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Visit to Islington Ambulance Station 68-70, Brewery Road, N7 9NT

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					Visit to Islington Ambulance Station

68-70, Brewery Road, N7 9NT

Call sign: G1

Name of AOM: John Huggins (john.huggins@lond-amb.nhs.uk)

Patients’ Forum Members at visit: - Malcolm Alexander and Bill Marks

Name and contact details of Forum Support Officer -

Daisi Ogunro, ForumSupport.Inhouse10@cppih.org
<mailto:ForumSupport.Inhouse10@cppih.org>,

Tel: 020 7619 0919; 07843 075605

Were signers present? Not necessary for this visit.

Date and Time of Visit: 2nd February 2006: 1100 - 13.15 Hours


Overview of Islington Station:

The station is a single site complex, which has been located on Brewery
Road, N7 for 5 years. The road does not have a high volume of traffic and
connects quickly and directly to Caledonian Road and York Way - both key
thoroughfares. There are no sub-stations. There is a locked car park for
LAS vehicles. The main hospital served is the Whittington in Archway,
N19.

We met AOM (Ambulance Operations Manager) John Huggins (JH), who
provided detailed information about the station and the area and
informed us he was to transfer to Isleworth Station on 7th February. He
introduced Forum Members to the incoming AOM, Mick Connett (ex
Whipps Cross and Romford).

JH said that there is a plan to eventually move the station to a more
central location, perhaps leaving the Brewery Road Station as a sub-
station. The local management team will find a new location and prepare a
business plan.
1) Station Performance Data:

How well is the sector doing re Performance Standards?

The station has performed very well. For Category A calls, performance
for January 2006 was 77.69% against a target of 75% (Year to date:
78.94%).


2) Problems and Remedies:

What are the key local pressures on the service in this sector and how
might they be solved?

Staff Morale:
The key pressures on staff have been due to Agenda for Change, which
has caused serious morale problems for EMTs (Emergency Medical
Technicians) who believe they should have been put on a higher band.
Eventually, longer serving EMT3s will be upgraded to EMT4. Paramedics
and EMTs usually work together on an equal basis, the paramedic taking
over clinical tasks for which they have received specialised training, e.g.
use of morphine. This can lead to EMTs feeling they are underpaid, but it
does not lead to conflict between staff. The real significance of Agenda
for Change, is the opportunity for constant staff development within the
knowledge and skills framework. JH said that some performance issues
could be dealt with through better training and staff development.

Staffing of Stations Relative to Need:

Poor staffing in other areas can lead to problems with achieving
performance targets, because vehicles move outside Islington to meet
demand and need in other areas. Staff know their own area well
(sometimes better than the MDT route planner) and can operate much
more quickly in their own area than when they are transferred to other
areas. The Islington Station has a high ratio of calls to the number of
paramedics and technicians working at the station, compared to other
stations. There is a need for more staff and vehicles in relation to the
number of patients served. Fortunately, the average age of front line
staff at Islington is low which enables them to operate at high capacity.




Effectiveness of the Emergency Operations Centre

JH said there is a need for clear boundaries between complexes,
flexibility in the positioning of vehicles and more effective communication
between EOC (‘Emergency Operations Centre’ at Headquarters) sector
desks. Currently delays occur because jobs are passed between desks,
rather than each desk having an overview of location of calls and location
of ambulances and because EOC sector desk staff may not know their
own areas well enough. Therefore the nearest ambulance may not be sent
to the casualty. The ‘target’ clock starts ticking once EOC staff have
confirmed the coordinates for the location of the patient.

Security of Drugs Store

Three vials of morphine disappeared from the Islington station. This
matter has been investigated and two of the vials were subsequently
found and returned to Islington.


3) Support Services:

   a) Is there a Make Ready Scheme - Is it going well? What
      progress is there with improving standards?

   There is a Make Ready (MR) Scheme in place, which started in
   December, earlier than expected. The scheme does not seem to be
   working very well at the moment because the MR team (which services
   Camden as well) is understaffed and there has been difficulty in
   recruitment of the right kind of staff. The MR team clean the vehicles
   as well as general office cleaning and the mess room. Staff are
   generally happy with vehicle cleaning, but the station cleaning is not
   good enough at the moment.

   MR are cleaning vehicles at the Islington station, which was not agreed
   in the specification. There is limited space in the Islington garage and
   the environment is unsuitable for cleaning of vehicles. Cleaning should
   be carried out at the Camden Station, but some MR staff do not have
   a driving license so cannot move the vehicles.




   b) Blankets: JH said that the system for supply of blankets doesn’t
   work. Many go missing and there is a suspicion that they end up with
   other ambulance services.

c) Do you have effective mechanical support services for your
vehicles? Mechanical support is generally satisfactory, but the Fast
Response Vehicles (Vauxhall Astras and Zafiras) are not designed to be
used as ambulances and do not cope well with the level of work they are
subjected to. Problems with vehicles come in waves, which impacts on
their availability. Another problem is the large number of speed humps in
Islington.


  4) Urgent Care:

 a) What Urgent Care Services are run in this sector and what local
developments are planned? There are no Urgent Care Services at
Islington. Mick Connett the new AOM would like to introduce an Urgent
Care Service for Cat C calls (green). These calls are currently designed to
collect patients within a specified time period, sometimes up to 3 hours.
The advantage of this development would be to release ambulances used
for higher grade emergency calls, from being used to transfer patients
from one hospital to another (although there is an understanding that
many of the ‘Urgent’ patients are very ill).

b) Do you have Emergency Care Practitioners (ECPs) in Post? How
many and how well is the service developing? Would you like more?
There are no ECPs in post at the moment. However, there is proposal to
establish an ECP service in the new walk-in centre at Whittington
Hospital. The centre would be run in collaboration with Camidoc the local
GP coop, which provides out of hours services.

Currently, there is some concern with the workload of ECPs, e.g. they may
only attend to 2-4 patients a day, compared to 10 patients seen by
paramedics. In Havering the ECP services was terminated because they
were doing too few jobs. JH said there is a need to re-access the role and
capacity of ECPs.




5) PTS:

Do you run a PTS? What are the local successes and problems with
this service? There is no PTS service at the Islington station and no
LAS/PTS contract in the area.

6) Environmental and Safety Problems:

Are there local problems with traffic calming measures, e.g. road
humps?
Speed Humps: JH said that the speed humps cause problems for patient
care and put a great deal of pressure on vehicles. He said some research
had been carried out on this problem and agreed to let the Forum have
details. We asked JH to identify three roads which ‘front line staff’ find
to be a particular cause of difficulty during the transportation of
seriously ill patients.

Access and Egress to the Islington Station

JH said he has a very good relationship with the Islington Council. The
Council have put a ‘hatching’ on the road outside the station and this is
likely to be enlarged to give ambulances priority over other vehicles. It
has also been agreed by Islington Council to install nibs on the road
outside the station to slow down passing traffic.

7) Communications:

a) Do you have good communication with local PCT and NHS Trusts?
JH agreed that it would be good practice to establish a better
relationship with the PCT, but as their Cat A PCT performance for
Islington had been good (79.96% - 1/4/05-2/2/06) regular contact had
not been necessary.

There has been some contact with the Whittington NHS Trusts because
of high numbers of emergencies on some days. For very serious cases the
A&E assembles a team (on the advice of the crew via EOC) to receive the
ambulance and deal immediately with the patient. On occasion this has
gone up to seven such cases per day, which led to concerns by the Hospital
Trust and discussions with the Islington station.




b) What are your links like with the Voluntary Sector?
JH agreed that this was and essential part of PPI work and a good way of
educating the public about the LAS. They have had links with the Moslem
Welfare House in Seven Sister Road and would like to develop stronger
links with the Voluntary Sector.

Mosques and Overshoes: An agreement by the LAS (clinical governance
committee) to distribute overshoes to mosques has not been transmitted
to the Islington Station. Overshoes are used when front line staff enter
mosques in an emergency and have no time to remove their shoes.

8) Local Demography:
What are the key local social pressures? e.g. population diversity,
languages spoken by local communities, deprivation, alcohol, mental
illness? Alcohol is the key local pressure. The impact of the change in
licensing hours has not been felt yet by the Islington station.

9) Complaints:

a) What type of complaints have you received over the past year and
how many?

Five complaints were received in 2004-2005. Over the past two to three
months seven had been received, which were all generally related to the
attitude of front line staff.

JH said that complaints are in general mostly investigated locally and he
was definitely in favour of developing conciliation to resolve complaints by
face-to-face meetings between the complainant and the paramedic/EMT
who is alleged to have led to the complaint.

He added that investigations can be very complex and time consuming.



10) Patient and Public Involvement:

What type of PPI work have you done locally?

Not much PPI work is being done at the moment because the AOMs are
preoccupied with performance issues.



11) The Strategic Role of AOMs

JH said that he felt AOMs should be strategic managers of complexes
rather than de facto station managers and should be concentrating on
influencing external partners and working with the Patients’ Forum. He
said that using strategic skills to resolve problems is not possible when
the service is primarily involved with target achievement. JH added that
the relationship between AOMs and DSOs needed to be resolved and
there was a need for AOMs to work more closely together to develop
strategic, joint decision-making. JH said that management needs to be
released to get on and do the job - at the moment some staff felt
switched off and held back. To resolve this problem better communication
was needed with Headquarters. At the moment the London wide view is
the responsibility of Martin Flaherty and his three section manager
(South-Mike Boyne, West-Peter Horne, and East-Richard Webber as well
as the Performance Manager Russell Smith).

12) Clinical Issues and Local Expertise:

a) Children?

No particular issues

b) Sickle Cell?
There are some concerns about patients with sickle cell.

c) Mental health patients?
Not a great problem, except for those who are repeat callers.

d) Alcohol related issues?
They have a lot of alcohol related issues.




13) Other Issues:

   1   Training needs to be improved for some clinical skills, e.g. for
       conditions which do not occur very often.

   2 Positional asphyxia: This has not been dealt with in detail in the
     past but is now being focussed on following a recent inquest.

   3 Data recording: New data recording equipment may be installed in
     ambulances with would enable recording to begin when the top of
     the vehicle is struck sharply. The data protection issues were
     discussed.

   4 Major Incidents: A tabletop exercise will be performed on March
     2nd in connection with the opening of the new Arsenal (Emirates)
     stadium. A real time exercise might follow. Staff would like to be
     more involved in these sessions, but this is not possible in current
     climate due to performance pressures.

   5 Visits to stations by Peter Bradley and Fionna Moore. These are
     highly valued by staff.
Part Two Questions: JH Responses

  Are there vehicle shortages? Yes, we do sometimes have vehicle
shortages. Problems never come in ones and twos so when we are pushed,
we end up going other complexes and they come to us for support. I think
the fundamental issue is that we are not buying/leasing purpose built
vehicles that are intended to run, in general, for 24 hours over 7 days a
week.

 Is Training Adequate? In my past life I was in the Army as a musician.
The key thing that the services do (not just musicians) is to keep training.
I think training keeps the individual ‘fit for purpose’ and motivated as well
as empowered and deals with some of the more fundamental staff issues.
In the current environment one key thing that stops us being a world-
class ambulance service is the lack of training. Even though current
training is funded, all of this goes out of the window and staff do not
develop when there are performance pressures. Ideally, I would like to
see more clinically focussed performance targets that can assist with
crew motivation to be better professionals. Agenda for Change is
designed to help staff develop and constantly better themselves, but I
see it being difficult to live up to in the current LAS environment, where
we are always chasing targets and not dealing with the fundamental
issues. Call numbers are an issue. How do we educate the public to use
the LAS (and the NHS) more wisely? Or do we accept that this is what
the public want - in which case do we need more staff and ambulances?
Electronic Data capture is a must, but currently seems too far away.

What Vehicle Are Stationed at Islington?

                          Vehicle Reg & location
Fleet No        Reg            Type            Location         Other info

6387            X387GGO         LDV             Islington
6441            X441GGO         LDV             Islington
6371            X371GGO         LDV             Islington
6103            P103APL         LDV             Islington
6265            R265KGH         LDV             Islington
6225                            LDV             Islington
6463            X463GGO         MERC            Islington
6915            LJ53BWO         MERC            Islington
6906            LJ53BWD         MERC            Islington
6870            LJ53BTX         MERC           Islington
6811            LJ53AXO         MERC           Islington
7073             LJ54GHK        MERC(II)       Islington
6719            LG52NXC         CORSA          Islington       Admin
6606            LF51MRV         ASTRA          Islington       FRU
6693            LG52RHO         ASTRA          Islington       FRU
6937            LJ53BXD         ZAFIRA         Islington       DSO
6767            LJ03 KRG        AMB-RRU        Islington




 Recommendations:
 1) Relocation of the Islington Station

 The Islington Station clearly has insufficient space for its vehicles,
 staff and management activities.

 •     The Forum recommends resiting of this station within three years
       and requests consultation on the draft business case for this
       redevelopment. (MV)

 2) Staff Training

 The conflict between responding to higher levels of target activity
 and continuous staff training has frequently been raised.

 •     The Forum recommends that the LAS agree a strategic approach to
       solving this problem that enables performance issues to be dealt
       with, at least partly, through better training and staff
       development. (MV and BON).

 •     The Forum recommends that staffing levels are adjusted to ensure
       that all staff, systematically receive training and development as a
       right and as a duty. (MV and PB)
3) Review of Staffing and Vehicles

   •   The Forum recommends a review of staffing levels and vehicles
       at the Islington station in relation to demands on the service.
       (MV and MC)

4) Emergency Operations Centre

   •   The Forum recommends an audit of the EOC sector desks to
       ensure they are communicating with each other effectively and
       have sufficient overview of London to allow the most effective
       dispatch of staff to the location of calls. MF

5) Drug Storage

   •   The Forum recommends a sample audit of drugs storage
       facilities and governance arrangement in ambulance stations, to
       ensure appropriate levels of safety and security (MV).

6) Make Ready

   •   The Forum Recommends that the current Make Ready staffing
       problems are addressed urgently and that staff skills are
       reviewed to ensure that MR staff have skills that meet the
       requirements of the job. (MV and Gadge)

7) Road Humps

   •   The Forum recommends that information about the location of
       ‘road humps’ in Islington, which impact on the effectiveness of
       clinical care for patients is provided to the Forum, with a view
       to raising this issue with Islington Overview and Scrutiny
       Committee. (MC)

8) Voluntary Sector

   •   The Forum recommends a more proactive approach to linking
       with local voluntary and community organisations in Islington.
       (MV and MC)

9) Overshoes

   •   The Forum recommends that following the decision of the LAS
       Clinical Governance committee to distribute overshoes to all
       mosques in London, that the LAS audits the effectiveness of
       this distribution. (MV)
Other Information:

Muslim Welfare House

ADDRESS
Muslim Welfare House
Regeneration & Community Cohesion
233 Seven Sister Road
London
N4 2DA233 Seven Sisters Road
N4 2DA
Internet Address: www.mwht.org.uk
Contact Khalid Omer Mujib Miah
Tel:020 7263 3071
Minicom:
Fax:020 7281 2687
Email: info@mwht.org.uk

DESCRIPTION

Social, cultural and educational charity, offers counseling and support
services to the Muslim community through its 14 branches. Prayer
facilities are available. Runs courses including: basic computer skills,
ESOL, careers and employment advice, NVQ1. Also runs a youth club on
Sat, 12-6pm. Meeting rooms for hire. Hall for hire for seminars.
Supplementary school and library. Restricted wheelchair access.



Checked MA- Feb24th. OK for PF, March 2006

				
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Description: Visit to Islington Ambulance Station 68-70, Brewery Road, N7 9NT