Andrew Finlay

Dear Mr Winter Inquest in respect of the death of Andrew Stephen Finlay (Deceased) Response of the North East Ambulance Service NHS Foundation Trust (NEAS) to the Regulation 28 Report to prevent future deaths I am writing in response to the Regulation 28 Report issued to North East Ambulance Service following the Inquest into the tragic death of Mr Finlay. In your Regulation 28 Report, you highlighted the following concerns: “Although the plans for recruitment and retention of personnel and the purchase of additional vehicles were encouraging to hear evidence about, I was told there were still 32 paramedic vacancies to be filled a year on after Andrew’s death”. I will address your concerns below Documentary evidence provided for the purposes of the Inquest In advance of the Inquest, we disclosed a detailed management statement, dated 18 August 2017, from the Trust's Strategic Head of Operations. This statement highlighted the issue of paramedic staff shortages, which is a national issue and the demands currently being experienced by Ambulances Services throughout the United Kingdom. The statement also provided detail regarding the Trust's Emergency Care Workforce Plan and measures taken as regards recruitment of staff. We do not propose to repeat the contents of this detailed evidence in this letter, given that a copy of the statement has previously been disclosed to you. Present position and going forward Following the Trust's CQC inspection in April 2016 and the published report in October of the same year, it was identified that North East Ambulance Service had the lowest paramedic establishment per square mile and lowest paramedic establishment per head of population compared to other Ambulance Trusts. At that time we were also running with a high percentage of vacancies being 20% against that establishment.. The Trust's skill mix ratio compared to other Ambulance Services nationally was low as a consequence. In addition to this, the Trust's activity overall had increased. Also some service reconfigurations across the region such as the development of specialist stroke units etc. had resulted in an increased overall travel time, thereby increasing overall job cycle time, therefore reducing the number of patients each vehicle could attend each day. Without further investment in the service to counteract these changes, resulted in lowering the Trust's overall performance. Chairman: Ashley Winter | Chief Executive: Yvonne Ormston The North East Trust NHS Foundation Trust is registered, and therefore licensed to provide services, by the Care Quality Commission (Provider ID: RX601).

[Page 2] Through the completion of a robust recruitment campaign, the Trust reduced the 20% vacancy rate and reached full establishment against its 16/17 workforce plan in March 2017. However, as a result of the CQC published report, following discussions with the Trust Commissioners, the Trust were successful in securing additional funding for the contract year 2017/18 which provided resources to recruit 84 extra staff, this being 42 paramedics and 42 clinical care assistants, along with associated vehicles and equipment. This funding however was not planned for release until October 2017 and February 2018. Our current vacancy rate which reflects this new establishment mentioned above is now at 7%. Our attrition rate has also reduced to 6.98% therefore slowing the number of staff leaving the Trust. In order to close this vacancy rate we have regular paramedic training courses planned across the financial year, with courses commencing in April, June, September, October 2018 and February 2019. The number of courses is regularly reviewed and additional courses scheduled to meet the demands of the paramedic pipeline. We have 41 graduates from Teesside University who will be available to commence practice from September 2018. In addition the Trust have regular paramedic assessment dates planned and are looking at a further proactive advertising campaign to include social media adverts in order to attract paramedics to the region. There are 3 new double crewed ambulances that have been running since November 2017 covering a 14:00-02:00 shift daily. This is where our demand profile has increased with our peak demand falling into early afternoon and evening. These vehicles are spread geographically across our area based on our demand profile It was acknowledged however by our commissioners, that further demand and capacity profiling would need to be carried out as a result of the introduction of the new Ambulance Response Programme (ARP) in October 2017 and that the 84 extra staff would likely not meet the overall workforce gap. As a result, the Trust and Lead Commissioner jointly commissioned a demand and capacity review which was published in January 2018. The review identified further resource, 79 paramedics and associated equipment, vehicles and support staff, is still required over and above the previously agreed 42 Paramedics in order to meet the new Ambulance Response Programme targets. The Trust is therefore now in discussions with their Lead Commissioner on how to progress this and a formal contract variation has been submitted. Following the outcome of these discussions we intend to host a summit with all stakeholders, such as Coroners, MP’s, and Hospital Trusts, including the CQC, to clearly present the outcome of the discussions and plan, and explain the new ARP standards. Notwithstanding the above, we accept that we can contribute to improved performance by addressing inefficiencies and have already started to tackle handover to clear time at hospitals, reducing sickness absence, abstraction and working with acute hospitals to reduce handover delays. A good example is the progress we have made in reducing handover to clear delays which have already reduced by nearly 20%. We are hampered in making further progress without having the management capacity to address the issue on site across the Emergency Departments. This is a concrete example of where we need additional resources to help us fully realise the efficiencies. 2

[Page 3] I hope that the steps that have been taken address the matters of concern which you have highlighted. We are committed to taking all appropriate steps within our power to improve resource availability and response to meet current workforce pressures. If we can be of any further assistance please do not hesitate to contact myself or Alan Gallagher, Head of Risk at the Trust.