Statements from the Commissioners, HealthWatch and Overview and Scrutiny Committees

The following section contains statements received from stakeholders following the 30-day consultation period. Some of the feedback received will also be used to formulate next year’s Quality Account.

Ipswich and East Suffolk CCG, North East Essex CCG and West Suffolk CCG:

Date: 18 May 2022

The West Suffolk (WS), Ipswich and East Suffolk (I&ES) and North East Essex (NEE) Commissioning Groups confirm that EEAST have consulted and invited comment regarding the Annual Quality Account for 2021/2022. This has been submitted within the agreed timeframe and the CCGs are satisfied that the Quality Account provides appropriate assurance of the service.

The CCGs have reviewed the Quality Account (and enclose some feedback for your consideration). The information contained within the Quality Account is reflective of both the challenges and achievements within the organisation over the previous 12 month period.

The WS, I&ES and NEE Commissioning Groups 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 user experiences is delivered across the organisation.

This Quality Account demonstrates the commitment of EEAST to provide a high quality service.

Lisa Nobes
Chief Nursing Officer

Healthwatch Norfolk:

Date: 9th May 2022

Review of East of England Ambulance Service NHS Trust Quality Account 2021/2

Healthwatch Norfolk welcomed the opportunity to review the draft East of England Ambulance Service NHS Trust (EEAST) Quality Account for 2021-2022. We have a number of general observations:

We are pleased to see the statement from the Board and Chief Executive Officer (new in post May 21) reflecting a continued strengthening of leadership around quality of services and improvement, together with the stated goal for EEAST to “develop a culture of continuous improvement” and to move forwards with a new strategy with a focus on key areas, including “Experience of our patients’ and staff – ensuring better outcomes for patients”.
We note that the Trust is currently being inspected by CQC around its core services and that a focused ‘Well-Led’ inspection is also scheduled to take place shortly, with both reports to be published in due course. In the meantime, it is encouraging to note that 159 of the 174 actions identified by the Trust to address the issues arising from the April 2019 CQC inspection have been completed and we recognise the work taking place across the five areas of concern. Of the remaining 15 actions, we note that five relate to longer term projects including cultural change, which will be significant in the improvement journey.
We have noted and recognise the ongoing impact of the Covid pandemic on the work of the Trust, both demand and system pressure, and consequential impact on priority improvement areas, many of which are focused on driving performance improvement to reach national standards and, in turn, rely on the recruitment, growth and development of the clinical workforce.
We recognise the Trust’s ongoing ambition to focus on enhancing the quality of life for all, together with the aim to improve patients’ experiences of care they receive, which is highlighted throughout this Quality Account.

We have some specific observations and they are as follows:

Part 1

Note that incident reporting remains high with a 400% increase in serious incidents declared in the 2021/22 financial year compared with the previous year and that this is understood to be due to increases in operational pressure in the health and social care system. Also note, however, that most patient safety incidents resulted in no harm to the patient. Pleased that the Trust continues to foster a good culture in regard to reporting.
Note that, whilst the Trust has met the timeframes around implementation, the Learning from Deaths within the Ambulance Services recommendations from the National Quality Board is not yet fully adopted and embedded and remains an area of focus.
Also note the delay (national) with completing the development of the national Patient Safety Incident Response Framework, which aims to improve organisations’ ability to learn from incidents. Pleased that EEAST has worked with local and national partners to have a plan in place for when the full migration occurs from June 2022 and that this will continue to be a priority within 2022/23 with patient safety specialists in post ready to progress this work.
Note that the Trust has agreed a new and more robust way of monitoring compliance with national alerts relating to Patient Safety and has discharged all of its NPSA reporting obligations as required.
Note the Trust’s progress in submitting its baseline assessment for compliance with the Data Security Protection toolkit and that it is working towards completing the final standards by the 30 June submission.
Note the revised deadline for development of Public Health Strategy, in collaboration with PHE, to allow time to integrate the learning found from the COVID-19 pandemic into the Strategy and reiterate the need to ensure public/patient/carer involvement with this work (pleased to offer a communications conduit if helpful?).

Part 2

Progress on Priorities -Patient Safety, Clinical Effectiveness and Patient Experience.
Note that, due to the continued impact of the COVID-19 pandemic and the need to focus on delivering a safe service to patients, the majority of priorities were not completed last year and will continue in 2022/23. This is disappointing, although we do not underestimate the difficulties faced. We also note that arrangements are in place to monitor progress over the coming year with regular progress reporting through governance structures.
Progression on priorities for 2022/23 is outlined with clear statements of what success will look like. Pleased to see the involvement of patients/carers in some key priority improvement areas (eg in the design of the new PTS vehicle and in fully embedding thePatient & Public Involvement Strategy) and would welcome further opportunities for patients, carers and service users to be involved more generally within the organisation’s improvement journey.
Response times – we note that the Trust was only able to meet the national standards for one of the categories (C1 Immediately life-threatening injuries and illnesses) and the reasons outlined in the Quality Account are understood. It is encouraging to note that the targets agreed with commissioners over the winter period were met, demonstrating good understanding of how to progress overall.
STEMI care bundle – pleased to note that EEAST was the highest performing trust for this care bundle (April -November 2021) performing 17.2% above the national average.
Stroke diagnosis bundle – we are also pleased to note that EEAST was the second highest performing trust for this bundle (April -November 2021) and is performing better than the national average for all stroke timeliness indicators for the same period.
Non-Conveyance Care – note the introduction of a non-conveyance care bundle with the aim of improving the safety of patients who are discharged from EEAST’s care to another part of the healthcare system. Also note the introduction of an electronic auditing tool to enable further improvement to the safety and experience of patients not needing hospital treatment.
Clinical Supervision – concerned to note that plans to implement revised clinical supervision in the Trust’s patient-facing workforce, which was raised as a concern last year, has been further delayed. We understand the challenges faced, and note that some progress has been achieved with the approval of a Clinical Supervision Policy and the associated role development and initial recruitment, but would like to see greater reassurance in the QA about the specific timeline for implementation in the next year.
Clinical Strategy – concerned to note the further delay of the Trust’s Clinical Strategy which had been raised as a concern last year. We understand the challenges faced, including the ongoing covid pandemic together with the significant changes to the health and care landscape with the development of the new ICS structures and the need to work in collaboration (which we fully support), but would like to understand better the timelines for launch of the integrated strategy over the coming year.
PH Strategy – note the decision to put a hold on the timelines, primarily due to workforce priorities and capacity, but also the implications the pandemic would have on our approach to public health. It was felt that a revised deadline would be better to allow time to reflect, adapt and integrate the learning found from the COVID-19 pandemic into the PH strategy and as such, this will be an ongoing priority into 2021/22.
Participation in audits -Note that the Trust participated in all national mandated audits but that, due to the impact of the ongoing covid pandemic, not all audit topics in the Trust’s Clinical Audit Plan for 2021/22, were completed, and so the plan will be repeated in 2022/23, with the outstanding topics to be prioritised. Please to note that the Trust participated in the National epidemiology and Outcome from out-of-Hospital Cardiac Arrest registry study undertaken by the University of Warwick (which has been included as an audit within the Healthcare Quality Improvement Partnership annual programme).
Participation in research – pleased to note that the Trust continues to participate in clinical research demonstrating its ongoing commitment to wider health improvement and the contribution this makes to the continuous improvement in patient care.
Learning when things go wrong -the inclusion of a “What went wrong and what we did” section to illustrate how the Trust responds when something is identified is a positive step and helps demonstrate cultural values of openness, transparency and a learning organisation.
Patient/Carers/Relatives feedback -Welcome the inclusion of the “You said, we did” case studies for similar reasons plus helps demonstrate that feedback is taken seriously and, where possible, action is taken to improve.
Development of links between Patient Experience and patient safety This year has seen the introduction of the Patient Safety Improvement Specialist and Patient Experience Improvement Manager. These roles sit between Patient Experience and Patient Safety with a focus on developing pathways of learning from both Complaints and Serious Incidents. The triangulation of data across the Patient Experience, Patient Safety and Patient and Public Involvement Teams has started with the development of exciting new pathways of joint working across teams. Processes are being developed to centralise the actions set through both Patient Experience and the Serious Incidents. The aim is to make sure that more achievable and measurable actions are set across the departments which can be reviewed to ascertain how effective they were. This important piece of work has been set as a Quality Account priority for 2022/23
Raising Concerns – pleased to note the adoption by the Trust of a Raising Concerns: Freedom to Speak Up Policy, Strategy and associated action plan with a focus on providing staff with the assurance that they can speak up in confidence. The significant increase following this in staff actively supported to raise their concerns reflects the Trust’s commitment to embedding a culture of trust, openness and transparency. We note that evidencing learning and progression using case studies, lived experiences documented and feedback from staff is one of a series of priorities for the coming year.

To conclude, we considered that the overall presentation of material in the Quality Account is good and generally clear with helpful visuals to convey detailed information/data, plus a comprehensive glossary and other accessible formats available.

Alex Stewart
Chief Executive

Tel: 01953 856029

Mobile: 07437 018620

Email:

Alex.stewart@healthwatchnorfolk.co.uk

Alex.stewart1@nhs.net

Healthwatch Suffolk:

Healthwatch Suffolk (HWS) thank the Trust for the opportunity to comment on the Quality Accounts for 20121/22. We recognise this has been a period of extreme intensity for the Trust’s staff, clinicians and volunteers, and as a Healthwatch, we are naturally also acutely aware of the heightened and at times sadly, sometimes unmet needs of the public, during these past 12 months. A 28% increase in 999 calls as compared to the previous year is testament to the pressures faced. Such issues are to be owned by the wider health and care system at large, as it is not solely the responsibility of the ambulance trust.

HWS is the region’s local healthwatch representative on the Trust’s Quality Governance Committee, and we liaise directly with the Trust’s Suffolk based commissioners, and we are also responsible for coordinating regionwide engagement with the Trust. This can of course only take place successfully with the consistent and proactive support of all the other local healthwatch in the east, and a Trust that is open, responsive and engaging.

Co-production is a core value and ethos at HWS and so we are very happy to see several references to such a culture of enhanced engagement throughout the Trust’s report. Our observation refers to both the involvement of the public and staff/clinicians in co-production, the latter being key when reading about the need for major culture and leadership changes that have been highlighted by the CQC and whistleblowers.

Co-production training was provided by us through several workshops, and this eventually led to the creation of what is likely to be a unique ambulance trust Patient & Public Involvement Strategy. The Trust refers to this work as having “emphasised the value of co-production”.

Another example cited by the Trust is a survey with the Norfolk & Norwich SEND Association. Commitment to planned co-production also includes a Learning Disability survey for 2022-23, projects in relation to young patients, mental health, learning disabilities (and an easy read survey), maternity care, safeguarding and intelligent conveyance. Following the implementation of the revised Complaints Policy, a complaint handling survey is also planned to measure patient satisfaction in relation to the Trust’s complaints handling process.

In terms of engagement and priorities for improvement, we welcome the planned appointment of a Learning Disability & Autism lead, followed by a series of engagement events. The Trust also plans to “fully embed the Patient & Public Involvement Strategy” with the help of its Community Engagement Group. With regards to Safety the Trust has appointed a Safety Improvement Specialist, and training of clinicians is planned. The Trust’s mobile Stroke Unit (Norwich and Ipswich) Trial Team is seeking interested parties to engage in their project.

Engagement with Care Homes and a pilot survey with staff (Norfolk & Suffolk) regarding Dementia is welcomed, albeit this only generated a small survey return. Advice would be for the Trust to seek support from its local healthwatch in advance of a second attempt.

The Trust recognises the importance of both good practice and areas for learning and improvement. There has also been engagement regarding New Patient Transport Service Vehicle Specifications, and on dementia needs. It is good to note that work with the RNIB is also planned.

Patient Surveys are continuous, with a hyperlink to the numerous reports offered to the reader. Safeguarding, Maternity, Mental Health, and Young People survey reports can be found. These reflect a mixed set of results in terms of levels of satisfaction, but all are set for improvement work.

In terms of staff engagement, critical because of what CQC has highlighted (2020), we note Freedom to Speak staff assurances, and the honesty with which the extremely poor NHS Staff Survey results have been reflected. These are the worst results for Ambulance trusts, and the Trust is not hiding from this. Actions have thankfully been underway for some time now (since CQC 2020 report).

Under a heading of complaints, we note CQC requirements for the Trust, as “must-dos”, to address issues concerning recruitment, use of independent ambulance providers, handling of complaints, safeguarding processes, and the culture of the organisation. Complaints of note, for this period, are on ‘ambulance delays’ and for ‘when the public being asked to make their own way to a hospital’. The Trust refers to a system/regional action plan to address patient safety, and rightly so, as this is not an ambulance service only issue.

The Complaints and Compliments Policy was revised at the end of 2020-21, and future projects (one of four) is a complaint handling survey. The reference to the survey unfortunately does not offer any detail. It is good to note that the Trust’s ‘Discovery Interviews’ with patients are also being used for training, handling complaints, serious incidents, and staff induction.

The Trust is to develop links between Patient Experience and Patient Safety, in order to optimise learning from complaints and Serious Incidents, a Quality Account priority for 2022-23. It’s also worthwhile noting that the Trust averages over 200 compliments a month.

We welcome a commitment to improve accessibility to the complaints process, with some elements offered now, such as BrowseAloud and options such as Braille. We would however advise EEAST that the company behind BrowseAloud is now called ReachDeck. The Trust website possibly needs amending and service user re-testing.

There are three case studies related to what were originally complaints, under the heading of “You Said, We Did”: One on the readiness of defibrillators, one on patients who are part paralysed (through previous Stroke, in this case), and one on a fall. The latter reached the Ombudsman’s attention and according to the Trust has actually led to worldwide learning (a dispatch system issue).

Performance concerning heart related matters, such as STEMI care (highest performing trust), PPCI (above national average) and Stroke Diagnosis Bundle (2^ndhighest trust) are to be commended. Conversely, ambulance response times for all bar C1(latterly), Utstein patients (survival to discharge), incidents concerning non-conveyed patients, asthma patients (peak flow recording), serious incidents (400% increase) and falls recording (decrease in ECG completion) will rightly remain under the spotlight due to below average or poor/worrying performance.

There is unfortunately little in the way of the subject of health inequalities in this report, other than what the Trust had gleaned from Equality & Diversity Monitoring data around Learning Disabilities, and a limited amount of feedback from Black and Minority Ethnic communities BME (only 38 returns for the year). With respect to the latter, we would advise the Trust to conduct a bespoke project with key local healthwatch in the region in order to uncover what appears to be a largely hidden issue. It is however encouraging to see the Accessible Information Standard specifically referenced under Priority 3 ‘Patient experience – work to enable a more inclusive feedback process for all patient groups.’

We could not find any references to the Trust’s Covid Vaccination programme, important because of the safety of staff, and patients alike.

Andy Yavoub
Chief Executive

Wendy Herber
Independent Chair

Healthwatch Luton:

Healthwatch Luton deem the Quality Account by EEAST to be reflective of the feedback that Healthwatch Luton have received over the last year.

In particular focus on the Priority 3: Patient Feedback area, we acknowledge and appreciate the involvement and inclusion of Healthwatch across the East of England, and the patient views and voice being integrated into EEAST’s progress.

It is clear from this Quality Account that the provider is working toward a learning culture and developing from the CQC inspection. Healthwatch Luton feel a responsive and reactive attitude toward feedback provided, and value the developing relationships within the organisation and the Healthwatch network.

The priorities for improvement outlaid in the Quality Account are challenging but will drive measured improvement in the service provision. Healthwatch Luton would like to acknowledge the difficult few years EEAST has faced during the pandemic, and acknowledge the steps they are taking during a difficult time to address concerns which have been transparently acknowledged and highlighted.

Healthwatch Luton receive feedback on EEAST but over the year and it has been mainly positive, including

“Ambulance service have been amazing, called for my parent and the staff were quick and caring”

“We should all praise and be grateful for all the workers in our hospital and ambulance service for all they have done over last few years.”

Healthwatch Luton have received minimal negative feedback over the last year on EEAST, and we feel this has been a reflection of the management and priority focus areas outlined in this Quality Account.

We will continue to support their developments and hope more local engagement and feedback measures are developed to support the culture moving toward developing patient feedback into their operational progress.

Lucy Nicholson
Chief Executive
HealthwatchLuton

On Behalf of the Board of Director at Healthwatch Luton

Healthwatch Central Bedfordshire:

EEAST Quality Account 21-22 Review

This detailed report clearly reflects how the Trust was operating, in what were the most testing of conditions (during the pandemic), and how it is responding to previous inspections and advice. For the lay-man the document is not an easy read and could perhaps benefit from a shorter Executive Summary, but it is appreciated that, under its legal obligations, there is a lot of information that the Trust needs to supply to the public.

The Trust has been honest and open in facing up to criticism - and we note the staff survey results (which are a concern) but equally has been able to point out areas where the Trust performs well,

for example in relation to dealing with heart attacks and strokes. The Trust covers a vast geographical area, and this covers much open countryside and some areas of true deprivation. Its work crosses many ICS’s and it is recognised that each of these entities will be placing differing demands on EEAST in the future.

It would have been helpful to Healthwatch Central Bedfordshire to see some localised information – for context. All the figures/data and graphics relate to the overall performance of the Trust. As a local Healthwatch we would seek some reassurances around local performance and ask that in future such data might be added.

That said, we recognise the outstanding work that our ambulance service has carried out in truly testing times and pass on our thanks to all who were engaged in managing the response to the pandemic, and dealing with the ‘ordinary’ and extra-ordinary.

Healthwatch Central Bedfordshire

Capability House, Wrest Park, Silsoe Bedfordshire, MK45 4HR

T: 0300 303 8554

E: info@healthwatch-centralbedfordshire.org.uk

www.healthwatch-centralbedfordshire.org.uk

Registered Charity No: 1154627
Registered Company No: 08399922

Healthwatch Cambridgeshire and Peterborough:

Healthwatch Cambridgeshire and Peterborough welcome the opportunity to review the draft East of England Ambulance Service NHS Trust (EEAST) Quality Account for 2021-2022. We continue to enjoy a positive relationship with the Trust, in general liaising with Healthwatch Suffolk who work in a co-ordinated way with other local Healthwatch across the area covered by EEAST.

We recognise that this has been another challenging year for the Trust in line with challenges experienced in the wider health and care environment, also that the pressures created by the pandemic has had a continued impact on progress in priority areas. We also recognise that the Trust have been honest and open in acknowledging areas of concern.

Healthwatch Cambridgeshire and Peterborough are pleased to hear of the work being carried out to bring about overall improvement in the culture of the Trust. Feedback provided on the staff survey, whilst concerning, shows the trust is willing to acknowledge areas in need of improvement. We welcome the launch of the Freedom to Speak Up Ambassador Programme, also to hear of the increased capacity within the FTSU Team.

We acknowledge the progress made against actions raised following the previous CQC inspection, with 159/174 actions having been completed to date. We look forward to hearing outcomes of the recent inspection of Core services, also the focused Well- Led inspection due to take place shortly.

Feedback to Healthwatch about the Trust’s services in our area includes positive comments around care received with people being treated professionally and with compassion. There are however issues around response times which will have been further impacted due to the pandemic. We continue to hear of concerns around the provision of non-emergency patient transport.

We have found the Trust to be responsive to concerns raised and intelligence shared during 2021/2022. We have also welcomed the opportunity to be involved in engagement meetings between EEAST and local Healthwatch and continued input and attendance at our Health and Care Forums.

Caroline Tyrrell-Jones

Healthwatch Cambridgeshire and Peterborough

Peterborough Adults and Health Scrutiny Committee:

Date: 20th May 2022

The Adult and Health Scrutiny Committee has welcomed the opportunity to comment on the Annual Quality Account 2021/2022 for the East of England Ambulance Service NHS Trust (EEAST).

Marcus Bailey, the Chief Operating Officer attended a meeting of the Adults and Health Scrutiny Committee in November 2021 to report on the Progress of the CQC Inspection target and Overview of the performance of the service within the Peterborough Area. The Committee received a detailed report and were able to challenge and question the Chief Operating Officer.

The Committee acknowledge that this year has been extremely challenging, especially for frontline staff to deal with, but they rose to the occasion, delivered the care, and changed their working conditions when necessary.

As a Scrutiny Committee we note with interest that the Trust are currently undergoing a focused ‘Well-Led’ inspection by the CQC and we are hopeful for all concerned, that there is a significant improvement from the overall “requires improvement” and “inadequate” for ‘Well Led’. Having addressed 159 of 174 arising actions, it is clear the Trust is working hard towards improvement, which is great to see.

We are encouraged and pleased to see that through the priority objectives, the Trust is focussing more heavily on obtaining feedback from those with learning disabilities, dementia, younger people and those from smaller ethnic backgrounds.

Likewise, we would hope to see a greater drive around the care for those with Learning Disabilities and Autism, in line with the Learning Disabilities and Autism Strategy now that you are more able to interact post severe Covid restrictions.

The Trusts performance for delivery of the STEMI Care Bundle for heart attacks, was great to see, achieving 17.2% above the national average which was a fantastic result in an area which is still one of the biggest causes of premature mortality.

The Trust has continued to focus on their core provisions and required improvements, despite the increased activity caused by the pandemic.

Progress against priorities has been difficult to achieve, and it is disappointing to see categories C3 and C4 have not met the national standard. Although some goals have been met it is understandable why others have not. It will be good to see progress after the next 12-month period on greater patient facing hours as this year should be more balanced.

It is good to see the recruitment of another 100 plus call handlers, however the Scrutiny Committee were advised that 200 paramedics were to be trained but there is nothing in the report to say how many have been trained or are in training.

There is still a need to improve performance with the high number of staff concerns and there is more that must be done to make a safer working environment for staff.

Throughout the report the Trust have made progress and improvements, despite the pressures of the Covid-19 pandemic and the Adults and Health Scrutiny Committee would like

to say well done and congratulate everyone on achieving these. A big thank you to all of the staff who have worked extremely hard under difficult circumstances.

As a stakeholder the Adults and Health Scrutiny Committee are committed to providing feedback and working closely with EEAST over the coming year to deliver their objectives and improve the experience and quality of care for all our residents.

Cllr Elsey
Chair, Adults and Health Scrutiny Committee

Cllr Rush
Vice Chair, Adults and Health Scrutiny Committee

Cambridgeshire County Council:

STATEMENT BY CAMBRIDGESHIRE COUNTY COUNCIL ADULTS & HEALTH COMMITTEE

The Adults & Health Committee, in its Health Scrutiny function, have received the Quality Account 202021 from EEAST. The committee recognises the achievements made by the trust given the impact that the Covid-19 pandemic has had on all NHS Trusts.

The committee requested attendance from the Trust at a public, health scrutiny meeting on the 9^thDecember 2021. The meeting focused on the trust’s response to the September 2020 CQC inspection, termination of the apprenticeship offer, performance, pressures on the service from the impact of the pandemic and winter preparations. The committee requested attendance from the Trust at a future meeting.

Adults & Health Committee Mins 09-12-21

The committee is pleased to note that the Quality Account addresses the Trusts progress on the CQC improvement requirements following an inadequate inspection rating on the “Well-led” domain. The committee heard from representatives from the Trust in December that the service was actively looking to change the workplace culture to prevent discrimination.

Members are keen to follow up with t

he Trust the outcomes of the CQC “Well-led” inspection that has been undertaken in early May 2022.

Norfolk Health Overview and Scrutiny Committee:

Norfolk Health Overview and Scrutiny Committee has decided not to comment on any of the Norfolk provider Trusts’ Quality Accounts and would like to stress this should in no way be taken as a negative comment. The Committee has taken the view that it is appropriate for Healthwatch Norfolk to consider the Quality Accounts and comment accordingly.

Suffolk Health Scrutiny Committee:

As has been the case in previous years, the Suffolk Health Scrutiny Committee does not intend to comment individually on NHS Quality Accounts for 2021-22. This should in no way be taken as a negative response. The Committee acknowledges the significant ongoing pressures faced by NHS providers as a result of the Covid-19 pandemic and wishes to place on record our thanks for everything being done to maintain NHS services for the people of Suffolk in the most challenging of times.

County Councillor Jessica Fleming
Chairman of the Suffolk Health Scrutiny Committee

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