Your questions answered - PPP

Yes – we have been trialling the use of military responders in both Poole and the Royal Naval Dartmouth College for the past 12 months. The next step is to evaluate these trials, develop a standard model for military responding and potentially roll it out further.  We have been having some discussions in Wiltshire with some military units about this issue.

Currently, our Community First Responders submit an application through TRAC which is the same system that is used for paid roles. We recognise that this is not the most volunteer-friendly platform.  As we are increasing both the number of volunteers and the range of volunteering roles, we are very keen to look at a Volunteer Management System which may also give us the opportunity to recruit our volunteers in a more appropriate manner.  This is a development which we are keen to progress next year, business case permitting.

With regards to the question about already operating at PHEM Level F. It would be helpful to have a conversation with your local Volunteering & Community Services Officer to understand your current role and whether that is in the pre-hospital environment.  We have worked with individuals to tailor the course if they are already operating to a more advanced level and have significant pre-hospital experience.  In which case, we may just need the final assessments to be completed. 

Onboarding obviously also includes the pre-volunteering checks such as DBS which do need to be completed prior to go live together with at least one supervised shift either on a double crewed ambulance or together with an experienced CFR.

It is worth noting that all CFRs, however, operate to an agreed scope of practice.  And even though, in a day job, you may operate to a more advanced PHEM Level, as a CFR, you would be governed by the CFR scope of practice.

Currently, the only national network for the co-ordination of public accessible life saving equipment is for defibrillators, through The Circuit. Most of these are privately owned defibrillators.

Work is underway to create a similar platform for ‘bleed kits’ which is likely to be ‘hosted’ by the Police but would allow ambulance services to direct someone to a bleed control kit in the case of a haemorrhage call being received. This does not currently exist.

So, no, there are no plans for SWASFT to supply these kits. Many kits are bought and the challenge for SWASFT is having a reliable source of information about this equipment and its status so that we can give 999 callers clear pre-arrival instructions.

It is essential that you call 999 if you are seriously ill, or injured, or if you feel your life is at risk, so the most appropriate help can be arranged for you, as quickly as possible.  

As is commonly made aware by media reports on the subject, the Trust and the wider NHS emergency and urgent care services continue to experience an unprecedented level of demand.  For the Trust’s part, this demand can result in delays to some of our patients.

When a ‘999’ call is received in the Emergency Operations Centre (‘EOC’ formerly known as the ‘999’ Control Room), the aim is to quickly identify the clinical needs of the patient and arrange appropriate assistance. The caller is taken through a series of questions developed by national medical experts, and the outcome of those questions determines the category (urgency) of the incident.  This is to ensure that emergency medical help is sent to the most life-threatening incidents without delay. 

Ambulance resources are prioritised to attend the patients who appear to have the greatest clinical need so the sickest patient will receive help before a less sick patient, even if that less sick patient has been waiting longer. 

The system used by the Trust’s EOC to prioritise ‘999’ calls is called the Medical Priority Dispatch System (MPDS) and is an internationally recognised protocol for emergency prioritisation. Emergency Medical Dispatchers (EMDs), formerly known as Call Takers, are appropriately trained and certified to receive ‘999’ calls, provide scripted medical advice over the telephone, and triage (classify and prioritise) calls which may result in the allocation of ambulance resources. 

Unfortunately, we are unable to provide an estimated arrival time for non-emergency calls as allocated ambulances can be diverted to patients where there is a more urgent clinical need or risk to life. This is a dynamic process as 999 calls are continually received. Clinical colleagues (within the EOC) have oversight of all calls to help ensure that the clinical priority assigned to the call remains appropriate for our patient’s needs. It is, therefore, important to keep telephone lines open so that we can call patients back unless, of course, there is a change in the patient’s condition, then it is essential they call back 999 for re-assessment.

Coupled with the demand on our service, this is further compounded by hospital handover delays and system pressures within the wider NHS and social care . There is a 15-minute target time frame for hospital staff to take responsibility of a patient from an ambulance crew when that patient is conveyed to the emergency department. Anything above that target constitutes a delay and will have an impact on the availability of ambulance resources.

On 15 November 2021, the Association of Ambulance Chief Executives (AACE) published a report highlighting the impact of handover delays nationally and the potential for harm. In addition to the AACE report, the Trust also commissioned ‘a ‘system’ review into the wider reasons for the significant ambulance delays. This review's purpose was to understand the underlying causes and environmental context of ambulance delays.   

A series of recommendations and actions to improve the position were identified from this review, not just for South Western Ambulance Service but for other NHS providers such as acute hospitals, General Practitioner’s, NHS111 and the Integrated Care Boards. Since publication, work has been ongoing, and an addendum report was published in January 2024, providing an update to the current position. This report can be found on our website: https://www.SWASFT.nhs.uk/download.cfm?doc=docm93jijm4n1336.pdf&ver=958  

Please be assured that we do not want to see any of our patients waiting longer than necessary for an ambulance and, if the triage of your call determines that an ambulance resource is required, assistance will be sent to you as soon as a resource becomes available. 

Further, we continue to work incredibly hard with our partners in the NHS, and social care, to do all we can to improve the service that patients receive.

We would love to explore other options and would need advice from our IT department. We will keep you updated on our progress. 

This is being considered by the Operations, Patient Experience and Emergency Operations Centre teams.  Operational leaders visited the Isles in September to meet with key individuals, listen to their feedback, and share what we’re doing as a Trust to improve our services on the islands. 

There has been a lot of work done around the meal break policy. We knew that our crews were unfortunately getting a lot of overruns of their shifts, which is not practical with everyday life outside of their working hours. So, by changing the meal break policy, the crews are getting breaks when they require them, and ultimately that has led to an improvement in overruns. The Trust has received positive feedback from staff members regarding the change in policy.  

In short, yes. We have had an increase in our staff utilising body worn video over the last two quarters last year, which has shown acceptance towards it, so it is being used more frequently and in a more positive manner, resulting in more incidents being reported. The use of body worn camera has resulted in some staff not having to attend court to give evidence because the video was enough, which is really positive. When body worn camera was first rolled out in the Trust, we noticed that crews would only generally start using it, after they had attended an incident that made them think they needed it. However now staff feel more positively about it and have seen its benefits such as reducing things such as writing statements and going to court which is encouraging.  

The implementation of this service has been staggered over the UK with some counties not fully rolling this out until April and May this year. We do not at present have enough data to enable us to see how the ambulance service has been impacted by this service. We do know that the overall demand for mental health into SWASFT has increased by nearly 20% this year, it is unclear at this stage whether this relates to 111#2 or other significant changes, such as police withdrawing from mental health calls under the Right Care Right Person initiative.  

Yes, absolutely, we have a link with every police force that lies within the SWASFT area. We meet monthly to discuss trends and patterns to data which we have collected. In regard to operations that may need medical assistance this would lie with our Hazardous Area Response Team (HART), and they would notify them if an operation was taking place.  

Statistics show that the types of circumstances you mention make up only a small percentage of violence and aggression cases against SWASFT colleagues. However, bar fights and similar circumstances are normally already being managed by the police, therefore the proportion of violence and aggression is not typically attributed to this. Most of the violence and aggression that our frontline face is usually from situations such as mental health crisis, when patients are not receiving the support they may need, or from patients suffering from dementia. This is why the violence and aggression team work with multiple agencies and not just the police force. 

We have CFRs in Chipping Campden, Bourton-on-the-Water, Moreton in Marsh and Upper Rissington. We also have Fire Co Responders in Moreton in Marsh, Northleach and Stow-on-the-Wold. 

Our charity website is at South Western Ambulance Charity | Abbey Court, Eagle Way, Exeter (swambulancecharity.org). Alternatively, please do get in touch with us with any questions or thoughts at charity@swast.nhs.uk 

Unfortunately, there is no official data for this as there is not a data collection point for the use of the chairs. Capturing this data is now something that has now been put forward as a suggestion.

The annual crime and violence reduction report is currently in the middle of being produced so we will imminently have an updated overview of the position.  

Current statistics currently show there has been a rise in incidents reported to the trust, however reporting has recently become a lot easier, which would suggest that prior to this, incidents were going unreported. The next PPP on the 9^th of August will be attended by a crime and violence officer who will be able to answer any further questions.  

Turnover is reviewed on an ongoing basis within the Trust’s People Committee, Board and Strategic Workforce Group. The most recent data capture is  included below to provide an overview of recent years:

Turnover had increased in 22/23, however it has reduced in recent months at around 12.5%. It is recognised by the Trust that the Emergency Operations Centre (EOC) has the highest turnover, and the Assistant Director of the EOCs is working closely with the People Partner and the Staying Well Service and Freedom to Speak Up Team to introduce new initiatives to create the conditions where colleagues want to stay and can thrive within their role.

In terms of the wider Trust, during the past 12 months, the People Partner Team introduced a new and in-depth exit interview process that has enabled our Head of Operations (and People Partners) to better understand why colleagues are leaving at a local and corporate level. It is the exit interviews that resulted in the introduction of the stay conversation, because it was felt that a proportion of the reasons for leaving could have been resolved, prior to them leaving – such as flexible working, and professional working relationships. 

The People Partner Team review the exit interview intel on an ongoing basis and have also compared against the staff survey results – which will also result in further local and corporate plans moving forward. Career progression is also an important consideration for us, and one that is being taken forward through the People Partner Team. This has been clearly evidenced through the EMD to paramedic conversion programme, which has retention in excess of 90%.

As a Trust we are constantly reviewing on activity and resourcing levels to plan for the future.

We are currently developing a refreshed clinical operating model to ensure we are developing a service to continue to meet future needs this will link to our 5 year Trust strategy which was released in 2023.

There are no current projects like this that are funded by SWASFT. Initiatives like these are funded by either local councils or integrated care boards which means that where and when they are used is dependent on which areas have funding and which areas do not.

At this time, we have no plans to fund C1 in the Devon area.  Unfortunately, we don’t have the same recruitment challenges in Devon as we do in Dorset, Somerset and Wiltshire where we are offering the funding.