Behind The Headlines
Transparency and clarity when working with the media
The Trust works closely with all media outlets in the eastern region and nationally on a regular basis.
This page features the full responses which relate to contentious issues EEAST is approached about for a response. Often the outlets do not run a full response, and this page allows stakeholders to see what was shared.
It also honours the efforts that go into getting accurate, transparent and full information to reporters to help broaden their understanding of an issue related to EEAST.
Response to rotas and other matters - 27th September 2018
“A number of assertions are being made this week about rotas and other matters, including a petition which portrays these concerns. Staff have a range of options to raise their concerns, including the newly-agreed joint Disputes Resolution Procedure.
“Sharing misinformation via external stakeholders and outside of formal partnership working routes, is a massive concern, and one we’re following through with our colleagues at UNISON.
“Assertions that EEAST is the worst performing trust in England are being made without any challenge, or base by those agreeing with the assertion. On average, response times to our sickest patients improved over the summer by nearly 30 seconds. Five of eight indicators of ‘care bundles’ (the measure how we’re treating patients with conditions like heart attacks and strokes) showed an increase in compliance, and complaints about the 999 service were at the second lowest number (58 in August) since April 2016. This is all available information in our latest Board papers.
“Nearly 1,000 stakeholders informed this year’s Deloitte’s leadership review, and whilst we are working to improve culture and engagement where identified, Deloitte recognised EEAST’s many areas of good practice. This included ‘cohesive leadership from the CEO and Chair and a professionally-run Board…the overall Board dynamic is friendly, supportive and generally cohesive’. Deloitte were aware of significant ongoing concerns and a lack of confidence in senior leadership raised by certain stakeholders, but did not find evidence to suggest that events around winter were specifically linked to weaknesses in senior leadership.
“There has been a long-identified capacity gap but, under Robert Morton’s leadership, EEAST secured the independent review of capacity and as a result received a significant increase in investment. This will see the Trust recruit more than 300 front line staff and deploy more than 100 more ambulances. Public perception impacts on how EEAST is viewed as an employer, and thus on our ability to recruit; EEAST faces the same challenges as other ambulance trusts with a national shortage of paramedics but is working with the sector and the NHS system to find a sustainable solution to this sector wide workforce challenge.
“In the case of the Building Better Rotas programme, it is not true to say that final decisions have been made – three out of four working parties have been held involving more than 150 staff all over the region who represent their colleagues, and our engagement started early in 2018, including both face-face and online. Staff can still contribute to the outcome of project as the final working parties are held next week, then suggested rotas are voted on. Staff are being listened to throughout this process – for instance, two core principles which the rota project are built on have been amended based on what staff have been saying, and feedback is being used in the development of a new Relief Policy.
“Building rotas is one part of the Trust’s overall transformation programme following much needed investment into our recognised capacity gap through the Independent Service Review. We are proud our staff deliver outstanding care, but still we see patients waiting disproportionately longer for an ambulance when their 999 call is not life- or limb- threatening. By using the output of the rota project, more resources will be available over a wider period to attend these calls in a more timely way - reducing the risk of a minority of patients deteriorating and maximising a patient’s experiences and their dignity. The Trust recognises the challenges in the Norfolk health and social care system at present and it is important we play our part by supporting patient care in our communities and being available for those most in need, particularly over winter.
“We have taken every opportunity to learn where we can from last winter. The Trust is working with its system partners at every opportunity to prepare for the coming months, and beyond. Achieving patient safety across this system will not be a quick fix; we have to embed a system and culture that supports our commitment to delivering compassionate care whilst valuing our people and their wellbeing.”
Response to MP press release (13/7/18) re: EEAST Board leadership
This press release was supported by three Norfolk MPs and follow-up responses requested by the Health Service Journal, ITV Anglia and BBC Norfolk. This is our full response, with abridged versions also shared with broadcasters to help condense the information within it.
“Our united Board-level team has a wide range of expertise and experience to help strengthen our service and ensure focus remains on patients. We’re in the best position ever to provide the high-quality and sustainable health services our communities need. With the right investment, we will get better and better.
“The leadership responsibility involves regularly meeting with, and briefing, 56 MPs across the region. We take part in robust meetings to answer the key questions and constructive criticism these Parliamentary colleagues have. We are accountable to the millions of residents in the eastern region who are our past and future patients, and we do that most effectively with MPs who understand the ambulance service operations and commissioning, and who view the system challenges and solutions together.
“It’s disappointing these three Norfolk MPs appear not to recognise the context our emergency service core business operates within. Norfolk is a highly rural area and doesn’t commission national standards and the Trust continues to work with commissioners to be able to improve this - we would encourage these MPs to work closely with us and our commissioners to fully understand where their support could be best placed.
“To reiterate, we are not currently commissioned to deliver national standards of performance either at a regional or local level and so to draw comparisons is misleading. We focus our attention on getting to the sickest patients first as quickly as we can and we have exceeded our commissioned target of getting to nine out of 10 patients about one minute quicker during the first quarter of the year. During May, EEAST was the best performing trust at helping lower acuity patients get a more appropriate response, such as through Hear and Treat in our control rooms. Meanwhile, patient handovers at hospitals are improving so that we can get back out into the community. It is important that we are focussed on patients rather than on just hitting targets which we know in the past, has led to the wrong operational behaviours nationally.
“By working with our staff on rotas to improve their working patterns and ensure ambulances are available when patients need them most – these improved rotas launch from next February – and using £11.5m investment for 330 additional frontline staff over the next three years, we will see positive changes, but training up new paramedics, for example, takes time and our hard-working patient teams do everything they can each day to place patient safety and good outcomes at the heart of what they do.”
Response to Norman Lamb MP press release (18/6/18) re: patient safety information release
The East of England Ambulance Service NHS Trust (EEAST) rejects Norman Lamb MP’s latest allegations in the strongest terms.
All MPs representing our region have been briefed that EEAST is not currently commissioned to deliver national targets so comparing trusts while not recognising variation in Trust resources is inaccurate. It was announced last month (May) that the Trust is to receive a significant increase in funding to recruit 330 additional frontline staff and 160 more ambulances to meet performance standards by 2019. Our staff work hard to deliver excellent patient care and deserve recognition for that.
This is a statutory appeal against the Information Commissioner’s decision, which we believe is incorrect. In responding to this highly technical request we would go beyond the maximum time and resources allowed for under the Freedom of Information Act. In this case, the applicant, and constituent of Mr Lamb, is a Trust employee and UNISON branch secretary. This applicant has made 171 FOI requests between November 2015 and October 2017 – more than 10 per cent of all the FOI requests the Trust received in that period. As far as possible, we have sought to reply positively to those requests. Given the large number of requests and that the applicant says the information is needed for union activities rather than issues of patient safety, the Trust has sought to agree other, more proportionate ways of providing UNISON with relevant information and much of this information is now voluntarily and regularly reported to UNISON.
The Trust performance is published nationally and this appeal has nothing to do with winter pressures. Our aim is to use Trust resources appropriately over the long term and that is precisely why this appeal is being brought.
Regional UNISON officials recently took the step of taking the local branch into supervision having made a number of commitments to the Trust, including the proportionate use of FOI legislation. We are pleased that we are making progress with regional colleagues and we remain committed to working with UNISON at the regional level. We would be pleased to discuss this matter with Mr Lamb.
Statement regarding the death of a patient in Lowestoft: 19th January 2018
An East of England Ambulance Service Trust spokesperson said: “At 3.46pm on 27th December, the Trust received a call from police to a report of concerns for a man who was conscious and breathing and sitting outside at an address in Lowestoft. We were informed he had no obvious injuries or medical complaint and following triage, the call was categorised as a non-emergency call not requiring a response.
“At 10.33am on 28th December we received a call to the same address to a report of a man who was not breathing and was in cardiac arrest. A paramedic in a rapid response vehicle attended in eight minutes followed by another rapid response vehicle and ambulance officer. Sadly, the patient confirmed as deceased. This case is being formally investigated by the Trust and our findings will be reported back to the family in due course.”
Statement following concerns raised by MPs: 19th January 2018
“We are aware of the claims made by MPs but note no complaints have been received from patients or their families at this time. Nor have any concerns been expressed internally through our line management, whistleblowing or freedom to speak up processes.
"The Trust had plans in place however experienced extreme levels of demand over the new year period in particular. The Trust was unable to respond to a very small number of the 50,000 calls we handled over a 15 day period as quickly as we would like. The Trust is undertaking a rigorous analysis of that small proportion of calls. Where any suspected cases of potential harm are identified, then the Trust will exercise it’s duty of candour to notify patients or their families. It is worth noting that any cause of death not certified by a doctor can only be established if there is a coroner’s case.
"It is best practice to always review the effectiveness of any plans and the Trust will be doing that. Depending on any preliminary insight, the Trust will invite an independent review of our decision making process. The Trust has also requested a system wide review of these periods of high demand and lost capacity.
"The Trust absolutely refutes claims that there were no senior managers in over the Christmas period. In line with all ambulance trusts, this Trust operates a Gold Command system which consists a 24/7 on call rota of the most senior operational managers whom are highly experienced and well trained. To ensure complete resilience, two Gold Commanders are available at all times in case a substitute is required. The Gold Commanders are supported by an on call team of managers and, during busy periods, are further supplemented with a Tactical Command Team. While members of the Executive Team were working across the festive period to provide Board level support, Gold Commanders are the most senior operational manager in charge of and responsible for managing daily service delivery.
"The Trust is on the public record http://www.ipswichstar.co.uk/news/we-don-t-have-the-money-to-provide-the-services-we-are-expected-to-provide-ambulance-boss-tells-mps-1-4450263 stating that it has a gap between funded capacity and demand. It is good financial planning to ensure that the Trust is in a position to hire any additional resources that may become available across the months of January, February and March. The Trust is well placed to buy such resources where available.
"Demand has now lessened, and while our festive plan has come to an end, our winter plan remains in force and ready to respond to the expected peak in the flu driven demand. We continue to urge everyone who has not yet done so, especially those who are in the risk groups, to have a flu vaccine as early as possible."
Clacton death statement: 5th January 2018
Sandy Brown, Deputy Chief Executive at EEAST said: “Our sincere condolences and apologies go out to the patient’s family and friends and we are truly sorry for the ambulance wait that occurred at this incident.
“We have very publicly expressed how stretched the ambulance service is and the pressures our staff and the NHS as a whole have been under the past few days. As a Trust, we have experienced our busiest days ever and we know our partners in the hospitals are in the same situation.
“We are working in partnership but we are facing hospital handover delays, which can prevent us from responding as quickly as we need to.
“Regarding this incident, we received a call just before 8pm on 2nd January to a report of a woman with chest pain in Clacton. Due to extremely high demand on the service and delays at accident and emergency units, we were not able to immediately dispatch an ambulance. We had more than 4,200 calls across the East of England that day, more than 1,300 of which were in Essex and more than 250 were in North East Essex.
“A clinician in one of our control rooms made a welfare call and spoke to the patient at 9.47pm and an ambulance crew arrived at the address at 11.46pm. The patient was found unconscious and not breathing and sadly died at the scene.
“This incident is being investigated by the Trust and we will report back our findings in due course.”
Echo article about Canvey Island rapid response vehicle: 18th December, 2017
A story about the impact of the ambulance response programme on Canvey Island's rapid response vehicle has been published here: http://www.echo-news.co.uk/news/15778856.Paramedic_urges_MP_to_save_rapid_response_vehicle/
The full EEAST response has been drastically cut. The full comment and information from the Trust is here:
"The national Ambulance Response Programme (ARP), which is supported by the College of Paramedics and health unions, is about making sure patients get the right response first time for their clinical needs, rather than simply hitting a mandatory target. The new standards recognise that in the past rapid response vehicles were used to get to a patient quickly, often to meet a target, even though the patient still needed an ambulance to get them to hospital. Under the new system, the aim is to make sure patients get the right clinical response, which is more often an ambulance than a rapid response vehicle.
"To be able to implement this, and provide patients with the best possible service, EEAST will be increasing its ambulance cover and reducing the number of Rapid Response Vehicles it operates something our colleagues in UNISON have been calling on for a number of years. Every ambulance service in England is implementing these changes for the benefit of patients.
"The Trust implemented ARP standards in October. This is about providing more transportable resources so that if a patient is having a stroke or heart attack, they receive the most appropriate response – an ambulance – to get them to hospital quickly for further care rather than simply hitting a time target.
"This new set of ambulance standards will help us focus more towards counting patient outcomes as performance and not measures which failed to take into account the care we gave, and focused more on how quickly we go reached someone even when the need to do so had no bearing on outcome.
"ARP still means we focus on the life-threatened patients first but also puts more emphasis on benefits to people suffering strokes, for instance and getting the right type of emergency response first time for the right outcome.
"It’ll still be some time before we can bed down these changes and be clear on the operating model. However, any changes we propose will involve a full consultation with our staff."
For more information on the new response standards, visit http://www.eastamb.nhs.uk/your-service/campaigns/its-your-call.htm
Mirror/Sunday People report on lease cars: 5th November, 2017
An article about the cost of the EEAST lease car scheme article was run online here http://www.mirror.co.uk/news/uk-news/ambulance-trust-doubles-spending-bosses-11467780 and in the Sunday People newspaper. The EEAST response was paraphrased briefly at the end of the articles, which was challenged and changed online. The print version did not have this response and background within it:
A spokesperson said: “Staff with blue light-enabled lease vehicles are clinicians as well, which means they make a significant contribution to emergency responses on a day-to-day basis and support the frontline at hundreds of incidents; they are also the resilience contingency to respond to significant or major incidents, such as full emergencies at an airport, or a terrorist threat. The resilience of the Trust is a business critical consideration.
“The spend on lease cars has reduced this year and the number of users has stayed about the same. In 2016/17, £825,238 was spent on lease cars and this year it is projected to be £778,248. The draft business travel policy aims to further reduce this significantly, so staff are equipped with the right vehicles to do their duties at the best value for money. The Policy has been under review involving a cross-section of expertise including union representation and Healthwatch and will be considered by the Remuneration Committee.
“Last month new national standards of four response categories were introduced in EEAST. Up to the point of changeover, EEAST delivered fully on its contracted performance trajectory. The Trust has the second lowest level of staff attrition in England and has delivered significant operational improvement resulting in one of the lowest users of PAS in England.”
Notes to Editor
- The lease car costs are calculated as lease costs + insurance costs - personal contributions made by staff towards the vehicle
- The projected figure for 2017/18 takes the spend on lease cars (as detailed above) for the first six months of the year and multiplies it by two to give a 12-month effect
- This takes into account all lease cars, of which blue light lease cars is one element
- The National Audit Office Report debated by the Public Accounts Committee in March 2017 confirmed that EEAST has one of the lowest spends in England on executive and senior management
- There is no overtime ban
- Private ambulance service (PAS) cost has been approx. £160k a month on average since April
- The Trust has recruited to all its paramedic vacancies, having employed hundreds of student paramedics over the last few years. However, EEAST continues to believe it has a capacity gap (i.e. a gap between what it is funded for staffing and what it actually needs)
- An independent service review has been commissioned by NHS England and NHS Improvement to understand what funding and staffing EEAST needs to meet patient demand.
Mirror online report on financial consultants: 12th November, 2017
An article about the cost of the financial consultants was run online here http://www.mirror.co.uk/news/uk-news/ambulance-trust-splashes-100k-month-11506650. Again, the EEAST response was paraphrased briefly at the end of the article. EEAST’s full response it submitted to the Mirror was:
A spokesperson said: ‘The Trust has been really open about the significant challenges faced nationally both in meeting rising demand and the money available. The deficit in 2016/17 was around £10m which mainly related to capacity issues and decisions made to increase capacity to deliver a safe service to patients - issues that had built up over a number of years as the gap between funded capacity and demand grew.
‘One-off funding, funding through patient-facing vacancies held for a number of years or through stripping back support services went some way in keeping the gap small financially, but the need to actively recruit to vacancies, reduce attrition and bolster support services changes that financial position.
‘NHS Improvement (NHSI) introduced a financial improvement programme (FIP) for trusts which face a significant financial challenge. Once EEAST was invited to this programme, a financial improvement team – in this case SSG – analysed the effectiveness and efficiency to come up with potential solutions to improve the service to patients and the financial position.
‘The SSG team started work in December and was paid if the required savings were delivered; because of the efforts made by staff in tackling this challenge coupled with some extra funding, EEAST is currently reporting a surplus of nearly £1m. The Trust has paid £574,000 for the work.’
- SSG is one of the firms on the panel procured by NHSI for the FIP
- The fees paid to SSG were based on the NHSI FIP framework rates
- EEAST had two phases of workwithSSG:
- Phase 1 was that the equivalent savings were made (or costs avoided) and the cost was £406k
- Phase 2 was a prescribed-fee basis to further develop and embed the schemes identified in Phase 1, including the development of EEAST’s cost improvement plan for 2017/18. The cost of Phase 2 was £168k.
- For 2017-18 EEAST gained some recognition of the capacity gap and secured further income. Because of this, the cost control measures introduced and the benefits of the work with SSG, EEAST has been able to enter the third quarter of this financial year ahead of plan with a marginal surplus of £0.9m as at the end of September.