East Midlands Ambulance Service NHS Trust

Action Planned (AI summary) NHS England's regional colleagues have reached out to Derby and Derbyshire ICB, who advised that East Midlands Ambulance Service will be responding directly to the concerns raised, and that the Trust is reviewing Memorandums of Understanding and revising clinical presentation protocols. The Trust will continue its participation in the Police Regional Clinical Governance Forum to align training and response protocols for ABD, work with regional police forces and health partners to explore the development of a single joint operational framework for ABD management, and review its internal clinical guidance.

Action Planned (AI summary) The ICB facilitated a system wide After-Action Review (AAR) to enable collaborative learning and improvement across all relevant partners, and improvement initiatives identified by the review will be taken through and monitored for assurance within the existing governance for the relevant systems. EMAS has worked with partners to develop a Sepsis Observation Safety Net, implemented enhanced clinical review processes prior to call transfer, and ceased manual ITK push transfers to NEMS. NEMS has stopped manually pushing calls, implemented a standardised Sepsis Observation Safety Net, and provided additional training and resources to clinicians; furthermore data sharing agreements are in place to share discharge summaries and admission avoidance alerts. The ICB facilitated a system wide After-Action Review, EMAS have stopped the ITK push of calls, a review and redefinition of the existing UCCH service specification has occurred, and analytics team have developed the ability to join up multiple data sets to understand patient journeys.

Action Planned (AI summary) The ICB facilitated a system wide After-Action Review (AAR) to enable collaborative learning and improvement across all relevant partners, and improvement initiatives identified by the review will be taken through and monitored for assurance within the existing governance for the relevant systems. EMAS clinicians now review all available information prior to transferring calls, and clinically assessed calls are no longer pushed to any EMAS Clinical Assessment Service (CAS). Manual ITK push transfers to NEMS have ceased. NEMS implemented changes to clinical practice and referral processes, including revised sepsis screening tools, enhanced clinical oversight, and improved information sharing with system partners. They have also invested in staff training and equipment to improve the management of complex patient presentations. The ICB facilitated a system-wide After-Action Review, reviewed and redefined the UCCH service specification, and developed the ability to join up multiple data sets to understand the patient journey across the pathway. They also committed to sharing PFD learning and assurance actions across multiple committees and processes.

Action Planned (AI summary) The Trust is providing training for all acute facing mental health staff on ABD in August and October 2025 and signs and symptoms, clinical assessment and escalation processes are now included within the Trust Fundamentals of Care training for mental health staff. The Trust has updated Internal Working Instructions and established a strategy group and works across the system to strategically plan access and treatment for people with dual diagnosis needs. The NPCC clinical panel is reviewing existing guidance developed by the Faculty of Legal and Forensic Medicine regarding Acute Behavioural Disturbance. The College of Policing provides the Mental Health Approved Professional Practice (APP) to assist forces in developing their policies and responses to incidents relating to people with mental ill health. The Department and NHS England are finalising the Co-occurring Mental Health and Substance Use Delivery framework to improve delivery of integrated, person-centred care across drug and alcohol treatment and mental health services.

Action Planned (AI summary) MFT has developed a draft "Out of Hours Discharge Avoidance" SOP to manage delayed discharges, which is due to be presented for ratification at the MRI Quality and Safety Committee. They also intend to formally communicate this SOP to external transport providers once ratified across relevant sites. EMAS will continue to contact the ward when a patient is going to be discharged into the evening to ensure that this is appropriate. EMAS has subsequently contacted Manchester Royal Infirmary for a copy of the new policy, but this is not available to share at present. The organisation amended inaccuracies in the Serious Incident Review (SIR) and reshared it with relevant safeguarding boards and the Manchester Foundation Trust Safeguarding Team. They have implemented a system to ensure investigations are completed in a timely manner and are reviewing processes for discharges to 'out of area' localities.

Action Planned (AI summary) EMAS will be sharing updated guidance, national PGD and learning from this PFD across the Ambulance Pharmacists Network. Updated guidance and training package is being developed and will be rolled out during 2022/23 which will include the option for clinicians to administer buccal midazolam to adults (18 years and over) who present with convulsive status epilepticus when it is not available within the home as a prescribed medication.

Action Planned (AI summary) NHS England is developing a thrombectomy credentialing programme with medical bodies to address workforce gaps, piloting a new data set for service expansion, and creating an ISDN-level implementation strategy for widespread 24/7 mechanical thrombectomy rollout. Nottingham University Hospitals NHS Trust has established the CareCentric Portal as its main conduit for ePRFs from EMAS. The trusts are implementing automated processes for ePRF sharing via CareCentric to improve accessibility for handover and wider benefits.

Action Planned (AI summary) EMAS acknowledges exceeding response times and states that additional funding was agreed to address this. The funding will be used for clinical staff, ambulances, and other resources to improve response times and consistency across the East Midlands.

Action Planned (AI summary) EMAS is negotiating with its Coordinating Commissioner regarding the contract settlement for 2018/19 and 2019/20, and anticipates recruiting and training additional frontline operational staff and staff within the Emergency Operations Centre. They have already established an Urgent Care Transport Service (UCTS) which went live on Tuesday 3 April.

Action Planned (AI summary) East Midlands Ambulance Service (EMAS) has discussed the concerns within the Coroners Working Group and developed an action plan, reintroduced monthly meetings with hospitals and commissioners to improve ambulance turnaround, and increased available hours for ambulances and fast response vehicles by recruiting staff and realigning rosters. Hardwick CCG, on behalf of 22 CCGs across the East Midlands region, will undertake a jointly commissioned external strategic review focussing on capacity and demand with EMAS, with implementation over three years and have provided additional funding to EMAS to undertake further recruitment. NHS England notes that an external strategic review of capacity and demand will be undertaken and that the 2016/17 contract settlement also provided additional funding to EMAS in order to increase front-line staffing with the intention of improving ambulance response times. NHS Improvement is working with the East Midlands Ambulance Service NHS Trust to address resourcing issues and improve response times and highlights that in 2015/16, the trust carried out a significant recruitment campaign and educated 350 whole time equivalent frontline posts.

Action Planned (AI summary) HMP Gartree revised local contingency plans and re-issued instructions in May 2016 to ensure all staff understand that they must not delay calling an ambulance in all cases where there are serious concerns about the health of an offender. The prison is also working with EMAS to ensure effective Joint working and consistency of approach in all the prisons, with a joint emergency response protocol expected by 31 July 2016. East Midlands Ambulance Service (EMAS) has formed a senior regional group to address issues relating to secure environments, such as prisons and secure mental health units. They also plan a meeting with secure environment teams to address access issues, ambulance activation protocols, and partnership working principles.