A presentation was conducted for the Committee by representatives from the London Ambulance Service NHS Trust (LAS). They made a number of points as follows:
· London had been divided into 7 sections for the operation of the LAS;
· The LAS had undergone a service transformation which had included a management restructure. A new Chief Executive of the service had also been appointed;
· A new set of purposes and values had been adopted by the LAS to modernise the Trust;
· Demand for the LAS increased year on year. In 2014/15 over 1.7 million requests were received;
· The operating budget for the LAS was £316 million;
· The LAS had about 5,000 staff. Approximately 71% of these staff operated on frontline services;
· There were 70 Ambulance stations across London;
· Retention of staff had been a big challenge for the LAS. Opportunities for paramedics outside the NHS had increased dramatically;
· The LAS were focusing on national and international recruitment drives;
· The contract for the LAS included 9 Commissioning for Quality and Innovation schemes (CQUIN). These were a contractual requirement for NHS providers and offered financial incentives to the innovative development of services;
· The LAS produced a suite of reports as a requirement of the commissioning contract;
· The LAS and the NHS faced a number of financial challenges. The LAS income was dependent of demand and performance. Money was being spent on private ambulances and overtime payments but the LAS were striving for value for money;
· There were three major challenges for the LAS which related to staffing, demand and culture;
· There was an increased emphasis from the LAS to make it a better place to work. This involved the launch of a LAS academy, filling all front line vacancies, creating 500 band six senior paramedics and continuing with VIP awards;
· The LAS were not achieving the 75% target response rate. However reports and reviews undertaken had demonstrated that a safe service was being provided;
· A detailed improvement programme had been developed. Some of the actions identified were the reduction of absences from front line staff relating to sickness and reducing the out of service hours relating to people and vehicles;
· In relation to front line recruitment of staff, processes had been redesigned to include revised training and supervision to allow staff to work on the front line as safely and quickly as possible. University places had increased and a media campaign had been launched;
· There was closer work being undertaken with Emergency Department leads to improve Hospital handover processes;
· There was greater work being done on standardising referral pathways.
Councillor Filson queried what was being done regarding vehicle utilisation which was currently at 85%. This provided very little flexibility for the LAS. Councillor Filson also asked whether vehicle serving and maintenance facilities could be shared with the Fire Services. Councillor Filson also asked whether filling vacancies only up to 95% created extra stress for staff. Additionally was the level of training being proposed from October 2016 realistic given that proportionally it was small.
The representatives from the LAS responded that the level of current vehicle utilisation was not desired. However it was expected that some of the actions as part of the improvement programme would help to reduce the levels of vehicle utilisation.
There was currently work being done by the Government on collaborative working between the LAS and the Police on equipment and vehicles although it was not believed that vehicle maintenance was one of the issues being addressed.
The recruitment of staff up to 95% was a result of feedback from existing staff who expressed a wish to have the ability to work overtime.
There would be reflection on the issue raised in relation to the training of staff and a separate response would be provided.
Councillor Filson also asked why there was not a greater emphasis on recruiting staff from London. The representatives from the LAS responded that there was a significant amount of time required to qualify fully as a paramedic. Another challenge was that upon qualification there were usually other career opportunities for paramedics given the unique set of skills which they possessed. It was also stated that the 32 CCGS across London all commissioned the LAS services and recruitment and retention of staff was recognised as an issue.
Councillor Mithani asked whether the 500 band six senior paramedics had all been provided with relevant training.
The LAS responded that the 500 band 6 senior paramedics had all received this promotion as a result of the retention programme. Funding had been made available to promote 500 of the most senior and experienced paramedics and they had been provided with tailored training to develop their skills.
Councillor Mithani also asked whether frontline staff were well trained in answering calls and dealing with delays. The representatives from the LAS employed a robust triage process and this operated well.
Councillor Williams asked for some further information regarding the benefits provided to recruitment from overseas and also asked for information regarding the standardised referral pathways across North West London. The representatives from LAS responded that the package offered to overseas recruits was the same as that offered to national recruits.
The referral pathways involved getting all relevant parties together and developing new and efficient pathways. It had been identified that the previous pathways were not as effective as it would have been liked.
Councillor Vaughan asked when response times from the LAS would improve. Councillor Vaughan also asked what factors relating to the cost of living in London were affecting retention rates and whether any further rewards were offered for performance.
The LAS had a trajectory to improve its performance in relation to response times. Whilst its performance was not where it wished for it to be, the trajectory pathway for improvement was being met.
The main issue for the retention of staff appeared to be other career paths which paramedics could embark on due to the skills that they possessed. It was sometimes difficult to compete with these other roles due to their differing natures and salary.
The Chair thanked the representatives from the LAS for their presentation.
RESOLVED: That the presentation be noted