Report evidence summary
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
× Source evidence
How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Ambulance shortages amid severe demand
Wider context from the report “A root cause analysis comprehensive and independent investigation report undertaken by the North East Ambulance Service discloses that the reasons for the delay of the ambulance arrival include severe demand and shortages in the division . Road closures and diversions did not assist the crews.
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How this individual concern was interpreted PFD Monitor created a concise, searchable interpretation from the report wording shown below. Response links show a clear evidence connection; they do not assign responsibility.
PFD Monitor interpretation Road closures and diversions affecting ambulance crew access
Wider context from the report “A root cause analysis comprehensive and independent investigation report undertaken by the North East Ambulance Service discloses that the reasons for the delay of the ambulance arrival include severe demand and shortages in the division. Road closures and diversions did not assist the crews .
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Deploy Hospital Ambulance Liaison Officers and Emergency Care Clinical Managers to improve hospital handover and ambulance turnaround.
Verbatim wording from the response “The Trust once again deployed Hospital Ambulance Liaison Officers (HALOs) across the region during the winter period, in order to assist both hospitals and ambulance crews during times of pressure. The HALOs ceased their role in March 2016. This responsibility has now been taken up by the ECCMs who undertake this role throughout the rest of the year.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Run a six-month trial dispatching Emergency Medical Responders alongside ambulances for life-threatening community emergencies.
Verbatim wording from the response “In January 2016, the Trust commenced a new six-month trial scheme with the four Fire and Rescue Services based in the region. This includes Cleveland Fire Brigade, County Durham and Darlington Fire and Rescue Service, Northumberland Fire and Rescue Service and Tyne and Wear Fire and Rescue Service.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Review the appropriateness of Red calls to reduce avoidable demand.
Verbatim wording from the response “The Trust has also carried out demand reduction work looking at how to reduce the number of red calls made by looking at the appropriateness of those red calls.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Deploy Emergency Care Clinical Managers to spend half their time on frontline work and cover operational shifts.
Verbatim wording from the response “The Trust has also recruited a total of 56 Emergency Care Clinical Managers (ECCMs) who have been recruited from the current team leader pool. ECCMs manage the Trust's ambulance stations and ordinarily spend 90% of their time undertaking management/supervisory/governance work, with the remaining 10% on the front line. However, in order to help ease frontline pressures in the current climate, the ECCMs will spend 50% of their time working on the front line and will be able to cover a number of shifts.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Develop an arrangement for volunteers to respond to Red 1 calls during meal breaks.
Verbatim wording from the response “The question as to whether staff should be available to respond to calls during their statutory meal break has been debated extensively by the Association of Ambulance Chief Executives and with the Secretary of State for Health. We have held detailed discussions with other ambulance services about this issue also. The Trust have now proposed to the paramedic Unions that crews should be asked whether they will agree to cease their meal break in order to attend life threatening Red 1 (8 minute emergency response) calls. This proposal was initially rejected by the Unions. However, we have continued to seek the Unions' engagement on this issue and both Unison and GMB have since both agreed in principle for their members to be asked to volunteer to respond to R1 calls while they are on their break.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement winter care projects and engage alternative care pathways to manage suitable patients outside hospital.
Verbatim wording from the response “Furthermore, the Trust has been working closely with the local Clinical Commissioning Groups to sustain and improve the provision of patient care over the winter periods through specific winter projects. A winter care plan was in place to help alleviate the additional seasonal pressures. The Trust has also undertaken a review of its agency and partnership arrangements in order to determine if current arrangements can be improved. These measures are aimed at maximising patient care within the home environment, where appropriate, in order to avoid unnecessary Accident and Emergency Department attendances. This is designed to increase Trust emergency ambulance resource availability. The Trust also continues to engage with other providers/pathways in order to manage patients outside of hospital, where appropriate.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Change the Patient Transport Service meal-break policy to permit breaks away from base stations and improve resource availability.
Verbatim wording from the response “In addition, there was to be a change to the meal break policy across the Trust PTS team in order to enable staff to be able to take their meal breaks at locations away from their base stations and at other sites. Pursuant to the previous meal break policy, staff returned to their own base stations in order to have their compulsory meal break and were effectively unable to respond to any incoming calls during this period. The aim was therefore to reduce travelling time going to/from base stations and to improve resource allocation and utilisation of staff time by reducing travelling. Such changes were also intended to reduce vehicle usage, with less fuel and vehicle maintenance being required, therefore allowing the Trust to keep more vehicles on the road to attend emergency calls.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Work with GPs and other health colleagues to reduce requests for ambulance transfers.
Verbatim wording from the response “The Trust has worked with colleagues in relation to demand reduction. The Trust has worked with health colleagues for example GP’s, to ascertain whether requests for ambulance transfers can be reduced.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue using Advanced Paramedic Practitioners to assess and treat suitable patients at home, reducing unnecessary emergency transfers.
Verbatim wording from the response “Finally, the Trust are also continuing to utilise Advanced Paramedic Practitioners (APPs). These clinicians have proven advanced patient assessment skills of the same level as Emergency Care Practitioners and are able to assess, treat and in most cases, ensure that the patient is safely treated at home, where appropriate. As a result, suitable patients are assessed and treated by APPs in their own home if this is more appropriate than a transfer to hospital. This forms part of the Trust's focus on improving patient care and experience, as well as to reduce the demand on front line emergency crews by recognising the importance of ensuring that only those patients who are in need of a hospital admission in an emergency situation receive an emergency ambulance disposition.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Review agency and partnership arrangements to identify improvements.
Verbatim wording from the response “Furthermore, the Trust has been working closely with the local Clinical Commissioning Groups to sustain and improve the provision of patient care over the winter periods through specific winter projects. A winter care plan was in place to help alleviate the additional seasonal pressures. The Trust has also undertaken a review of its agency and partnership arrangements in order to determine if current arrangements can be improved. These measures are aimed at maximising patient care within the home environment, where appropriate, in order to avoid unnecessary Accident and Emergency Department attendances. This is designed to increase Trust emergency ambulance resource availability. The Trust also continues to engage with other providers/pathways in order to manage patients outside of hospital, where appropriate.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Work with police to reduce ambulance requests made by police.
Verbatim wording from the response “The Trust has also worked with the police to see if any reduction in ambulances requested by the police can be effected.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Implement an overtime policy increasing paramedic availability across shifts.
Verbatim wording from the response “On a separate note, the Trust has been planning for some time to implement a new overtime policy which would see an increased number of paramedic resources being available across all shifts. This has taken a while to implement as a consequence of extensive negotiations with the Unions however the Trust anticipate such a policy being introduced very shortly.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Arrange for Sunderland University to train paramedics on demand rather than only according to the academic year.
Verbatim wording from the response “An arrangement has also been negotiated with Sunderland University whereby they will train paramedics as and when requested by the Trust and not just in line with the academic year in order to help match our demand.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Provide updated training for former staff joining the paramedic bank.
Verbatim wording from the response “The Trust has also implemented a paramedic bank for recent leavers, whereby qualified paramedics who leave the Trust's employment, are asked whether they are interested in joining the Trust's paramedic bank. This is designed to increase the number of qualified paramedics available to fill vacant shifts. The Trust proceeded to complete recruitment checks on these individuals and will provide updated training for ex-members of staff who join the paramedic bank. It was initially anticipated that these individuals would be available to undertake frontline clinical duties from around May 2015. Given the recruitment pressures which the Trust has faced, this was pushed back slightly, however the paramedic bank has been in place since around October/November 2015, therefore allowing cover for the winter pressure period.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Use framework third-party crews, vehicles and equipment to cover vacant shifts and resource shortfalls.
Verbatim wording from the response “Third party agencies on the Trust's local framework continue to be utilised on a daily basis in order to provide support and to assist with responding to G2 (30 minute) and low priority emergency and GP urgent calls, which are within their capability. Third party providers on the framework are trained to an equivalent level as a Trust Ambulance Technician or a Trust PTS Assistant. The Trust is still currently seeking qualified paramedics from third party providers as a further short term solution to increasing higher skilled operational roles whilst recruitment continues pursuant to the above mentioned Workforce Plan. Using the Trust's local third party framework, an agreement has been reached where our third party partners can be drawn upon to cover short falls in emergency and urgent care resources, where necessary.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Continue workforce recruitment strategies beyond ordinary workforce planning to increase emergency-care resources.
Verbatim wording from the response “In light of the above issues, all ambulance services across the country, including the Trust, are pursuing various workforce recruitment strategies in an attempt to increase their emergency care resource base. Over the last 12 months, the Trust has improved its paramedic resource base and attrition rates have improved, whereby there are now more paramedics commencing roles at the Trust than the number of staff leaving employment. At this stage, the Trust has a skill vacancy of around 20% which has reduced from 25%. The Trust's attrition rate has therefore improved in comparison to other ambulance services across the country. However, there still remains a shortfall of people entering the paramedic profession nationally. As such, the Trust will continue with its workforce recruitment strategies which go beyond ordinary workforce planning.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Recruit internationally qualified paramedics, including processing recruits from Poland for frontline roles.
Verbatim wording from the response “Moreover, the Trust had also placed an advert for qualified paramedics in the periodical "Ambulance Life" which has an international reach and has been pursuing other international recruitment campaigns. This has resulted in the recruitment of 19 paramedics from Poland, with 4 individuals ready to commence front-line clinical roles and the remaining 15 currently being processed.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Recruit an additional 40 student paramedics during 2016–2017.
Verbatim wording from the response “At this stage, the Trust has recruited 104 student paramedics and 204 emergency care assistants since January 2014. In addition the Trust has planned to recruit an additional 40 student paramedics during 2016/2017. The Trust has also recruited 31.5 qualified paramedics and will continue to recruit in this role with a healthy pipeline. The emergency care assistants and technicians will support paramedics in attending emergency calls, including driving the ambulance and assisting with medical intervention, having been trained in basic life support.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Integrate Patient Transport Service staff into the workforce system and allocate work matching their skills.
Verbatim wording from the response “In addition, the Trust has been looking to increase the number of PTS (Patient Transport Service) staff. A PTS member of staff transports patients to and from planned appointments at a range of healthcare providers. Our PTS staff are now fully integrated into the Trust's workforce system and are allocated jobs appropriate to their skill base. This should help free up the Trust's more experienced and qualified paramedics to deal with the most urgent emergency calls.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate the Emergency Care Workforce Plan and Task and Finish Group to increase emergency workforce numbers and address paramedic attrition.
Verbatim wording from the response “In order to seek to address this shortfall, the Trust has been following an Emergency Care Workforce Plan. This Workforce Plan has always existed however, given the increase in attrition of staff, a Task and Finish Group was established in October 2014, in order to ensure that the Trust is employing as many strategies as possible to increase emergency workforce numbers. This includes a two-year programme designed to increase the number of paramedics employed by the Trust and involves various initiatives which are aimed at tackling the problem of paramedic attrition. We will explain in greater detail below the specific steps which the Trust is taking pursuant to the Workforce Plan to address resource and recruitment issues. It was previously hoped that the process to address the current shortfall in paramedics would be fully addressed by September 2016.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate the interim Operational Recovery Action Plan using short-term measures and third-party providers to increase daily operational resources.
Verbatim wording from the response “The Trust have also implemented an interim Operational Recovery Action Plan, which focuses on short term solutions to deal with operational resource availability and is expected to increase the Trust's resources on a day to day basis by utilising third party providers to fill current vacancies. A number of initiatives have also been implemented to improve response times to low priority calls (i.e. calls which are not categorised as a red '8 minute' emergency response).” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Use Ambulance Resource Assistants to restock equipment and position vehicles so crews return to incidents sooner.
Verbatim wording from the response “Similarly, the Trust has sought to make use of dedicated Ambulance Resource Assistants (ARAs) over the recent winter periods, who play a key role in supporting the utilisation of our front line emergency and PTS crews by ensuring equipment and consumables are restocked at hospitals and operational stations, thereby reducing the need for crews to travel back to core sites to restock, losing valuable operational time which could be spent responding to incidents. The ARAs also ensure that vehicles are transported to the appropriate locations for the commencement of shifts, thereby maximising the utilisation time amongst crews responding to incidents.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Operate a paramedic bank for recent leavers to provide additional qualified cover for vacant shifts.
Verbatim wording from the response “The Trust has also implemented a paramedic bank for recent leavers, whereby qualified paramedics who leave the Trust's employment, are asked whether they are interested in joining the Trust's paramedic bank. This is designed to increase the number of qualified paramedics available to fill vacant shifts. The Trust proceeded to complete recruitment checks on these individuals and will provide updated training for ex-members of staff who join the paramedic bank. It was initially anticipated that these individuals would be available to undertake frontline clinical duties from around May 2015. Given the recruitment pressures which the Trust has faced, this was pushed back slightly, however the paramedic bank has been in place since around October/November 2015, therefore allowing cover for the winter pressure period.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Transfer advanced technicians into frontline operational roles to relieve lead-clinician pressures.
Verbatim wording from the response “At the same time, the Trust has been transferring advanced technicians to frontline operational roles in order to reduce frontline pressures for lead clinicians. 20 members of staff have so far agreed to this. Advanced technicians, like paramedics, are trained to deal with life threatening illnesses and injuries. They are therefore very experienced members of staff. However, paramedics are also trained to undertake invasive procedures which may need to be performed during the most serious medical emergencies, including intubation (where a tube is inserted into the windpipe to help a patient breathe) and cannulation (where a thin tube is inserted into a vein in order to introduce fluid and drugs as quickly as possible).” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Recruit student paramedics, emergency care assistants and qualified paramedics to increase emergency response capacity.
Verbatim wording from the response “The Trust has been actively working to recruit more paramedics into the service in order to increase the resources it has available to respond to the higher volume of emergency calls which it is required to deal with in the present climate. The Trust has always had a workforce plan in place however new strategies have since been introduced after the Trust discovered in/around mid-2014 that more paramedics were leaving their employment than the numbers being recruited to fill vacancies.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Educate the public about appropriate ambulance-service use through extensive advertising and vehicle signage.
Verbatim wording from the response “The Trust is limited in ways in which it can control the calls made to it and the demand on its services. However, the Trust has undertaken initiatives to seek to educate both the public in relation to the appropriateness of making calls and to work with colleagues in other sectors to try to reduce the demand on Trust services.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Increase recruitment, human-resources and training staffing capacity to fill frontline vacancies more quickly.
Verbatim wording from the response “In addition to those measures set out above, in the long term, the Trust has been looking to increase its own recruitment capacity, by employing more staff in recruitment, human resources and training roles. This will enable new staff to be recruited and trained in a timely manner in order to fill frontline vacancies. This remains the case.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Increase the in-house graduate paramedic training programme from 24 to 48 places with two annual intakes.
Verbatim wording from the response “As noted above, one major issue faced by Ambulance Trusts nationally with respect to recruitment is the fact that all would-be paramedics have to undertake a 2 year training course at University, which effectively means that the Trust has to recruit 2 years in advance of employment commencement. As such, and in order to attempt to tackle the resource shortfall, the Trust has increased the number of places on its 2 year in-house graduate training programme from the usual 24 places to 48 places, with a two-stage intake in February and April. This results in the Trust having a year-end forecast number of student paramedics of approximately 100. The Trust have also visited universities in an attempt to recruit paramedics who are pursuing their studies but are not yet licensed to a particular ambulance service upon qualification.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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How this respondent action was interpreted
PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Introduce tri-responders working across police, fire and ambulance services.
Verbatim wording from the response “Finally the Trust has worked in partnership with Durham Constabulary and County Durham and Darlington Fire and Rescue Service to introduce the region’s first tri-responders working for police, fire and ambulance. The Community First Responders work for Durham Constabulary as PCSOs, County Durham and Darlington Fire and Rescue Service as retained firefighters and as first responders for the NEAS.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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PFD Monitor interpretation Control over calls and demand is limited, although demand-reduction initiatives are undertaken.
Verbatim wording from the response “The Trust is limited in ways in which it can control the calls made to it and the demand on its services. However, the Trust has undertaken initiatives to seek to educate both the public in relation to the appropriateness of making calls and to work with colleagues in other sectors to try to reduce the demand on Trust services.” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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Recipient-stated actions An action is something a recipient says it has done, is doing, or plans to do in response to a concern raised. 1 1 Automatically upgrade specified delayed low-priority calls to faster response categories as waiting-time safeguards.
Stated by North East Ambulance Service NHS Foundation Trust Stated completedThe respondent said that this action was complete when they made their response on 23 March 2016. View source
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PFD Monitor created a concise, searchable interpretation from the published response wording shown below.
PFD Monitor interpretation Automatically upgrade specified delayed low-priority calls to faster response categories as waiting-time safeguards.
Verbatim wording from the response “Furthermore, the Trust has introduced other initiatives which are designed to alleviate the pressures on front line resources and achieve faster response times to emergency calls. For instance, in December 2014, a memo was sent to all dispatch staff which noted that with immediate effect, a G2 (30 minute) disposition would be upgraded to a G1 (20 minute) response for patients 65 years of age and over, who had suffered a fall and had waited for one hour longer than the original G2 disposition (i.e. 1 hour 30 minutes in total).” Source location 2016-0116-Response-by-North-East-Ambulance-Service
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