighting areas for improvement.

Learning from lives and deaths of people with a learning disability and autistic people (LeDeR)

LeDeR is a service improvement programme funded by NHS England that reviews deaths, identifies issues and takes actions to improve health and wellbeing for people with a learning disability. EEAST’s safeguarding team contribute information to LeDeR reviews where the service has had contact with the patient. More information can be found within our Safeguarding Annual Report at www.eastamb.nhs.uk.

Next steps:

In 2024/25 we will;

• Deliver training to all Band 7 clinical managers as well as to our Advanced Paramedics.
• Embed our review process to incorporate a minimum of 40 SJRs per month.

Embedding the Patient Safety Incident Response Framework into the organisation

The Patient Safety Incident Response Framework (PSIRF) is the new way that the NHS looks at patient safety incidents. It has replaced the Serious Incident Framework (SIF) and represents a significant shift in the way the NHS responds to patient safety incidents.

Working closely with our lead commissioner and regional patient safety specialist, EEAST successfully launched the PSIRF on 01 October 2023.

The PSIRF allows for more in-depth thematic reviews so that Trustwide learning can take place, leading to improvements in patient care and reduction in future harm. A number of new roles for patient safety specialists and partners have been recruited to and the first thematic report, relating to cardiac care, will be shared with the Integrated Care Board (ICB) in spring 2024.

Next steps

This important piece of work will continue as a local priority and in 2024/25 we will;

• Continue to embed the PSIRF into the organisation.
• Aligned to the previous priority, deliver a programme to provide After Action Review training for all Band 7 clinical managers as well as to our Advanced Paramedics in the After-Action Review
• Embed our review process to incorporate a minimum of 40 SJRs per month.

Implementation of a Continuous Improvement Assurance Framework

Our aim for the year was to implement an overarching Continuous Improvement Assurance Framework (CIAF) to link up a number of important processes and reporting functions including our CQC recommendations, improvement plan actions, audit programmes and processes including internal audit and our identified risks to undertake monitoring, identify good practice and further areas for improvement.

To date a number of these are now included within our bespoke software; CQC actions, annual clinical audit plan, recommendations from claims and inquests and assessments against the previous CQC KLoE prompts. Recommendations from our internal audit activity have also been included with the lead external audit contact being provided with access for monitoring purposes.

Next steps

Work on linking supportive data within the system with our existing Power BI reports has been constrained by our IT fire walls, however this is in the process of being resolved – this will mean that we can evidence embedded change within the organisation. We are also working with the software providers to develop the new CQC ‘We statements’ within the system, which will enable to us to provide and evidence these, not only for the Trust overall, but also for each of our six sectors within our emergency and urgent care service as well as for patient transport services and our emergency operations centre – the core service categories as defined by the CQC.

Priority Two: Clinical effectiveness

Embedding of clinical supervision

Placing the patient at the centre of our organisation also means we need to focus on the clinician to enable them to care for others safely and effectively. The Trust had recognised that there were gaps within the provision of clinical supervision with sometimes undefined processes.

Following on from work started in 2022/23, our priority for 2023/24 was to embed clinical supervision in our patient-facing workforce delivered by approved supervisors, in a relationship-based education and training system that is work- focused and which manages, supports, develops and evaluates the work. This aligns with our Operational Performance Improvement Plan (OPIP) which recognises that recruitment of additional supervisors and managers is required to ensure good levels of support against the ratio of staff.

Clinical supervision has now been implemented across our six operational sectors.

This process has involved the appointment of clinical supervisors and then training for all the successful clinicians. Following the business planning round for this financial year, 2024/25, it has been agreed that the jobs are now permanent and staff will be appointed into the role. Clinical supervision allows clinician to receive a clinical supervision session each twelve months. Initial feedback across the region has been positive with people saying how useful the sessions are. The aim of clinical supervision is to support the development of practice and to reduce variation. Some of the key areas of initial work are job cycle time and also referral of patents to appropriate care pathways as outlined in the intercollegiate document developed by AACE, the College of Paramedics and NHSE&I, Clinical Supervision. A framework for UK ambulance services 2021

Our operational sectors aligned with our region’s Integrated Care Boards (ICBs);

• Bedfordshire and Luton
• Cambridgeshire and Peterborough
• Hertfordshire and West Essex
• Mid and South Essex
• Norfolk and Waveney

Next steps:

To monitor the outcomes from clinical supervision to support better care for our patients and ensuring the time on scene element is appropriately being used as well as looking at how safe appropriate use of pathways is affecting how we can better deliver patient care.

Implementation and completion of year 1 objectives of the Clinical Strategy

The Clinical Strategy, including our Clinical Operating Model as developed with our system partners, was approved at Board in November 2022, and so 2023/24 has been our first full year of delivery.

The Clinical Operating Model brings together:

1. An emergency call handling and initial triage response to patients who need an immediate life-saving emergency response;
2. Liaising with our NHS system partners to provide remote clinical assessment of patients to direct them to appropriate alternative treatment, when an emergency response is not needed; and
3. Outstanding face to face care that responds directly to a patient’s needs when an ambulance is dispatched.

In year 1 of delivering this model, we have:

• Delivered C2 segmentation, which means we respond to the sickest patients first and make further checks on other calls to make sure they get the appropriate level of clinical response
• Supported the establishment of six unscheduled care hubs with our Integrated Care Boards in each sector, which are now delivering improved access to alternative care, reducing unnecessary admissions.
• Developed our advancing practice offer and recruited 7 additional advanced practitioners, with an additional 25 in training, to support our most complex patients with urgent care needs.
• Delivered our clinical workforce plan to increase our patient-facing clinicians by 240 against a target of 220.

Next steps:

Building on the programmes delivered so far, the focus in 2024/25 will be:

• Continue to drive improvements across the regional Emergency Operating Centre Transformation programmes. This includes improving our call taking capability to support collaboration with other services, embedding a new model where non-emergency calls are dealt by non-emergency call handlers. This enables our emergency call handlers to focus on responding to patients in the community in urgent need of care. We will review our current dispatch model and reflect changes against fleet availability, alongside reviewing and streamlining our resource allocation guidelines. Continue to deliver excellence in remote clinical assessment to ensure our response resources are available for our trauma patients and patients who require emergency treatment at scene or en route to hospital. This supports our hear and treat model ensuring alternative care is offered when appropriate, working in collaboration with other services through the unscheduled care hubs, focusing on increasing access to alternative providers to support appropriate care close to home.
• Expanding the advanced practitioner programme with an ambition to reach 100 at the point of closure of the clinical strategy (2026), and ensuring their advanced practice operating model is effective.
• We will also continue to deliver our Time to Lead programme which invests in building our leadership capacity and capability in all frontline clinical operational services to drive culture change and ultimately better care to our patients.

Publication of our Public Health Strategy in collaboration with Public Health England

Through the pandemic, a considerable amount of work was undertaken on a collaborative strategy with PHE and the service worked closely with them regarding coronavirus data. In 2023 AACE produced a report: “Strengthening the role of the ambulance sector in reducing health inequalities” alongside a consensus statement which set out a shared commitment to strengthening the role that everyone working in the ambulance sector can play in reducing health inequalities. As set out in the 2023 AACE report our aim is to unlock the potential to improve population outcomes, tackle inequalities and challenge the demands placed on the sector by preventable causes.

An implementation toolkit was provided containing information and links to further resources that support a focus on embedding a public health approach within the ambulance sector with the aim of reducing health inequalities experienced by the populations and communities we serve.

NHS England’s Operational Planning Guidance for 2023/24, set out priorities for addressing highlighting the importance of reflecting the Core20PLUS5 approaches for adults, children and young people in plans and taking a quality improvement approach to addressing healthcare inequalities.

In 2023/24 we completed the self-assessment benchmarking using the AACE maturity matrix and identified areas for development within four themes:

1. Building public health capacity & capability
2. Data, insight, evidence & evaluation
3. Strategic leadership and accountability
4. System partnerships

These link to our Trust priorities building on the work we are already undertaking.

Next steps:

This will continue to be built on in the year ahead with a bid to secure some dedicated resource to support the public health work.

Priority Three: Patient Experience

Patient survey programme

EEAST has had a comprehensive annual patient survey programme in place for many years, however our priority for 2023/24 was to enhance this to ensure that views were obtained from patients who have used different aspects of the service or are from seldom heard groups. We recognise that different patients that patients have different needs and access a variety of our services including being treated at home.

Two specific aims were included within this local priority;

1. Bespoke user-friendly survey forms, and
2. Identification and removal of barriers to enable a more inclusive feedback process from all patient groups.

A number of key points were achieved during the year;

• Usage of the EasyRead survey, co-produced with the Disability Real Action Group of Norfolk (D.R.A.G.O.N.S), a group of young people with disabilities that are looking to make sure that SEND opportunities, in Norfolk, are accessible, at the Norfolk and Norwich SEND Association (NANSA), to patients who used either our emergency or patient transport services.
• Building on our co-production efforts around patient surveys by co-producing a short video to sit alongside the easy read survey. This was also co-designed with the D.R.A.G.O.N.S, and a young person has undertaken the voice over for the video as part of this work. The video will be available following the launch of the new public website in April 2024. This survey project has highlighted the importance of co-production and working with experts by experience as equal partners. We are looking to build on this and support co-production in other departments throughout the next year.
• Bespoke surveys for different patient groups/conditions including;
  • maternity care,
  • skin tear treatment,
  • those who had been referred to another service e.g. mental health services, falls team, GP, local authorities and the Fire and Rescue Service as part of our safeguarding processes,
  • patients who had received additional assessments via pre-hospital stroke video consultation,
  • young person Instagram survey - designed in collaboration with the Youth in Mind Group at the Mancroft Advice Project,
  • online mental health survey (co-produced with the SUN Network) which was trialled as a social media poll survey.

Outcomes for all of these surveys, can be found within the Patient Experience section of this report from page 46.

Next steps:

The Trust is committed to developing its patient experience and engagement activity and continually explores new methods to obtain feedback and to ensure the voice of patients within seldom heard groups are heard. Co-production and working with experts by experience will continue, placing our patients and communities at the heart – particularly during the development of the Trust Strategy 2025-2030.

Patient and Public Involvement (PPI) Strategy

In 2023/24 we planned to implement the year 3 objectives of our Patient and Public Involvement Strategy, this included:

• Setting up public Engagement Forums to improve engagement with members of the public. These Forums will be an opportunity to involve the public in any recent developments at EEAST, and to hear their views and feedback and sharing what EEAST has learnt and developed in response to public engagement.
• Establish a definitive list of EEAST committees and meetings where the public voice should be involved and implement CEG representation at these.
• Work with Communications and other EEAST colleagues to publicise EEAST engagement opportunities to the public, staff and volunteers.
• Identify learning from patient and public involvement activities linking in with other patient experience feedback.
• Restructure the Community Engagement Group to ensure it is ‘fit for purpose’ and accessible to a wider more diverse range of people and communities to improve engagement volunteering.
• Work in conjunction with EEAST volunteer group support and management colleagues to improve links and align practices.
• Continue to provide resources to support staff and volunteers to undertake engagement activities.

During the year, we achieved:

• A full restructure of the Community Engagement group, introducing 3 roles to engagement volunteering which enable volunteers to join us in a role which best suits their skills, capacity and interests. The new structure was launched publicly on 1st December 2023. The group has a new action plan and are now undertaking training, and recruiting new members.
• We have established closer links than ever before with our colleagues from across EEAST who support different volunteer groups. This has provided opportunities to improve the Community Engagement Group recruitment processes, training and sharing of news and information. It has also provided more joint working opportunities and support for public engagement events.
• The PPI team has supported staff and volunteers to attend 277 events and engage with over 8700 people in 2023/24, providing promotional items and resources to enable engagement.
• The PPI have undertaken 19 patient discovery interviews with patients or their relatives to better understand their experience of the care EEAST provides, and to identify way to improve the service. This learning has been shared at public Board meetings throughout the year.

Next steps:

• We will be introducing Public Engagement Forums in the summer 2024. The first will be a face- to- face event and will focus on some of the engagement work needed for the development of the EEAST 2025-2030 strategy. Virtual engagement sessions will also be offered to provide alternative engagement options for the public.
• We will continue to work closely with other volunteer support colleagues to embed the introduction of the Assemble volunteer management software from July 2024 onwards and look at joint opportunities for engagement and support.
• We will continue to recruit to the community engagement group and provide to support to help them deliver their action plan, ensuring patient voice representatives are included at Trust meetings and committees.

For more information on how we work with patients and their representatives, please see the Patient Experience section of this report which can be found from page 46.

Clinical audit is a crucial part of the Trust’s strategy to improve health care to service users. The evaluation of clinical performance against standards or through comparative analysis, with the aim of informing the management of services, is an essential component of modern healthcare provision. It forms part of the Trust’s clinical governance arrangements helping to ensure safe and effective clinical practices.

During 2023/24, EEAST participated in 100% of all required national audits which for ambulances are those defined within the Ambulance Clinical Quality Indicator (ACQI) programme, three of which: stroke; cardiac arrest and STEMI were included earlier in this section. It also fully participated in the National epidemiology and Outcome from out-of-Hospital Cardiac Arrest (OHCA) registry study undertaken by the University of Warwick and is included as an audit within the Healthcare Quality Improvement Partnership (HQIP) annual programme, of which more information and the latest publications can be found at https://warwick.ac.uk;

Within the year ambulance services began undertaking a new quarterly ACQI for Falls in Older People. This is currently in the pilot stage and although EEAST has submitted data in line with the requirement, data has not yet been published by NHSE. It is expected that this ACQI will be adopted into the annual programme within 2024/25 once the pilot stage has been completed.

Local Audits 2023/24

Undertaking audits in relation to the nationally mandated Ambulance Clinical Quality Indicators relating to cardiac arrest, stroke, STEMI and sepsis patients is a huge amount of work, however in 2023/24 we completed our annual audit plan in full including local audits prompted by a number of other drivers including incidents and patient experience, as well as those prompted as re-audits from the previous year.

The following tables show the audit topic, levels of compliance, identified areas requiring improvement and next steps to improve the quality of care we deliver.

Audit of capacity to consent forms

We understand that some patients do not want to be treated or go to hospital and it is important to determine as to whether we are acting in their best interests and that they have a positive experience.

Mental Capacity Act (MCA) assessments are completed regularly by frontline staff to evidence a patients decision making capacity. A standard decision-making tool is included within the electronic Patient Care Record (ePCR) that allows crews to record their assessment.

A random sample audit was undertaken in 2023/24 to look at the appropriateness and quality of capacity to consent forms to aid safe decision making taking into account patient’s wishes.

The following fields were audited:

• Is there and impairment or disturbance in the functioning of mind or brain (Permanent or Temporary)?
• With all possible help given, is the person able to understand the information relevant to the decision?
• Are they able to retain the information long enough to make the decision?
• Are they able to weigh the information as part of the decision-making process?
• Are they able to communicate the decision?

Additionally, the following questions were asked:

• CAD reference number?
• Has any additional information in relation to the MCA assessment been included in the Supplementary Comments section of the ePCR?

From the audit it was found that a high level of compliance was found across assessments that were audited in relation to the “yes/no” questions within the assessment.

However, only 30% of MCA assessments included additional information within the supplementary comments section of the ePCR to expand on the “yes/no” questions within the assessment. Section 5 of EEAST’s Mental Capacity Act Policy sets out that “Written records should clearly indicate what decision or consent to act the person was assessed for and how the decision was made that the person lacked capacity. This should include the steps taken to establish 'reasonable belief'.

Next steps:

The outcomes of the audit have been shared with staff with a reminder of the importance of including information in relation to clearly recording what decision or consent to act the person was assessed for and how the decision was made that the person lacked capacity. This should include the steps taken to establish 'reasonable belief'. Learning from the audit is also being incorporated into future training for clinical staff.

A repeat audit will be completed in 2024/25 to determine as to whether any improvements have been made.

Quality of documentation An improvement identified and required within all audits is the quality of documentation, a topic also identified within complaints and incidents investigations.

As a result, EEAST began a monthly Quality of Patient Care Records (PCR) audit in June 2023. The audit is set against the minimum data standard requirements for ambulance services (20 indicators) and each area is required to undertake and submit data for 50 records each calendar month.

Although this shows that the Trust overall achieved relatively high standards of documentation, there are consistently three areas where improvements are required. As found within the management of pain audit, the documentation of a second pain score to determine the impact of actions/treatments; the recording of the name and place of the educational establishment for patients of school/college age (a recommendation from Lord Laming’s report into the death of Victoria Climbié); the name of the person to whom the patient’s care was transferred. This is needed to ensure that in any subsequent investigations, the correct members of staff within all organisations are identified.

As a result of these outcomes, one sector has been working closely with the quality improvement team, clinical audit and legal services managers to develop a number of things to be rolled out Trust-wide including the development of pod casts and posters.

This audit will be ongoing with the aim of achieving at least 85% for these indicators with an aspirational target of achieving 95%.

Other outcomes

An internal audit undertaken within the year resulted in EEAST’s clinical audit processes being awarded with ‘substantial assurance’ an improvement on the ‘limited assurance’ reached two years ago.

Next steps

The annual clinical audit plan will continue to be an integral part of monitoring and improving the quality of care delivered to our patients with work on the approved annual plan for 2024/25 already started.

Results are shared with staff across the organisation in the form of posters and podcasts, the introduction of supervisors within the organisation will provide an additional opportunity to share outcomes with staff to improve the quality of care delivered.

Clinical research is an important function within the NHS, bringing benefits to patients, clinicians, and NHS trusts. High quality research activity provides evidence for new ways of delivering care, as well as preventing, diagnosing, and treating conditions. Many patients want to take part in research, the findings result in better treatment for patients, involvement in research helps clinicians to understand evidence and use this in their clinical practice, and research-active trusts tend to attract more forward-looking clinical staff.

The EEAST Research Support Service (RSS) works with academic and other health and social care partners regionally and nationally to develop, support, deliver and promote research as a core part of service provision. RSS ensures that patients and staff have a broad range of opportunities to participate safely in relevant pre-hospital ambulance research.

During 2023/24, EEAST recruited 630 participants (patients and NHS staff) into seven high quality research studies approved by a Research Ethics Committee, all of which were National Institute for Health Research (NIHR) Portfolio pieces of work, and one was an EEAST sponsored study as follows:

• Should I stay or should I go: NHS staff retention post COVID-19. (n=249)
• Exploring the use of pre-hospital pre-alerts and their impact on patients, ambulance service and Emergency Department staff - Pre-alerts. (n=141)
• Paramedic delivery of end-of-life care: a mixed methods evaluation of service provision and professional practice – ParAid. (n=93)
• Medication route in cardiac arrest - PARAMEDIC3. This study is on-going. (n=88)
• Exploration of behaviours and lifestyle factors impacting levels of vitamin D within a UK ambulance service workforce - EVOLVED - EEAST Sponsored. (n=40)
• Co-producing an Ambulance Trust national fatigue management system - CATNAPS. This study is on-going. (n=17)
• Randomised trial of paramedic delivered Fascia Iliaca Block (specialised pain management) for hip fracture - RAPID-2. (n=2)

Note: n= relates to the number of participants in each project.

Further information is available by contacting RSS at research@eastamb.nhs.uk. EEAST has a reputation for successful development and delivery of high-quality research. Such continued participation in clinical research has demonstrated the Trust’s on-going commitment to improving the quality of care offered and contributing to wider health improvement.

A patient safety incident is defined as any unintended or unexpected incident which could have or did lead to harm for one or more patients receiving NHS care. This includes:

• incidents that caused no harm or minimal harm
• incidents with a more serious outcome
• prevented patient safety incidents (known as ‘near misses’).

The number of incidents reported by staff during 2023/24 demonstrates a good culture of reporting and being open and honest. Where a near miss has happened, proactive steps can be taken to reduce the risk going forwards and to maintain a learning from incidents culture. The number of patient safety incidents relating to delays has decreased since 2022/23.

The chart below shows the number of patient safety incidents reported versus our activity during the year.

Previously all NHS organisations had a responsibility to report any safety incidents relating to patients through the National Reporting and Learning Service (NRLS). However, within the last year, this was superseded by the Learning from Patient Safety Events (LFPSE) which EEAST implemented on 01 October 2023. More information on LFPSE can be found in the next section.

Prior to the implementation of the Patient Safety Incident Response Framework (PSIRF) EEAST reported on the level of harm they directly caused in relation to individual incidents. Since the implementation of PSIRF in October 2024, the parameters to which levels of harm are reported has been updated in line with Learning From Patient Safety Events (LFPSE) guidance to reflect how EEAST may have contributed towards harm.

A requirement within the Quality Account requirements is for each trust to provide a comparison of their patient safety incidents reported to NRLS against the national average for similar services.

However, with this process moving to the new reporting platform, reports have been paused and no data had been published for 2023/24 at the time of writing this document.

In 2023, the system used to report and monitor the progress of Serious Incident investigations across the NHS, transferred from the Strategic Executive Information System (StEIS) to a new reporting system, Learning from Patient Safety Events (LFPSE).

This is supported by a new Patient Safety Incident Response Framework (PSIRF) which makes no distinction between ‘patient safety incidents’ and ‘Serious Incidents’. As such it removes the ‘Serious Incidents’ classification and the threshold for it. Instead, the PSIRF promotes a proportionate approach to responding to patient safety incidents by ensuring resources allocated to learning are balanced with those needed to deliver improvement.

Within this framework, organisations are required to implement a plan that takes account of a number of categories including;

• The involvement of patient safety partners
• Engaging and involving patients, families and staff following a patient safety incident
• Responding proportionately to patient safety incidents
• Oversight roles and responsibilities
• Patient safety incident response standards

Recording patient safety events, whether they result in harm or not, provides vital insight into what can go wrong in healthcare and the reasons why. At a national level, this allows for new or under-recognised safety issues to be quickly identified and acted upon on an NHS-wide scale, ensuring providers across the country take action to reduce the risk.

*The data in the table shows SI figures from 01 April – 30 September 2023, PSIRF data shows figures under the new framework which EEAST implemented on 01 October.

Serious Incidents and PSIRF data

With a commitment to treat more patients in the community, an important piece of learning from a thematic review of non-conveyance serious incidents, was the introduction of a non-conveyance care bundle. This is designed to improve the safety of patients who are discharged from EEAST’s care to another part of the healthcare system.

The organisation developed an electronic auditing tool to sit alongside the care bundle which has allowed continuous monitoring of its use and identify focused areas of improvement to further improve the safety and experience of patients not needing hospital treatment. This piece of work is continuing to be developed and monitored by the Patient Safety Team into 2023/24 with further training planned to be rolled out.

Never Events

There were no ambulance specific Never Events within the NHS Never Events List for 2023/24. It should be noted that Never Events formed part of the previous Serious Incident Framework, with the implementation of PSIRF, NHSE is currently consulting on a new Framework.

It remains important to us to act in a timely manner when something goes wrong. This part of the report shows the response we made in acting on some of these things and what we did about them following the reporting of an incident.

NHS providers have a statutory duty to inform and involve patients and their families in investigations where there has been severe harm under Regulation 20 of the Health and Social Care Act. In line with our policy, Duty of Candour (DoC) is overseen by the Patient Safety team and is attempted to be discharged for every serious incident, regardless of the level of harm caused. Further relevant cases are identified through a daily review of incidents reported. Contact is made with the patient, or a nominated representative, via telephone in the first instance. Following the primary telephone call, the conversation is summarised in a letter.

The content of our primary Duty of Candour conversations include:

• An introduction
• An explanation of the incident identified
• A sincere apology from us and condolences if the patient has sadly died
• An explanation of the investigation process
• An opportunity for the patient or nominated representative to ask any questions which they would like to be answered in the investigation
• Establishment of preferred methods and frequency of involvement and communication throughout and after the investigation period.

There are often instances when it takes us longer to identify the individual most appropriate to discharge the Duty of Candour to. This is due to us not always having full patient or next of kin information. Our approaches to finding out this information include:

• Communication with GPs
• Liaising with the patient safety specialists at the admitting hospital
• Close working relationships with His Majesty’s Coroners.

Regulation 20 of the Health and Social Care acts requires the Duty of Candour to be discharged as soon as is reasonably practicable but always within 10 working days.

Analysis of our data demonstrates the following compliance with Duty of Candour for 2023/24 for serious incidents and Patient Safety Incident reviews compared to the previous three years.

*For cases where Duty of Candour was not discharged, this is due to not being able to identify or make contact with next of kin despite best efforts to do so.

Patient safety issues that require national action are identified predominantly through incidents reported by providers to the National Reporting and Learning System. When these issues are identified, work is undertaken with frontline staff, patients, professional bodies, and partner organisations to decide if there is a large enough risk to issue a National Patient Safety Alert (NPSA) through the Central Alerting System, which in turn sets out actions that healthcare organisations must take to reduce the risk. These alerts must be acknowledged and, where appropriate, actions taken.
The Trust has a robust way of monitoring compliance with national alerts and this year we responded to three relevant National Patient Safety Alerts:

• June 2023 – Potential risk of underdosing with calcium gluconate in severe hyperkalaemia
• July 2023 – Potent synthetic opioids implicated in heroin overdoses and deaths
• March 2024 – Shortage of salbutamol 2.5mg/2.5ml and 5mg/2.5ml nebuliser liquid unit dose vials

All other safety alerts released were reviewed and deemed not relevant to EEAST or the ambulance sector.

Although not mandated to report on patient experience, as a Trust we feel that it is really important to tell people how we are continually improving our services as a result of our patients’ experiences and feedback. Patients are at the heart of everything we do, and as such we believe that patient voice should be a key driver in the way that we improve our services. The following pages provide information on what our patients and their families have told us through complaints, concerns, compliments and surveys, what steps we have taken to improve and how we intend to improve further in the future.

The Patient Experience Team co-ordinate complaints, concerns, compliments and comments for the Trust, in line with the NHS Complaints Regulations 2009 and local policy. All feedback, both positive and negative, is managed and recorded by the department. Communication with patients or their families is maintained throughout the process and they are provided with a response to their feedback, with a focus on resolving complaints and identifying learning at the earliest opportunity.

Compliments

Compliments always far outweigh the number of complaints received, and in 2023/24, 3,634 compliments were reported to the Trust, which equated to an average of 302 per month (a significant increase on the previous year’s average of 225 per month) compared to 495 complaints received. Compliments are reported to the Trust board and the individual colleague and are recorded on the staff member’s personnel file. This year we have started looking at themes from compliments to help us learn from excellence, and the common themes include kindness and compassion, calmness and reassurance, professionalism and good clinical assessment and treatment, with many compliments described as lifesaving.

Complaints

As a Trust we closely monitor the numbers and themes of complaints that we receive and use this learning to support service improvement. During 2023/24 complaints and concerns arose from 0.06% of our contacts with patients which is an improvement of 0.1% on the previous year. All complaints and concerns which cannot be resolved under early resolution receive a local investigation and depending on the nature of the complaint or concern, may also be reviewed by the patient safety team. Complainants are supported through the process of raising a complaint and investigation by our patient experience coordinators, and upon receiving a written response, face to face meetings are arranged where complainants require further support.

The number of re-opened complaints remains very low, meaning complainants are usually satisfied that our responses have addressed and, where able, resolved their questions and concerns.

The biggest themes from complaints and concerns were delay (these mostly related to delays in the patient transport service, with only 22% of delay complaints relating to emergency operations centres and emergency services), transport and driving (which again mostly related to the patient transport service, which accounted for 94% of these), and clinical assessment and treatment (of which 85.9% were for emergency operations centres and emergency services). These themes reflect the improvements in emergency ambulance attendance times achieved via the Trust’s delay action plan, however a significant number of the clinical assessment and treatment complaints relate to either no sends or treatment at home under this same plan, suggesting that some patients have not felt confident that the alternative care pathways offered were right for them. These complaint themes also reflect a challenging year for the patient transport service, with some of our services delivering journey volumes more than the contracted levels.

You said, we did

As a Trust we recognise the importance of learning when things have not gone as well as we would have liked. Through feedback received from our patients, carers and relatives we have an opportunity to put things right and to prevent future recurrences. All our teams at EEAST are passionate about improving the services that we provide to our patients and the public.

The following case studies are just two examples of some of the learning that has been taken forwards by the Trust over the last year.

Parliamentary and Health Service Ombudsman (PHSO)

Although most complaints are successfully resolved through the Trust’s complaints process, complainants are able to refer their complaint to the Parliamentary and Health Services Ombudsman (PHSO) for an independent review. This happens if a complainant feels that their complaint has not been resolved and the Trust has exhausted all avenues of resolution. This provides complainants with an impartial, independent review of their complaint and gives clear guidance to the Trust on how to improve our investigations and responses.

In 2023/2024 the Trust was notified of eight cases which had been referred to the PHSO by complainants. Of these, so far none have been opened for investigation; four have been closed following initial review by PHSO and four remain in the initial review phase. In addition, there are three open investigations dating from 2022/2023. We have received initial feedback for one of these, and the PHSO have indicated that on current information this is unlikely to be upheld. The PHSO has a significant backlog in respect of investigations, and as such we are seeing cases remain in the initial review and investigation phase for extended amounts of time.

The PHSO continued to undertake training and develop processes in line with the PHSO NHS Complaints Standard Framework. The team and the Trust are largely working to this framework, however there are some changes required for 2024/2025 in terms of reporting and training.

Patient surveys

As stated within a previous section, the Trust has a comprehensive annual patient survey programme which includes continuous surveys for the emergency service (ES), Clinical Assessment Service (CAS) and the patient transport service (PTS). Planned survey projects undertaken will vary in line with the Trust’s priorities and strategies. These projects are often co-produced with experts by experience to ensure people and our community are treated as equal partners in service design, development, and evaluation.

Patient surveys are signposted using various methods, including the Trust’s social media channels, patient information cards and invitation to feedback letters, which are posted to random samples of ES and PTS patients every month. During 2023/24, Short Message Service (SMS) survey signposting commenced for PTS patients across the region. Approximately half of the PTS survey submissions received during year have been as a result of the SMS signposting.

Listening to the patient voice enables the Trust to identify, not only what is working well, but also to highlight areas for learning and service improvement. Feedback received through surveys is monitored and triangulated with the themes identified through complaints, patient engagement, and patient safety to ensure appropriate governance, learning, and to improve patient experience and outcomes.

All patient surveys include the Friends and Family Test (FFT) question, ‘Overall, how was your experience of our service?’ as good practice. The FFT is a method of calculating the overall satisfaction of the patient and is used as a benchmark across the Trust. The FFT result is calculated by dividing the proportion of ‘very good’ and ‘good’ responses (numerator), by the overall number of responses (denominator). The FFT is a national directive, and the Trust is required to provide all PTS patients with the opportunity to respond to the FFT question, with results reported to NHS England each month.

Outcomes from this and the previous year’s rolling overall satisfaction results for the ES/CAS and PTS continuous survey can be found in the table below. This shows a slight reduction for all services which is an indicator of the pressures that we experienced during the year.

Overall Satisfaction (Friends and Family Test)

Survey projects

The following provides further information on each of the surveys undertaken throughout the year.

Easy-Read

During 2022/23, an EasyRead survey was co-produced with the D.R.A.G.O.N.S at the Norfolk and Norwich SEND Association (NANSA) – highlighting the importance of co-production and working with experts by experience as equal partners. Since April 2023, the survey has been available for ES and PTS patients to share their experience relating to the service received. Feedback has generally been positive (overall satisfaction: 93.9%); the main area of dissatisfaction has related to delays/non-attendance, which has been shared as part of the wider system review.

Safeguarding

The safeguarding survey has continued throughout 2023/24, with the aim being to obtain feedback from patients who had consented to a safeguarding referral (e.g., mental health services, falls team, GP, local authorities and the Fire and Rescue Service). Overall satisfaction with the service received has been high (95.9%), with patients generally felt included to at least ‘some extent’ (88.1%) in discussions relating to their referral and support required.

Dissatisfaction has mostly related to clinical treatment/assessment and delays, with such feedback discussed as part of the Safeguarding Group.

Maternity

The maternity survey remained available throughout 2023/24, enabling patients to provide feedback following their maternity related 999-emergency call. Satisfaction has remained high (95.6%), with patients mostly reporting a positive experience of the service. Ambulance service staff continue to be rated as ‘good’ or ‘excellent,’ with patients also reporting that they were treated with dignity and respect.

Feedback has also related to the need for additional paramedic obstetric training, with a call for instructions provided by call handlers to be reviewed. This feedback was shared with the Trust’s relevant clinical lead and specialist midwife for consideration going forward.

No-Send

During 2023/24, a further mailout of the no-send survey was undertaken to capture feedback from category 2 to category 5 patients who had not received an ambulance response due to unprecedented demand. Overall satisfaction with the service received was poor, however, patients generally understood the instructions provided by the emergency call handler and 93.5% had followed the advice given.

Dissatisfaction predominantly related to ambulance non-attendance, and the lack of early communication to advise that an ambulance response would not be dispatched. The feedback received in relation to non-attendance/delays has been included as part of the wider work relating to the current urgent and emergency care situation.

Skin Tear

The skin tear treatment survey has continued throughout 2023/24, with the aim to obtain feedback from patients who had received skin tear wound treatment. All patients rated the service as ‘good’ or ‘very good,’ with patients treated at home generally pleased (93.3%) to have received out of hospital care and avoided the need for hospital conveyance.

The main area of dissatisfaction has continued to relate to ambulance delays, which has been included as part of the wider system review. Additional feedback related to the need for wound dressing guidance/instructions and follow up. The relevant clinical lead is leading a communications drive for Trust staff in relation to skin tear injuries and treatment.

Mental health

During 2023/24, two quarterly mental health surveys have continued to obtain feedback from patients who have contacted the service in relation to a mental health crisis. These survey projects include a young person Instagram survey (designed in collaboration with the Youth in Mind Group at the Mancroft Advice Project) and an online mental health survey (co-produced with the SUN Network) which was trialled as a social media poll survey during Q3.

Survey feedback continues to demonstrate satisfaction with the service received from the Trust (generally between ‘good’ and ‘very good’ on the sliding scale), although some patients have reported not feeling listened to or understood by the emergency call handler. Survey feedback continues to highlight the need for improved mental health service support and signposting prior to patients reaching crisis point. The survey results have been shared widely to ensure 360 feedback, working with commissioners, partner organisations and experts by experience to ensure system wide learning and improvements to the service provided to patients.

Going forward, call handler engagement sessions and training are planned. In addition, lists of area specific mental health services/support will continue to be shared, with plans in place to produce to a video relating to the 999 call-handling process and algorithm.

Stroke video triage

During 2023/24, two stroke video triage survey mailouts have been undertaken for patients who received a pre-hospital stroke video triage assessment within the West Essex and Peterborough areas. Patients have mostly felt satisfied with the service received (91.3%) and pleased to have received an assessment by way of video triage. However, some patients were unaware that an assessment had been undertaken using this virtual method – prompting the need for improved communication going forward.

The feedback received has highlighted the benefits of utilising technology to improve patient experience and outcomes, in line with the NHS Long Term Plan.

Next steps

The Trust is committed to developing its patient experience and engagement activity and continually explores new methods to obtain feedback and to ensure the voice of patients within seldom heard groups are heard. Co-production and working with experts by experience will continue, placing our patients and communities at the heart – particularly during the development of the Trust Strategy 2025-30.

The 2024/25 survey programme will include the continuous surveys and various planned projects, ensuring incorporation of the Trust priorities and the Patient and Public Involvement strategic objectives. Key survey results and themes will continue to be reported as part of the Trust’s quality and assurance reporting channels, with the monthly PTS FFT figures reported to NHS England.

Planned survey projects 2024/25

• Planned projects to be undertaken during 2024/25 will relate to; the experience of our younger patients, complaints handling, advanced practice team, the complaints handling process, maternity care, mental health, and the implementation of the Patient Safety Incident Response Framework.
• The survey team will also be involved in the facilitation of an urgent care hub survey and the ongoing the Trust Strategy 2025-30 development.

Although we are not required to report on our engagement with our patients and their representatives, we feel that it is important to hold ourselves to account for how we engage our patients and the public, and how we represent patient voice within the organisation.

Community Engagement Group (CEG)

The re-structure of EEAST’s Community Engagement Group (CEG) has been completed this year and the whole process has been co-produced with the CEG. This has led to a clearer structure and clearer work plan for the group around both community engagement and strategic involvement within the Trust. The group’s action plan has also been entirely coproduced with its members, reflecting both EEAST priorities for public engagement and members interests and areas of expertise. Following this restructure, the CEG has managed to recruit some new members, who recently attended their first meeting.

We have looked to involved CEG members more in the strategic decision making of the Trust in a “critical friend” role. This has led to CEG members attending the Patient Safety and Engagement Group, and to committees being asked to commit to how they could involve patient representatives more in their work. The feedback from these committees will inform how we move forward with increased strategic involvement from patient and public representatives next year.

Engagement Activities

Face to Face engagement events provide an opportunity to meet with the public and gain feedback from people who may not usually have contacted EEAST. It also provides an opportunity to provide education around first aid and Cardio Pulmonary Resuscitation (CPR) training, health promotion and what to expect when you call an ambulance. This work has included attendance at events, school visits and work with community groups and has been undertaken by the PPI team, frontline staff, and volunteers from both the CEG and Community First Responders.

The team have received great feedback from these events, including a young person who put his first aid training into action whilst out shopping just weeks after receiving it!

Over the next 6-months, the focus for engagement activities will be giving the public opportunities to engage in the Trust’s strategy development via face to face engagement, surveys, and online engagement opportunities.

Patient and Family Stories

Our discovery interviews with patients or their families supplement our other feedback received by giving people the opportunity to share their story in their own words. These are filmed and are shown at public board meetings and discussed by the board. We have used them this year to support learning from complaints and serious incidents and find that hearing directly from the patient is a powerful learning tool. This year we have completed discovery interviews on areas such as end of life, non-conveyance to hospital, a patients experience of being treated whilst under the influence of alcohol, and home birth. We have started to distribute these patient and family stories to our front-line clinicians (where appropriate), via the safety matters newsletter to increase the learning and impact of them.

Links with HealthWatch and Patient Representative Groups

Our PPI team and our Community Engagement Group volunteers regularly attend a variety of meetings of patient representative groups including mental health groups, diabetes groups, young carers meetings and Healthwatch. We continue to expand our representation with other organisations and specialist groups across the region. The Deputy CEO maintains regular contact with the Healthwatch groups in the region. We are currently working with Healthwatch on how they may be able to help us to independently evaluate the impact of some of our service changes. This is supported by the executive team and is to be commissioned independently.

Speaking up and enabling staff to raise their concerns helps to improve the quality of care provided to our patients, improve the working experience of our staff and supports the trust to promote learning and improvement from the concerns or improvement suggestions raised.

The ability to speak up within the Trust has evolved in the past year with the embedding of two new Deputy Guardians and the establishment of 15 FTSU Ambassadors. This has led to an increase in the staff and organisational understanding of what speaking up is, improved visibility, availability, capacity and resilience of the FTSU team, which has inevitably led to an increase in the number of new cases raised.

Whilst the organisation has three FSTU Guardians who support staff to raise their individual or group concerns and suggestions, there has been a more robust focus on enabling and supporting our managers to resolve staff concerns locally and more informally where appropriate. The organisational drive to encourage and direct staff towards the many different routes for escalation of concerns on quality has been strengthened with the development of the support services to staff and managers. The increased skill, resource and capacity within the People Services and Strategy Culture and Education directorates have increased the HR, Employment Relations and the Wellbeing offer as well as the progression of the Leadership Development Manager roles and the training and support being provided to our managers via the Time to Lead programme.

The progression of communication and engagement from the Chief Executive Office under the OCE email address has developed with a bi-weekly Executive message which provides updates on service developments, plans and appreciation shown for the work staff undertake via the ‘Thank you Thursday’ message. The Executive Q&A sessions continue on the alternate weeks to provide a confidential and anonymous route for staff to ask questions or raise concerns directly with the Executive team and senior leaders. This along with regular messaging on the various routes for staff to speak up, some with a focus on a specific theme such as bullying and harassment, evidence to staff that speaking up is being driven and welcomed by the leadership team.

There have been a number of successes from this continued work including the National Guardians Office (NGO) requesting an EEAST FTSU case study which was included in their annual report. In June 2023, the NGO published an analysis of the speaking up questions from the 2022 NHS Staff Survey, which replaced the preceding FTSU index. The survey identified that EEAST was 3rd in the top ten most improved FTSU score for trusts which is to be applauded. The report also identified that whilst we have improved significantly, we also scored least well for all four FTSU questions, which identifies there is still work to be done to gain the trust and confidence of all of our staff.

The National Staff Survey also evidenced a 3% increase in the number of staff feeling safe to speak up about anything that concerns them. Although it provides us with the assurance that the challenging work we continue to undertake is making a difference to the culture of speaking up within EEAST, our score is below the national average for all trusts and the team is working hard to close the gap.

Speaking up data - Case numbers

The additional resource within the team has enabled more targeted engagement to be undertaken within identified service areas where an increase in individual concerns have been raised or where there is soft intelligence which indicates underlying discontent. The team continue to actively support staff to raise their concerns whilst working in close partnership with leaders, managers and various teams across the Trust to facilitate resolutions to those concerns whilst maintaining confidentiality when there is no consent to share.

Empowering staff to speak up in a safe and confidential environment remains the primary aspiration of the FTSU function and any publication of data remains unidentifiable to protect individual staff members and teams within the Trust.

There has been a 20% increase in the number of new cases raised via the FTSU team which averaged at 28 new cases each month. These were anticipated peaks in contact during and following the FTSU awareness campaign month and when specific change programmes have been implemented.

Themes and emerging patterns

The top three themes of concerns reported correlate with previous years, with 8% more staff reporting a lack of consistency in the application of some of the Trust’s systems and processes. The following provides information on some of the outcomes:

• There has been a reduction in the number of staff reporting bullying and harassment, however the behaviours experienced within the inappropriate behaviours and attitudes correlates strongly with bullying and harassment which would effectively double the number of staff reporting negative behaviours. The Trust work on culture, professional standards and civility is in its infancy and so these numbers are expected to decrease over the coming year.
• The third highest reported theme is regarding senior and middle managers. They typically refer to staff feeling victimised by managers through their communication and actions, showing favouritism to others within a team, a lack of support and a mis-use of power. The consistent messaging regarding all levels of staff having the right to raise a concern appears to be succeeding.
• A FTSU key performance indicator is that less than 5% of staff report their concerns completely anonymously, this is where we have no information on the reporter’s identity. This remains the same as last year at 3%, no increase is seen as a positive.
• There has been an overall increase of 23% in staff reporting their concerns confidentially which is expected due to the rise in case numbers. However, the increase of 16% in the number of fully open cases where both the team and who the concern is escalated to knows the identity of the reporter is a positive sign that confidence is growing in the organisation to appropriately address their concerns.
• There has been an overall 2% reduction in the number of concerns raised which were related to a protected characteristic. It is important to note that there have been no concerns raised with regards age, gender reassignment, marriage and civil partnership or sexual orientations. Whilst this is viewed as encouraging, more focussed work will be undertaken with the Diverse Network groups to explore whether this is a lack of concerns or potentially a lack of trust.
• There has been an increase in the number of staff who have reported concerns around their return to work following maternity leave. The human resource business partners are now supporting managers on a more local level to ensure policies and procedures are being appropriately considered.
• The percentage of staff already suffering detriment or in fear of suffering detriment or repercussions if they raise a concern, has remained at 43%. The stability of this figure is positive and whilst we are in the middle of moving away from the historic and to some extent existing culture, staff will continue to have strong perceptions of detriment if they raise a concern and this is a key focus of the change programmes within the Trust.
• Additional traning packages, ‘Speak Up’ and ‘Listen Up’ are in place for managers and the Trust has also signed up to the national NHS sexual safety charter which included staff representation from across the organisation including the Chief Paramedic (Allied Health Professional) and Director of Quality.

Leadership and partnership working

The wider embedding of an open, honest and transparent speaking up culture has been emphasised following the publication in February 2024 of the NHS England commissioned Culture Review of Ambulance Trusts and the following recommendations form part of the Trust and the FTSU action plan for the coming year:

1. Balance operational performance with people performance at all levels
2. Focus on leadership and management culture and develop the ambulance workforce
3. Improve the operational environment, line management and undergraduate training
4. Translate NHS Equality Diversity and Improvement (EDI) Improvement Plan into a bespoke plan for ambulance trusts
5. Target bullying and harassment, including sexual harassment and enable freedom to speak up

The partnership and leadership working continues with:

• Monthly meetings between the Guardians and the Chief Executive Officer and quarterly meetings with the Guardians and FTSU executive and non-executive Leads.
• Monthly oversight of the FTSU function via the Cultural Oversight Group.
• Bi-monthly Raising Concerns Forum meetings which is a cross directorate meeting with senior leaders focussing on the triangulation of data sets, reviewing for patterns and themes and providing a focus for specific action within specific areas where patterns may be occurring.
• Quarterly oversight at Trust public board meetings.
• Direct support to directorates and departments regarding the reporting and resolution of concerns.
• Freedom to Speak Up Guardian presents at every corporate induction session.

We are supported by around 1,000 active and valued volunteers and other partners in a number of roles.

Community first responders

Our community first responders (CFRs) are volunteers who are trained by us to attend certain types of emergency calls in the area where they live or work. Their aim is to reach a potential life-threatening emergency in the first vital minutes before the ambulance crew arrives.

Their role is to help stabilise the patient and provide the appropriate care until the more highly skilled ambulance crew arrives on scene to take over the treatment.

They also promote community partnerships and integrated working.

Volunteer car drivers

Working with our Non-Emergency Patient Transport Service, our volunteer car drivers are essential to help us provide an additional ambulance car service to our patients helping to take them to hospitals and other services.

Co-responders

Royal Air Force (RAF) personnel are trained to provide life-saving interventions prior to our arrival working on response cars to immediately life-threatening calls and also non-injury falls.

Fire and Rescue Service (FRS) partnership sees us working with six fire services under memorandum of understandings enabling them to respond for the Trust to a selection of calls. These include cardiac arrest response, immediately life-threatening calls, non-injury falls and bariatric assistance.

Community engagement group

Our community engagement group (CEG) members are a knowledgeable, keen and enthusiastic group of volunteers, who are willing to participate and support us wherever they can, but also to be a “critical friend” when necessary.

Networked across the region and drawn from urban and rural communities, the CEG have their own work plan and members of the group sit on many of our groups and committees, to ensure patient and public representation is integral to how we plan and deliver our services.

Achievements in 2023/24

We have implemented a number of actions within the last twelve months, including:

• Distribution of polo shirts and epaulettes to CFRs
• Safer recruitment processes for all volunteering roles
• Provided specific additional training and continuous professional development (CPD) events
• Involvement of volunteers within wellbeing models
• Expansion of FRS collaboration
• Development and distribution of volunteer agreement
• Launched the EEAST Heart charity with community education on basic life support (BLS) for the public.

Looking forward

We have a number of activities and measures planned for 2024/25 including:

• Development of a Volunteer Management System
• Roll out of Trust email address to volunteers to facilitate access to online learning platforms
• Introduction and embedding of new volunteer roles
• Ongoing work with FRS and RAF with a Blue Light Collaboration lead in post
• Volunteers’ week 1st June
• Expansion of lower acuity responses.

For more information about how to become a volunteer, please go to Volunteering and volunteers

The CQuIN scheme is intended to deliver clinical quality improvements and drive transformational change and will impact on reducing inequalities in access to services, the experiences of using them and the outcomes achieved. Our CQuINs are agreed with our commissioners as part of our contract negotiations and have traditionally been a mix of nationally mandated and locally determined Quality and Service Delivery Improvement Programmes.

EEAST has been extremely successful in delivering these for many years, however since the Covid-19 pandemic significantly impacted all health and social care services in 2020/21, CQUIN deliverables were largely suspended by NHS England. This pause was to ensure the NHS’ focus remained very much on addressing the pressures caused by the pandemic without distraction, and more recently on the recovery from the pandemic to return services to sustainability.

As such, there were no locally determined CQUINs in 2023/24 as this approach continued, and the only national CQUIN for Ambulance Services related to the uptake of the flu vaccine, as there is each year in support of the protection against infectious illness. EEAST, achieved 79% for all directly employed staff with a further 10.23% of our volunteers also vaccinated.

Strategic Goals

• Goal 2: Provide Outstanding Quality of Care and Performance

Strategy Overview Areas

• Clinical Strategy
• Research and Innovation Strategy
• Quality Improvement Strategy
• Quality Account Priorities

Strategic Risks and Risk Overview Areas

• SR2: Failure to achieve continuous quality improvements and high quality care
• Clinical and Patient Safety
• Safeguarding
• Infection, Prevention and Control
• Estates
• Medical Devices
• Medicines Management

Key Change Initiatives

• CQC Improvement Plan
• Medicines Management Programme
• QI Faculty Development
• PAS Oversight Framework

Key Performance Indicators

• SI number, harm and actions
• IPC audit compliance
• Safeguarding compliance
• PAS metrics
• Drug audits and incidents
• Complaint metrics
• Fire and first aid compliance
• Clinical Quality Indicators

Key Independent Assurance Mechanisms

• Regulatory inspection reports
• Internal audit reports
• Healthwatch opinion
• Independent reviews
• Benchmarking

Sub-Group Structure

Compliance and Risk Group

• Patient Safety Group
• Clinical Best Practice Group
• Medicines Management Group
• Safeguarding Group
• Infection, Prevention and Control Group
• Patient Experience and Engagement Group
• Medical Devices Group
• External Provider Assurance Group

Statements from the Commissioners, HealthWatch and Overview and Scrutiny Committees

Following the 30-day consultation process, any statements for inclusion returned to EEAST are included within this section.

Suffolk and North East Essex

East of England Ambulance Service (EEAST) Annual Quality Account

Date: 20 May 2024

The Suffolk and North East Essex (SNEE) Integrated Care Board (ICB) confirm that EEAST have consulted and invited comment regarding the Annual Quality Account for 2023/2024. This has been submitted within the agreed timeframe and SNEE ICB are satisfied that the Quality Account provides appropriate assurance of the service. SNEE ICB have reviewed the Quality Account and the information contained within the Quality Account is reflective of both the challenges and achievements within the organisation over the previous twelve month period. SNEE ICB look forward to working with clinicians and managers from the service and with local service users to continue to improve services to ensure quality, safety, clinical effectiveness and a good service user experience is delivered across the organisation. This Quality Account demonstrates the commitment of EEAST to provide a high quality service.

Lisa Nobes

Chief Nursing Officer Suffolk & North East Essex Integrated Care Board

Healthwatch Suffolk

Healthwatch Suffolk response to the East of England Ambulance Service NHS Trust Quality Account 2023/2024

Healthwatch Suffolk thank the Trust for the opportunity to comment on the Quality Account for 2023/24. We recognise this has been a period of extreme intensity for the Trust’s staff, clinicians and volunteers. As a Healthwatch, we are naturally also acutely aware of the heightened and at times sadly, unmet needs of the public, during these past 12 months. The number of 999 calls for 2023/24 was marginally lower than the particularly high number in 2021/22, at roughly 26,600 calls a week. This equates to yet another challenging period for the Trust.

Healthwatch Suffolk is the region’s local healthwatch representative for the East of England Ambulance Service NHS Trust (EEAST). We liaise directly with the Trust’s Suffolk based commissioners (Suffolk & North East Essex Integrated Care Board), and we are also responsible for coordinating regionwide healthwatch engagement with EEAST. This does of course only take place successfully because of the proactive support of the other local healthwatch in the east, and a Trust that is open, responsive and engaging.

About 7 in 10 people in Suffolk, who shared their experiences of the Trust, rated them 4 or 5 stars out of 5. Information & Advice, quality of interactions with Staff, and Treatment & Care, were considered to be positive, whilst Access to Service was rated poor.

Three other local healthwatch have kindly shared their Statements with us, helping us to identify common themes, observations and suggestions. Healthwatch Central Bedfordshire, Southend and Norfolk have each studied the Trust’s draft Quality Account and offered reasoned and constructive feedback. One common theme that has also been raised in previous years, concerns the lack of Quality Account data and performance being broken down according to either (a) local healthwatch areas (coterminous with local authority boundaries) or (b) integrated care system boundaries. We have in our Statement identified some examples of where such breakdowns of data should be possible and easily extracted from their regional sources. Other common themes are referenced elsewhere in this statement.

Inaugural co-production training was provided by Healthwatch Suffolk through several workshops in 2021, eventually also leading to the creation of what is likely to remain a unique ambulance trust Patient & Public Involvement Strategy ‘on a page’ in 2021/22. We are therefore delighted to read about so many references to co-production, and the power of bringing lived experience into decision making at the Trust. There is definitely a cultural shift taking place; and the public, staff and volunteers, will all benefit in the long term. Perhaps a healthwatch led evaluation with staff and volunteers involved in such co-production initiatives, might underpin how far the Trust has come these past 2-3 years?

We welcome the news of improvements on all ambulance responses, and the continued work with the region’s six healthcare systems, an example being the establishment of Unscheduled Care Hubs, initially piloted in Suffolk. We recognise the Trust’s new Level 3 rating against the National Operating Framework, a recognition of the improvements made around its leadership, responsiveness and support provided to staff and the communities it serves. CQC has now removed four of the seven improvement conditions, and the Clinical Audit Department received Substantial Assurance, the highest assurance level by an Independent Internal Auditor.

There are now more trained clinical managers in the use of Quality After Action Reviews, and this can only be beneficial. A need to do more about safe discharges of patients left on scene, is indeed required. We look forward to reading about the outcomes of that review.

We wonder if the entry on page 19, concerning ‘Falls in older people’, might be better worded as ‘Non-injury falls in older people’? This would be a more accurate headline for what is being described as an improvement in this priority.

The patient survey programme seeks to work with seldom heard groups. We believe that a use of postal area data (associated with participants) can help reflect localised engagement and feedback, called for by local healthwatch from across the region. Such a breakdown of localised data is equally relevant for work led by the Community Engagement Group, which we are informed is paying particular attention to ‘young people and geographical representation’. It would be interesting to know why these two focal points have been chosen.

Progress on Priority One: Patient Safety. We note that the Trust will now have increased capacity in order to undertake over 40 Shared Judgement Reviews per month.

Progress on Priority Two: Clinical effectiveness. There is a reference to the Trust’s Public Health Strategy, which is a collaboration with Public Health England (PHE). It might be helpful to note that PHE was replaced with the UK Health Security Agency in October 2021 (page 32). All local healthwatch fully support the adoption of Core20PLUS5 approaches for adults, children and young people, in quality improvements that address healthcare inequalities.

Progress on Priority Three: Patient Experience. We welcome the focus on seldom heard groups, and the projects that are described, but we would also expect to read about the Trust’s actions on the statutory Accessible Information Standard. There is unfortunately no reference to this national standard. We can assist in this matter through a campaign that was initially launched by Healthwatch England; namely the Your Care, Your Way initiative, as set out by Healthwatch Suffolk.

The two aims of bringing about bespoke user-friendly survey forms, and the identification and removal of barriers to enable a more inclusive feedback process from all patient groups, are excellent. Projects such as an Easy Read survey, co-produced with the D.R.A.G.O.N.S at the Norfolk and Norwich SEND Association (NANSA), aimed at patients who used either the emergency or patient transport services, are to be applauded. The co-produced short film to sit alongside the Easy Read survey does not appear to be available online (planned to be available from April 2024). We note that other co-produced projects covered (for example) maternity care, skin tear treatment, and patient referrals to other services.

Performance of the Trust against quality metrics such as Response Times should ideally be available according to either local government/healthwatch or Integrated Care System boundaries. We note and welcome the varying improvements across all call Categories.

The Trust consistently moves about 4,000 calls a month of which 70% are accepted by the community providers. Is there an aim to improve such referrals i.e. increase from 70%, over time? Please explain the meaning of the term ‘co-horting’, used to describe patients at hospitals being released back into the community.

The Trust are currently piloting the first artificial intelligence ‘bot’ within the Emergency Operation Centres, aimed at automatically identifying and diverting low acuity falls to community services. Digitalisation is expected in the NHS and we hope such technology will prove to be successful. We appreciate that the pilot is being monitored with clinical oversight. The STEMI care bundle (heart attacks) performance of 93.0% compares extremely well with the national average of 76.8%, and the Stroke diagnosis bundle, at 99.3%, is also better than the national average 97.6%.

The Trust’s Clinical Assessment Service (CAS) team has been expanded and there are currently 24 validators with remote and hybrid working options available. The Patient and Public Involvement Team continue to undertake the very good patient discovery interviews (19 in the year). In terms of Patient Safety Incidents, please note that the chart on page 41 would be improved if the bars and the colour coded sections of them, also display the actual numbers. The small sub-sets are otherwise meaningless to the viewer.

Serious Incident Reviews are supported by a new Patient Safety Incident Response Framework (PSIRF), which makes no distinction between ‘patient safety incidents’ and ‘Serious Incidents’. We note that the PSIRF promotes a proportionate approach to responding to patient safety incidents, by ensuring resources allocated to learning, are balanced with those needed to deliver improvement. The chart on page 42 shows a very welcome improvement as compared to the previous two years. Please note that the figure ‘49’ is missing an * (a typo).

Under the heading of ‘When things go wrong’, there is a case study about a member of PTS staff who had not followed the correct procedure in relation to immediately dialling 999 if a patient sustains an injury in their care (page 43). Would the situation described have been re-considered to be a C3, C4 or another category? It would be interesting to know, from a ‘new’ response time perspective.

Duty of Candour (DoC) performance has improved in terms of the numbers of cases, but the average timeframe for DoC to occur, rose to 6 working days. This indicator stood at 2 working days in 2020/21. Is there a reason for this?

We note that compliments far outweigh the number of complaints received each year, and in 2023/24, there was an increase in the per month average. A decision to consider learning from compliments, in addition to learning gleaned from complaints and concerns, is a welcome move by the Trust. The biggest themes from complaints and concerns were delay, transport and driving (mostly related to delays in the patient transport service, which is not an EEAST service in Suffolk), and clinicalassessment and treatment, the majority of which were emergency related. Patient surveys are centred around the national Friends & Family Test (FFT) model. We recognise that FFT has to be used by an NHS Trust, but please note that FFT is notoriously biased towards positivity, for a number of reasons. We would therefore encourage every NHS Trust to be cognisant of this factor, and to seek out alternative methods of gaining public insights and feedback, in addition to FFT.

Face to Face engagement events has included attendance at events, school visits and work with community groups, and has been undertaken by the PPI team, frontline staff, and volunteers from both the CEG and Community First Responders. This is a great range of staff and volunteer involvement in community spaces, and we particularly like the story of the young person who put his first aid training into action, whilst out shopping, just weeks after receiving it. Please note that at least three local healthwatch (Central Bedfordshire, Essex and us in Suffolk) have young ambassador schemes, and we can be approached to assist the Trust in its ambitions to engage young people.

Several local healthwatch organisations have expressed an interest in hosting one of the Trust’s Patient Engagement Forums once a year; Central Bedfordshire, Norfolk and Suffolk, amongst those who are interested in doing so. The NHS Staff Survey shows some progress in Trust confidence, but this cultural transformation remains a longer-term challenge. Fewer than half of the staff who responded felt safe to speak up (49%), as compared to the national average of 56%. We acknowledge that both the CEO and Deputy CEO maintain regular contact with the region’s Healthwatch groups. We welcome future opportunities to help the Trust in independently evaluating impact, and news that a formal arrangement for such work is now supported by the Executive Team, is excellent.

As always, it is so very important to recognise the amazing contributions of the Trust’s 1,000 or so volunteers and other partners in their varied roles: Community First Responders; Volunteer car drivers; Co-responders; and the Community Engagement Group. A commitment to develop a Volunteer Management System is definitely supported by us, and EEAST may wish to seek advice and guidance/templates from NCVO nationally.

Overall, the Trust has achieved much considering the challenges it, and its partners, have faced during 2023/24, as described in the Quality Account. We are appreciative of your continued efforts and in your engagement of the public and local healthwatch network.

Andy Yacoub

Chief Executive

Wendy Herber

Independent Chair

Healthwatch Norfolk

Review of East of England Ambulance Service NHS Trust Quality Account 2023/24

May 2024

Healthwatch Norfolk (HWN) thanks the Trust for the opportunity to provide comments on the draft East of England Ambulance Service NHS Trust (EEAST) Quality Account for 2023-2024.

The Trust works with colleagues across a complex health and care landscape spanning six Integrated Care Systems. We recognise the ongoing effort by the Trust and the progress being made in improving the quality and safety of services. We also recognise that this is within the overall context of increasing service demand and a challenging health and care system environment.

Patient waiting times and how long ambulances are taking to reach people is an ongoing concern and we are pleased to note the improvement in ambulance response times across all categories. We know that delays and blockages in other parts of the system are part of the problem and note that close working with system partners has contributed to this improvement.

Quality Priorities for coming year

The Trust has set out its priorities for improvement across the themes of patient safety, clinical effectiveness, and patient experience and describes the outcomes sought. We are pleased to see that the patient experience, patient feedback, complaints, etc, have fed into the process for selecting these quality priorities but we would be interested to know whether any reports and recommendations of a Healthwatch organisation from across the East of England area have contributed to the identification of priorities.

Some of the priorities build on last year, including work to develop the annual patient survey programme to ensure that views are obtained from patients who have used different aspects of the service or are from seldom heard groups. If Healthwatch Norfolk can be of any assistance here then please get in touch. We are pleased to see the priority on ensuring patient engagement and feedback aims to increase engagement at the earliest stage of strategy development to ensure patients have a voice. We look forward to learning about progress with this priority. We also note that in the coming year the Trust intends to undertake a true staff and stakeholder collaboration approach to reshaping the clinical strategic vision.

We note the priority to increase the number of Community Engagement Group members to ensure that all groups within the Trust’s population are represented. We understand that this builds on the restructure of the Community Engagement Group last year, with the aim of the Group’s increased strategic involvement within the Trust. Again, if HWN can be of any assistance with this work then please get in touch.

We see that there are monitoring and reporting arrangements in place across the priorities but it would be helpful to understand when and how progress on improvements is reported back to patients, staff, and other stakeholders.

Performance against quality priorities for previous year

The Account sets out progress against priorities for last year outlining what was planned, what has been achieved, what hasn’t and why, and what the next steps are. This is helpful in enabling the public to understand how the Trust is addressing areas in need of improvement and the evidence being used to track progress.

We are pleased that over the past year the Trust has achieved improvement in ambulance response times across all categories and we note that there will be a focus in the coming year on reducing category 2 (emergency) response times. Progress has been made with the priority to embed the Learning from Deaths programme, in terms of training and increasing capacity for undertaking reviews, and note that this continues for 2024/25 with further actions to embed the process. This work is aligned with the ongoing priority to embed the Patient Safety Incident Response Framework and both are supported by the new Continuous Improvement Assurance Framework.

We note the outcomes of the first year of EEAST’s Clinical Strategy. We are pleased to see that revised clinical supervision has been implemented across the workforce, and the Trust has delivered its Clinical Workforce Plan to increase its patient-facing clinicians.

The existing priority around a public health strategy is now focused on the national Core20 PLUS5 programme, which takes a quality improvement approach to addressing healthcare inequalities, and EEAST has completed a self-assessment to identify areas for development.

We note that the Trust continues to work towards fully embedding its Patient and Public Involvement Strategy and is making some progress. This includes the restructure of the Community Engagement Group, and the patient discovery interviews undertaken by the Patient & Public Involvement Team to better understand patients or relatives experience. We are interested to see that the Trust will be introducing Public Engagement Forums in the summer 2024 – please let us know if we can be of any assistance with planning a forum in Norfolk.

More generally, we note that the Trust aims to use information on what patients and their families tell them about their experience (through complaints, concerns, compliments and surveys) to improve services and provides some examples in the Account in a ‘You said, we did’ format.

Accessibility

This detailed Account Is provided in a clear and readable way, with a summary, glossary and information on how to obtain the document in another format or language.

Conclusion

HWN is pleased to see the progress being made by the Trust in improving the quality of care provided. We are keen to assist the Trust in any way we can to ensure that the views of the patients, their families and carers are taken into account as EEAST continues to work to deliver the improvements needed.

With this in mind, we would very much appreciate the opportunity to meet with the appropriate Quality Lead at regular intervals. The purpose would be to enable the Trust and HWN to discuss the content of the Quality Account and help contribute to the process of making it a meaningful and useful document for all those involved in its preparation and publication.

Alex Stewart

Chief Executive, Healthwatch Norfolk

Healthwatch Southend

East of England Ambulance Service – Quality Account 2023/24

30 April 2024

Healthwatch Southend is pleased to respond to the Quality Account for 2023/24. The document is largely accessible to members of the public who wish to read about the Trust’s approach to and successes in improving care.

• The progress which the Trust has made in terms of meeting its Regulators’ requirements is to be welcomed
• The introduction of After Action Reviews is a positive step, as are the proposals to encourage feedback from a wider range of patients
• The Quality Account demonstrates a number of ways in which patient feedback has been used to improve service delivery – the use of the “You said, we did” is helpful
• It also gives a clear indication of how the Trust works with residents to improve care
• Progress against the national response times and specific targets for clinical conditions such as strokes etc are also positive.
• You state that a number of local audits did not meet their respective metrics. We look forward to seeing progress on these in the coming year
• We remain disappointed that the Quality Account does not allow us to examine whether there are any variations in access or quality at a local level. The ability to work at scale is understood, but it becomes difficult for a local Healthwatch to hold the Trust to account – or to celebrate good practice – without intelligence at a meaningful level
• Healthwatch Southend looks forward to greater opportunities to work with the Trust over the next few years

Owen Richards

Chief Officer

Healthwatch Central Bedfordshire

EEAST: Annual Quality Account 2023/24 Review: Healthwatch Central Bedfordshire (HWCB)

HWCB were delighted to read this Quality Account that clearly indicates areas of improvement achieved over recent years. The one main criticism of the report is that it still does not cover or look at local/regional performance but deals with the Trust as a generic' whole'. It would be good to know how the Trust is performing locally - even in any single county if not a Healthwatch area. As such if not data/figures/information relating to Central Bedfordshire, then Bedfordshire as opposed to the whole of East Anglia.

That said HWCB are aware of the continual and increasing demands on the service and many Members have witnessed the 'queues' of ambulances at the local Luton, Bedford and Lister Hospitals and acknowledge the frustrations that all must feel about this continuing position. But we also recognise the breadth of activity the Trust undertakes, the size of the organisation and its catchment area. We appreciate the challenges and the positive steps being taken to look after patients and support staff.

Specific Observations:

The last CQC inspection was in 2022 and this Quality Report details steps and on¬going actions to address CQC concerns. For example the Response Times are clearly improving year-on-year.

We note the Clinical Strategy and the Clinical Workforce Plan and the expectations coming out of both for the coming year, for example the Despatch Model and the training & development of Advanced Practitioners. Added to that the Lead Programme is clearly a positive response to the evolving organisational needs. We like the Core20Plus5 programme and its approach to health inequalities.

We endorse the on-going efforts to establish the true patient experience, as a way of both seeking feedback and looking for improvements. In that respect we would like to think that at least one Patient Engagement Forum might be held in the county if not in Central Bedfordshire.

Through the Local Audit it is clear that the Trust is aware of Areas of Improvement and is planning 'next steps' and, as a Healthwatch, we will be watching to see how successful those 'Next Steps' are.

The Trust has identified examples of 'things' that 'went wrong' and have shown what they did and how they are working and listening to local communities. That said the staff survey shows that less than half of the staff who responded felt safe to speak up, though we recognise that a) it often takes individual courage to do so and that nationally the Trust is not an obvious outlier with a figure of 49% (of staff feeling safe to) when the national average is 56%.

Overall and as mentioned above Healthwatch Central Bedfordshire recognises the steps taken by the Trust over recent years, is aware of local pressures and is reassured by the action plans.

Diana Blackmun

Chief Executive Officer Healthwatch Central Bedfordshire

Cambridgeshire County Council

The East of England Ambulance Service Trust Quality Account 2023/24 Statement by Cambridgeshire County Council Adults and Health Committee

The Adults and Health Committee received the draft Quality Account for the East of England Ambulance Service (EEAST) on 19th April 2024. A Working Group was established to consider the draft in the context of the Committee’s statutory health scrutiny function.

The Committee welcomes the co-operative relationship which exists with EEAST and the willingness of the Trust’s senior leadership team to engage with scrutiny. This was evidenced in the past year through the establishment of informal bilateral meetings to support an open and constructive dialogue outside of formal scrutiny enquiries.

The Care Quality Commission (CQC) last inspected EEAST in July 2022 and gave an overall rating of Requires Improvement. Following a previous inspection in 2020 the Trust was given notice under Section 31 of the Health and Social Care Act and had seven conditions placed upon it. Four of those conditions have now been lifted (relating to safeguarding, staff allegations, recruitment checks and DBS checks), and a decision is awaited on a fifth condition relating to how the Trust manages concerns, grievances and disciplinary action. Applications to have the final two conditions lifted are expected to be made by summer 2024 (sexual harassment and contracted private ambulance service provision). The Committee commends the Trust’s leadership team and its staff on the progress which has been made and for the commitment to continuing improvement expressed in the Quality Account.

The Committee recognises that all organisations face challenges in tackling discrimination and ensuring that staff feel supported to speak up. We welcome the action being taken by EEAST to address this which we feel is well reflected in the draft Quality Account, and we encourage the Trust’s continuing efforts on this. We would also like to see greater emphasis on employment rights and conditions within the service given the concerns which were expressed in the relatively recent past by staff about overly long working hours and stress. We would like to have confidence that these employment issues have now been fully addressed.

Response times are key to service users’ confidence in the service provided by EEAST, and we welcome the steps being taken to improve the Trust’s performance. This includes the deployment of additional call handlers and triaging calls to direct them to the most appropriate organisation. However, the progress on response times was not consistent across the reporting period and performance for all categories of calls remains below the national standard for average response times. For that reason we feel that the draft we saw presented an overly rosy picture of the current position. We recognise the complexity of the challenge, but ambulance response times remain an area of serious public concern in Cambridgeshire. The Committee shares that concern, and we would welcome greater transparency and openness in the Quality Account around the continuing challenges which the Trust is facing as a way to help drive further improvement.

As a committee we recognise the joint interests and responsibilities which exist between system partners and we would have liked to see this better reflected in the 2023/24 report, for example in relation to preventing avoidable hospital admissions. We do though acknowledge that the prescribed format of quality accounts can make it difficult to reflect this wider perspective.

EAAST has taken important steps forward during 2023/24 which have been recognised through the Trust moving from NHS Oversight Framework Segment NOF 4 to NOF 3 and the lifting of four of the seven conditions imposed on it by the CQC. The Committee welcomes this progress, and remains committed to working constructively with the Trust during the coming year both as a system partner and through its scrutiny role as a critical friend.