NEAS: Navigating Pressures and Performance

The North East Ambulance Service (NEAS) is a vital component of the healthcare infrastructure in the North East of England, responsible for providing emergency and non-emergency medical care to a vast population. Operating under significant pressure, NEAS plays a crucial role in responding to 999 calls, facilitating patient transport, and delivering essential healthcare services. This article delves into the various facets of NEAS, exploring its patient transport services, the current operational challenges it faces, notable incidents, and critical assessments of its performance, including a significant Care Quality Commission (CQC) report.

Patient Transport Service (NEAS)

NEAS operates a dedicated Patient Transport Service (PTS) designed for individuals who, due to a medical condition, are unable to travel to and from hospital or other healthcare appointments by conventional means. This service is not for medical emergencies but rather for planned journeys where the patient may require the specific assistance of an ambulance care assistant. Eligibility for this service is determined by an assessment of the patient's needs. Individuals can ascertain their eligibility by contacting Patient Transport Services directly on 0191 2151515. Alternatively, a General Practitioner (GP) or hospital staff can initiate the arrangement of patient transport. For those needing to cancel a pre-booked journey, the contact number is also 0191 2151515 during weekdays (Monday to Friday, 8 am - 6 pm). For cancellations for the next working day, a different number, 0300 111 0247, should be used. Patients who do not qualify for NEAS patient transport may find alternative arrangements through Community Transport & Volunteer Driver Services.

It is also important to note the Healthcare Travel Costs Scheme (HTCS), which can provide assistance with travel expenses for patients referred for hospital treatment or diagnostic tests. Eligibility criteria and further details are available on the NHS website.

Operational Pressures and 999 Call Demand

Recent reports highlight that NEAS is currently operating under considerable strain. This pressure stems from a combination of factors, including staff shortages and a significant rise in the number of 999 calls. Consequently, the service has had to implement measures such as a 'no send' policy, meaning that ambulances are prioritised for the most critical patients. Dispatch officers have indicated that funding cuts within the NHS are a contributing factor to these challenges.

The impact of these pressures is evident in response times. Delays for category-2 emergencies, for instance, have been reported as being up to five times longer than the target response times. This situation underscores the immense demand placed upon ambulance services nationwide and the difficult decisions dispatchers must make to allocate limited resources effectively.

A Day in the Life: Responding to Calls

To illustrate the reality on the ground, consider a typical shift. Crews might be dispatched to various incidents, ranging from a collapsed elderly individual with a leg injury to a patient experiencing ongoing chest pain. The dedication of long-serving staff, some with decades of experience, is a testament to the commitment within the service. However, even these experienced professionals are operating in an environment where the service is stretched to its limits.

The scenario can quickly escalate, with dispatch centres receiving multiple category-1 calls – those requiring immediate, life-saving intervention – in a short period. These can include responding to severe road traffic collisions, such as a motorcyclist involved in a high-speed accident, or attending to patients with acute breathing difficulties. The emotional and logistical challenges are immense, with crews needing to provide critical care while also managing patient anxieties, such as a fear of hospital admission or placement in a care home, as seen with an elderly patient in Stockton.

The gravity of the situation is further amplified when incidents involve vulnerable individuals, such as a child who has fallen into a river. In such cases, the lack of immediately available crews in the vicinity necessitates lengthy journeys, adding precious minutes to response times during critical moments.

Incidents in Newcastle

NEAS, in conjunction with Northumbria Police, has responded to various incidents across the region. One notable event involved an emergency response on Newcastle's Quayside. Emergency services, including the air ambulance, attended an incident where a man had fallen from the Tyne Bridge. A cordon was established while the situation was managed. These types of incidents, while requiring immediate and coordinated action from multiple agencies, also contribute to the overall demand on NEAS resources.

Care Quality Commission (CQC) Report and Findings

A significant development concerning NEAS is the publication of a critical report by the Care Quality Commission (CQC). The report branded NEAS as requiring improvement, with specific concerns raised about patient safety, the investigation of incidents, and leadership. The CQC's inspection, conducted in July 2022, rated the trust's leadership as 'inadequate'. Inspectors found that leaders were not thoroughly investigating incidents and were making decisions based on limited information, which hampered the ability to learn from mistakes and mitigate risks to patients.

The report also highlighted issues within the emergency and urgent care services, rating them as 'inadequate'. Furthermore, concerns were raised about the handling of whistleblowing complaints, with staff expressing fears of being "scapegoated" for speaking up. In the six months prior to the report's publication, 11 whistle-blowers had approached the regulator with their concerns.

Specific Failings Identified

The CQC report detailed several troubling findings:

• Missing Medicines: Staff were responding to emergencies without sufficient essential medications, such as morphine, sometimes due to insufficient pre-vehicle checks. An example cited involved a crew arriving at a road traffic collision without morphine.
• Fear of Reporting Concerns: A survey of nearly 500 staff revealed that over 50% did not feel safe reporting concerns without fear of reprisal and did not believe the organisation would act appropriately.
• Incomplete Mental Health Strategy: An action to develop a mental health strategy, due by September 2019, remained incomplete at the time of inspection. NEAS has since indicated a draft strategy is now in place.
• Incident Investigation: Some incidents flagged for investigation were downgraded to 'no or low harm' and closed without further action, despite opportunities for learning and incomplete information.
• 111 Service Staffing: The 111 telephone service was found to be understaffed.
• Leadership Disconnect: Staff reported a disconnect between senior and local leadership, although the Chief Executive, Helen Ray, was praised for her visibility.
• Under-reporting of Serious Incidents: The CQC raised concerns about potentially low reporting of serious incidents (SIs). NEAS reported six SIs in the year prior to inspection, compared to 43 reported by a neighbouring service. Subsequent to the CQC raising concerns, a further 19 SIs were submitted.

Areas of Praise

Despite the critical findings, the CQC did acknowledge positive aspects of NEAS's operations. The service was rated "good" for being caring and responsive. The community paramedic scheme in Berwick was specifically highlighted as an example of outstanding practice, contributing to reduced waiting times for patients with the most serious health emergencies. Other positive initiatives included efforts to minimise ambulance handover delays and safeguarding work for "frequent callers" under 18.

The trust had also taken steps to improve staff safeguarding processes, an issue previously raised in 2020. NEAS stated that since the initial inspection, it had taken swift action and provided additional assurance to the CQC regarding systems to ensure patient safety.

Addressing the "Blame Culture"

A significant criticism in the CQC report was the presence of a "blame culture" within NEAS. Staff feedback indicated a fear that speaking up about concerns could lead to negative consequences, with one staff member quoted as saying, "If there is a management failure then nothing will be done, but if an employee is deemed to be at fault, I feel they would be blamed rather than supported." Another commented on a "significant blame culture" and the fear of management "stringing them over the coals." This sentiment was linked to a perceived lack of priority given to national "freedom to speak up" policies.

In response, a NEAS spokesperson expressed disappointment that some staff felt unable to raise concerns and affirmed that the service actively encourages staff to do so with confidence in effective and timely resolution. They also stated that the service had increased its capacity to listen and act upon feedback from both staff and the public. NEAS is awaiting the results of a review into its handling of whistleblowing allegations.

Looking Ahead: Improvements and Monitoring

The CQC will be closely monitoring NEAS to ensure sustainable improvements are made. The Chief Executive, Helen Ray, acknowledged the unprecedented pressures on the NHS and expressed commitment to addressing the CQC's concerns. She highlighted that NEAS remains among the best performers in responding to 999 calls and stressed the importance of investment in the workforce. She noted that the service was beginning to see positive results from investments made in 2022.

Frequently Asked Questions

In conclusion, the North East Ambulance Service is a critical service facing significant challenges. While demonstrating dedication and providing caring responses in many instances, the recent CQC report underscores areas requiring urgent improvement. The ongoing efforts to address these issues, coupled with the commitment of its staff, will be crucial in ensuring the continued delivery of safe and effective care across the North East.