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News | Health 999 service ‘special measures’

A DAMNING report listing a catalogue of failings has recommended that South East Coast Ambulance Service (SECAmb) is placed into special measures. The advice from the Govern-

ment’s Care Quality Commission would allow the service to get the support it needs to improve from ex- ternal parties. The report by Prof Sir Mike Richards lays the blame squarely on the shoulders of service leaders. It raised concerns in 13 areas, includ- ing staff numbers, poor medicine management and hygiene practices, and in meeting national perform- ance targets. However, Sir Mike makes no se-

cret of where he feels the blame lies, praising staff for providing the serv- ice, in spite of management and a culture of harassment and bullying. He adds: “It is to the credit of the

staff that they have continued to pro- vide a vital service to the people of Kent, Surrey and Sussex – dealing with almost a million emergency calls a year.

“Throughout our inspection, we

heard how staff were giving their best, treating patients kindly, with dignity, care and compassion.” But, he added: “It was apparent that the leadership had not been supporting staff to do their jobs effectively.” Specific actions to improve include providing enough staff and man-

agers to meet patient safety and op- erational standards and the need for staff to take meal breaks, finish on time and get their administration and training done. Sir Mike went on to reassure the

public, adding that since the inspec- tion in May, when clear evidence was found that senior executives were not always “pulling in the same direction”, improvements were being formulated by an expe- rienced interim chair. The executive has also recently been strengthened by new appointments. He finished: “While we have sig-

Sir Mike Richards praised ambulance staff but criticised amanagement culture of harassment and bullying

nificant concerns about the perform- ance of the ambulance service, I want to provide some reassurance. Once care arrives, it is of a good stan- dard – with dedicated and caring call handlers, ambulance crew, para- medics and other frontline staff working hard to ensure this. “Secondly, the trust is taking ur-

gent steps and some improvements have already been made to ensure that everyone who relies on this service receives excellent, timely care.” A spokesman for the South East Coast Ambulance Service NHS

Foundation Trust confirmed the CQCreport had rated its service “in- adequate” overall and thatNHSIm- provementwas considering placing the trust into special measures. However, he added thatSECAmb remains committed to improving the quality of its service and would welcome the additional support placement into special measures would offer. Acting chief executive Geraint Davies said: “While we are pleased that the dedication and care of our staff is highlighted as good in this re- port, we are sorry that we have not met the standards expected in a number of other areas. “We have been working on and implementing a number of im- provements. I would like to reassure everyone that I, along with my sen- ior team,amcommitted and focused on ensuring these necessary changes continue.We are determined to im- plement the changes required to re- store confidence in our service.” He said action taken so far in- cluded recruiting more staff, al- though this remained a significant issue, and strengthened systems for the management of medicines and infection.

Services reviewed in bid to save £5m

“UNPRECEDENTEDpressure” on the NHS due to high demand, es- pecially in urgent care, will lead to early money-saving cuts and re- views of some local services. The GP-led budget-holdingNHS

West Kent Clinical Commissioning Group (CCG) has earmarked about 15 areas as it investigates making full-year savings of about £5m. This is on top of almost£20magreed ear- lier this year. The group says: “The proposed changes do not represent a sub- stantial change in service. They in- troduce better systems for preparing for surgery, managing repeat prescriptions safely, manag- ing ongoing care or a temporary suspension ofways to access care.” The key areas are:

Urgent care – frequent attenders Aproject will identify top-repeating users of local urgent care and a manager will be recruited to over- see a care plan management sys- tem. The aim is to reduce A&E attendances, 999 calls, ambulance conveyances, non-elective admis- sions, 111 calls andGPout-of-hours appointments. Homefirst Patientswhohave re- ceived medical care and do not re-

28 Maidstone November 2016

quire an acute hospital bed – but may require care services – will be provided with short-term support to be discharged to their home or a community setting. This will in- volve KCC social services. More treatments are planned at home. COPDrescue packs Chronic ob- structive pulmonary disease packs will be issued to suitable patients to cut down on hospital admissions. Hip/knee replacements Lifestyle advice will be offered to ensure pa- tients are fit for surgery. The aim will be to refer patients to advice services if their body mass index is above 30 or they smoke. Surgery will remain a clinical decision, weighing up safety considerations and effectiveness of intervention. Referrals to consultants GPs will be encouraged to use the Kinesis software system including guid- ance from consultants for advising patients to reduce outpatient refer- rals. A “virtual clinic” could be set up for most headache referrals.  Spinal injections The aim is to reduce the number of injections.An advice service could offer lifestyle counselling to ensure patients’ fit- ness for injections and offer advice on alternatives. Funding could

cease for non-specific back pain.  Audiology Access to this service will be restricted to patients with se- vere or moderate hearing loss.  Orthotics Devices are supplied for supporting limbs and service specifications will be put in place.  Enhanced recovery programme The aim is to improve outcomes for patients from surgery, reducing time in hospital and ensuring pa- tients are as fit as possible to receive surgery and preparing for recovery.  Temporary restrictions These will be imposed on MRI services with exceptions for spine, brain and knee, although GPs will still have access to these scans with consult- ant prior approval. Vasectomy and sterilisation proceduresmaybe sus- pended for six months.  Medicines Reviews will look to ensure best patient outcomes and reduce waste. A call centre will be created for repeat medications.  Gluten-free The CCG will carry out a consultation on a proposal that gluten-free products should not be routinely prescribed.  Thyroid The CCG will discon- tinue Armour thyroid and other desiccated thyroid extract products due to lack of evidence of benefit.


THE CCG needs the cuts to work within its budget. It says at this stage it has not included changes in: IVF, cataracts, a ban on non-urgent re- ferrals, statin prescribing, foot care, physiotherapy for minor in- juries, non-health essential treat- ments such as excessive sweating and over-the-countermedicines.


WEST Kent CCG has approved a “whistleblowing policy” to en- courage employees to raise con- cerns for the benefit of all patients. “We will look in to what you say

and you will always have access to the support you need,” says the CCG.

Ambulance plan

LOCAL ambulances are still miss- ing emergency targets and West Kent CCG has written formally to SECAmb requesting a recovery plan for this area and regular progress reports.

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