COUNTING DOWN
If you wish your communication to the Board to appear on this page please cc your reply to bransford@saveyoureoc.co.uk . The Board stated in the Worcester News July 5 2007 , that "if someone has a better solution that tackles all of the issues highlighted in our consultation document, tell us and we will give it full consideration". Homework for 722,500 people.
From: rnprosser@eml.cc
> To: kevin.ward@midlands.newsquest.co.uk
> CC: luffpj@parliament.uk; Richard@richardburt.org; harriett@harriettbaldwin.com; info@sirmichaelspicer.net; johnsona@parliament.uk; bransford@saveyoureoc.co.uk
> Subject: Copy of email to Mr Bradshaw.
> Date: Wed, 17 Oct 2007 13:18:08 +0100
>
> Dear Mr Bradshaw,
> I was angered and dismayed to read you comments in the Worcester News on
> Tuesday 16th October 2007.
> In reply to the request by Mr Luff (reported in the Worcester News on
> Wednesday 10th October) that an investigation be carried out into WMAS
> Trust Board’s handling of their consultation process because, as he
> said: "The feedback seems deeply flawed. Some MP's views were also
> mis-represented, including some of my own. I will ask the Secretary of
> State to investigate the accuracy of the analysis."
>
> Your comment in reply read, "The Department is clear that arrangements
> for where ambulance service control rooms are situated, and how calls
> into the control rooms are received, are a matter for the ambulance
> services themselves.
>
> This reminds me of the famous Two Ronnies sketch where one asks a
> question and the other answers the question before last.
>
> The request from Mr Luff was that the Secretary of State investigates
> the accuracy of the analysis, not the policy of the location of control
> rooms. It would seem incumbent on you therefore do as Mr Luff has
> requested, for it seems wholly irresponsible that, given the current
> trend, any NHS Trust Board is left to police itself.
>
> Yours faithfully
> R.N. Prosser.
> --
> Bob Prosser
> rnprosser@eml.cc
Date: Thu, 11 Oct 2007 10:19:06 +0100
> From: S.Kabani@sms.ed.ac.uk
> To: Anthony.Marsh@wmas.nhs.uk
> CC: bransford@saveyoureoc.co.uk
> Subject: Re: FOI response/069
>
> Dear Mr Marsh
>
> I would like to make a complaint concerning the manner in which my FOI
> request was dealt with. I feel that the reply came much later than
> necessary. As stated by Alan Percival, I made the request on the 10th
> September (I actually made the request on the 6th September (See
> below) but I understand it didn't get to Alan Percival until the 10th
> September. This in itself appears to be an unwarranted delay)
>
> Date: Thu, 06 Sep 2007 13:01:53 +0100 [06/09/2007 13:01:53 BST]
> From: S Kabani
> To: Anthony Marsh
> Cc: bransford@saveyoureoc.co.uk
> Subject: RE: EOC reconfiguration proposals
>
> However, I didn't receive a reply until the 5th October:
>
> Date: Fri, 5 Oct 2007 15:52:37 +0100 [05/10/2007 15:52:37 BST]
> From: Alan Percival
> To: s0680901@sms.ed.ac.uk
> Subject: FOI response/069
>
> Personally I consider this does not constitute "promptly" as required
> by the FOI. However, most frustrating was that the letter attached to
> the email with the reply containing the information I had requested,
> was dated 10th September, suggesting that the letter had been written
> that same day, but was delayed in reaching me via email (which, if
> sent, would have reached me immediately) and I can only conclude that
> this was done in order to stall any follow up. I understand that I am
> not the only person to have found fault in your handling of FOI
> requests.
>
> Therefore I would like to make an official complaint and also demand
> an explanation for this delay. Also, seperately, I would like to seek
> some clarification over some of the legal advice given to you that you
> provided me with. Alan Percival kindly constructed me a table into
> which he summarised the advice given to you by your lawyers, and
> ticked off which had been completed. My query relates to this summary:
>
> "A date should be set (maybe about one month after circulation of the
> proposals) for responses."
>
> Next to this, Alan has written the date 1st October, meaning that this
> has already be completed. I consider that this has not been done on
> account that only one proposal was ever circulated by you. I
> appreciate that this may seem to be a very minor issue, but from my
> understanding of the law, little details such as grammar and spelling
> can have huge effects on legal interpretation. It was your lawyers
> who advocated these proposals, in plural, but I am not aware that any
> other proposals have been written by you.
>
> So, in addition to my FOI complaint, I would also like to know why,
> after legal advice to the contrary, you chose to develop only one
> proposal.
>
> I would be grateful also if you would acknowledge receipt of this
> email as soon as you have read it, as I am afraid some post and emails
> to you may be getting lost and I would not like to overburden you by
> repeatedly sending you the same email just to ensure you have recieved
> it.
>
> Yours sincerely
>
> Sarah Kabani
To: consultation@wmas.nhs.uk
Subject: EOC re-organisation consultation period
Sirs
I have recently been made aware of the Health and Social Care Act 2001. Section 11(1) states:
"It is the duty of every body to which this section applies to make arrangements with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are, directly or through representatives, involved in and consulted on...(b) the development and consideration of proposals for changes in the way those services are provided..."
This means that a public consultation should have taken place before and during the drawing up of proposals. The consultation period for the WMAS re-configuration of EOCs was not opened until the consultation document which including the proposal, had been published. This seems to be a breach of your duties as set out in Section 11 (1) of the Health and Social Care Act 2001.
The case: Smith v North Eastern Derbyshire Primary Care Trust [2006] EWCA Civ 1291 decided that a trust is in breach of its duty under s. 11 when "there had been insufficient involvement of, or consultation with, patients."
As section 11 (1) requires a consultation for development and consideration of proposals, and this has not happened , in line with the judgment in Smith, there has therefore been insufficient consultation. You have failed to perform your duty to consult and this is unlawful.
I suggest that such unlawfulness can only be remedied by taking the consultation back to the very start, and by consulting properly with the public and relevant bodies in order to draft the proposals themselves, and, when this has been achieved, opening a fresh round of consultation based on the proposals in order to find the best proposal, probably based mainly on one proposal but fully taking into account aspects of others and points raised by members of the public during the consultation, and then tweaking this to perfection afterwards.
Are you going to be taking such action.
If so, please provide me with full details.
If not, why not and what are you going to do instead?
If not, and the reason that you are not going to is because you do not feel you have breached the law provided by Section 11 (1) of the Health and Social Care Act 2001 and the judgment in Smith, (as explained above) please explain why you do not feel such unlawfulness has occurred.
Yours faithfully
Leo Hughes
Harriett Baldwin, Conservative Parliamentary Candidate for West Worcestershire has joined forces with fellow Conservatives from across the two counties to propose an alternative proposal for the reconfiguration of Emergency Operations Centres to improve patient care, resilience and efficiency for the taxpayer.
On Friday at noon, she joins Sir Michael Spicer, MP for West Worcestershire, and Robin Walker, Conservative Parliamentary Candidate for Worcetser at Bransford, to present their proposal to the West Midlands Ambulance Service NHS Trust.
The proposal is also supported by Peter Luff, MP for mid Worcestershire, Bill Wiggin, MP for Leominster and Karen Lumley, the Conservative Parliamentary Candidate for Redditch.
The key features of this proposal are:
5 emergency call centres to be maintained in the West Midlands region to maximise resilience and local knowledge
Expansion of Bransford and Stafford to balance Brierley Hill and create a resilient “three-legged stool” of call centres – protecting local jobs and local knowledge
New virtual call centre technology implemented, ending current unsafe fallback arrangements and bring better technology to local centres
Cost neutral to current proposals (as far as can be determined with the limited financial information provided by the Trust)
A call for the proposal to enhance links with neighbouring Trusts, not just in the West Midlands region but across regional boundaries
Commenting on the proposal Harriett Baldwin said,
“Local campaigners all agree that the Trust’s one and only proposal raises serious concerns for residents of Worcestershire and Herefordshire, because of the gradual attrition of local knowledge needed for call-taking and the regional approach to dispatch. The Trust’s proposal also omits many hidden costs, which has meant that we have been able to put forward an alternative proposal that will be actually be better value for the taxpayer as well as safer for people in rural parts of the County. It is also more resilient. We urge the West Midlands Ambulance Trust Board to give serious consideration to the extensive amount of work that has been done to show that there is an alternative way that recognises the need for change but offers a solution that keeps all the centres open.”
ENDS
Notes for editors
This alternative proposal can be downloaded from www.harriettbaldwin.com/publications
Press Call 12 noon at Bransford EOC.
For further information please contact
Harriett Baldwin
Conservative Parliamentary Candidate for West Worcestershire
07768 518130
Harriett@harriettbaldwin.com
FYI
Peter Luff MP
Member of Parliament for Mid Worcestershire
Chairman, Trade and Industry Select Committee
House of Commons
London SW1A 0AA
Telephone 01905 763952
24 September 2007
AMBULANCE CALL CENTRE CHANGES THREATEN LIVES IN SOUTH WORCESTERSHIRESAYS LUFF
Proposals to close the Bransford ambulance emergency operations centre are a recipe for tragedy, says Mid Worcestershire MP, Peter Luff. He is formally opposing them in his response to the current consultation by the West Midlands Ambulance Service. The MP also says that the closure flies in the face of promises made to him at the time of the merger of the trust that Bransford would remain open, and that it owes more to an obsession with regionalism than to the needs of south Worcestershire. In his letter responding to the consultation, Peter Luff writes, "The decision to press ahead with a consultation on closures ...undermines the integrity of the NHS and means I can no longer tell my constituents that they are able to rely on any undertakings given by theNHS in this area. "Once again we see Worcestershire - and especially south Worcestershire- losing out to the obsession with the regional delivery of services out of Birmingham and the Black Country. The south of this county needs to co-ordinate its services, especially its health services, with Gloucestershire much more than with Birmingham. This was dramatically brought home during the recent floods when the regional structure of the ambulance service in particular caused difficulties in the efficient delivery of emergency services." Peter goes on to list four main areas of concern: local knowledge, jobsand recruitment, patient care and the consultation process. "The WMAS ... have gone to pains to point out that technological advances in recent years mean that reliance on local knowledge is no longer as vital as it once was.In some cases this might be true. I welcome the fact that 95% of addresses are registered on the electronic mapping system, and that calls from these addresses generate immediate locations and route plans.However that still leaves 5% unidentifiable under the proposals. It is,by definition, most likely that these 5% are in remote rural areas in south Worcestershire, and probably in Herefordshire too. They are precisely the properties I am most worried about when it comes to local knowledge and the appropriate dispatch of ambulances. Ninety-five percent is a high number, I do not dispute, but when we are talking about matters of life and death 5% is significant enough to warrant strong concerns over the need for a degree of local knowledge. "On top of this, I am told frequently that ambulances are called by third party callers reporting a relative, friend or patient in need of an ambulance. In these circumstances the computer aided dispatch system will identify the wrong address and again local knowledge will beneeded. Therefore the figure of 5% could be a worrying underestimate of thenumber of calls where local knowledge is needed to ensure dispatch. "I understand that control of all ambulances will be centralised so an Evesham ambulance could easily find it ended up on calls in Birmingham if its previous job had taken it there - or vice versa, with a Birmingham ambulance in Evesham. The lack of local knowledge of the drivers risks being reinforced with a lack of local knowledge at the EOC. This is a recipe for tragedy." "The WMAS proposal goes to some lengths to reassure that Bransford staff will be retained and offered the chance to move to one of the remaining EOCs, thus retaining the local knowledge already available. However this is not a solution for the long term. It is difficult to imagine Brierly Hill recruiting sufficient numbers of South Worcestershire or Herefordshire residents in say ten or fifteen years time to retain the current levels of local knowledge. "Nor has the Trust in my view done sufficient research to find out how much local knowledge will be retained in the shake-up. In response to concerns I raised about recruitment of operators with local knowledge,the WMAS responded that it could become difficult because explicitly requiring this attribute could fall foul of equal opportunity employmentlegislation, discriminating particularly against ethnic minorities whoare least likely to have such local knowledge. This is a farcical argument. The idea of equal opportunity legislation is to ensure those with the necessary requirements to fulfil a role are not discriminatedagainst on the grounds of race, age, sexuality etc. In my view local knowledge is a requirement for the role and therefore does not fall foul of such legislation, and this argument should be dismissed. "At the heart of this debate lies the issue of whether the closure of Bransford would lead to an improved service or not. In fact it has already been shown that Brierley Hill is severely strained. On 18th May 2007 it took operators over six minutes to answer an emergency call, dueto high demand for services. At Hereford and Worcester Ambulance Control no caller has ever had to wait that long. So there is a real risk that patients in Herefordshire and Worcestershire will be getting an inferior service to the one they currently enjoy. "The quality of the Bransford call centre was further highlighted during the recent floods in the county. Herefordshire and Worcestershire services operated as normal, coping with the increased number of calls and adverse environmental condition. The Brierly Hill centre, by contrast, failed on first day of the floods and was knocked out of action. EOC staff at Bransford were able direct ambulances around close routes, using their own knowledge and saving valuable time. "The Trust's proposals are just another sign of obsessive regionalisation. It is claimed the new approach would help cross-border communication however it only moves the boundaries - and in the wrong direction. SouthWorcestershire, Herefordshire and Shropshire have borders with Wales and Gloucestershire that are not taken into account by the proposals. "I am not arguing that nothing should ever be changed. Many in Worcestershire welcome a debate about how to improve our county's ambulance services and how we can also ensure money is spent effectively. However, there are many ways to crack an egg - and I feel the WMAS has failed to acknowledge legitimate concerns and counter proposals. Rather than opening a consultation period while their own proposal was in development, it was opened when the new policy was finalised, making it harder for others to have any effective input. Very little consideration has been given, for instance, to updating the existing EOCs or any other way of improving performance and finances,other than closure of Bransford. This is short-sighted and regrettable. "It is for these reasons, and those listed above, that I reject the proposals put forward by the Trust."
ENDS The full text of Peter Luff's response is available on request
Contact 01905 763952 (transfers to London office when necessary)
Mrs E. Bellamy,
9 Hatley Court,
81 Albert Road South,
MALVERN,
Worcestershire.
WR14 3DX
15th September 2007.
Mr. Richard Burt,
West Worcester Liberal Democrats,
Worcester
WR3 7ZD
Dear Mr. Burt,
I am writing to you directly as well as attaching this to “saveyoureoc” as I believe the subject in hand involves much more than our wonderful Emergency Operations Centres. We are, of course, dealing with the general malaise of the NHS and its overall mismanagement, for that’s what it is, mismanagement. I am sure that there has been enough money in the pot to do a first class job for quite some time but good management training has been missing for many years.
Why is it so difficult to remember that the combining of Hereford and Worcester in a joint Council authority did not work, so why do they expect to find more efficiency in a combined ambulance service? Local knowledge is always vital to such a service as anyone who has been the victim of a call centre in India will confirm. It seems that it was only yesterday that the new EOC was built at Bransford and already someone deems it a good idea to close it. It is quite obvious to many of us that problems are never thoroughly thought through and those with the power to do so seem to run around like “Chicken Lickin” shouting that the sky is falling.
A soon to be published book on managing organizations as complex as the NHS says, “Complex relationships are important but hard to manage. They have a life of their own and don’t respond well to attempts to control them from the centre or above. Discourse Management is the answer. This focuses on interfaces, aims, issues and views. It connects those who need to work together. It encourages the frank exchange of dissimilar views and discourages censors, bullies and casual observers. It makes it safe to talk, creates a Yala.”
“The government has listened to the ignorant and unscrupulous advice of management consultants rather than the views of its own Civil Service (a phenomenon chillingly described in Plundering the Public Sector, a book by Richard Brooks and David Craig published in 2006)” and a nasty condition, dubbed “targetitis” by the British magazine The Economist, afflicts the whole of the NHS, from big hospitals to local doctors’ surgeries. Targetitis, the blight of doctors’ lives, has driven some hospital managers to “massage” their numbers. But for the Government and its advisers, targets are the miracle cure for the NHS that will ensure that all the money being poured into the health service improves its performance.”
“Dazzled by promises of “Quick Hits” and “Early wins”, the Government has embraced the terrible oversimplification that “you get what you measure” and set targets for everything it hoped to achieve. But ill-judged attempts to control complex relationships can have unintended and often harmful consequences – and these are now visible throughout the British Public Sector, nowhere more so than in Education and Health.”
“Undeterred by the failure of targets, the Government just adds more and more. Doing more and more of what obviously does not work is sometimes called Humpty Dumpty logic: “If all the King’s horses and all the King’s men can’t put Humpty together again, it just goes to show that we need more horses and more men!”
I understand that a recent film called “Sicko” exposes the U.S. as a very dangerous place to be any combination of poor, sick and old and suggests that the American Medical Association ought to consider changing its Hippocratic oath from “First, do no harm” to “ First, check the wallet”. Are we becoming a nation with a similar ethic?
We all need this wonderful facility – the NHS, it’s the best in the world. Please don’t let it fall apart from lack of sound management. Until some confidence can be restored, voters will have little faith in any elected party. I very much hope your efforts are successful.
Yours sincerely,
Enid Bellamy (Mrs).
Please read this email bottom to top.
Dear Mr Marsh,
Your reply clarifies perfectly the position of the Trust.
Please have the courtesy to read my question and reply to it rather than
send a regurgitated standard response as you have previously. This is an
issue of enormous magnitude; if we are invited to ask questions, we
deserve to have them properly answered.
Clearly, from your response, cost savings are an objective and funding
is an issue. This is in direct contradiction to your statements and your
proposal, how is this possible?
Other than by withholding investment for technological upgrades in
Bransford and Shrewsbury, which is clearly your intention, or procuring
sub standard systems for Brierly Hill, Stafford and Leamington Spa, how,
as has been stated repeatedly, can three control rooms be more resilient
than five?
How can I be sure that the information you have provided in this email
is accurate and complete when your disclaimer clearly states that the
Trust, its directors, officers or employees accept no liabilty for the
accuracy herein, and you have not made an express statement to the
contrary?
How many other emails have been sent containing possible inaccuracies?
R.N. Prosser
Dear Mr Prosser
A full business case for the EOC rationalization has not been finalised;
as such a case may be undermined by the outcome of the consultation
process. It is the Trust's intention to submit such a case at the Trust
Board meeting after the end of the consultation period on 9th October and
it should also be noted that the proposals are not predicated on
financial savings. These savings will be invested to allow us to recruit
more call handling staff in order to improve our call handling
performance as well as upgrade the necessary computer systems to improve
the overall service provision and enhance the resilience and fall back
arrangements so that the operation is much safer than the current
arrangements.
However, in answer to your questions, savings are derived from two
sources; current costs saved and future costs avoided. In addition, and
in order to simplify matters, set-up or non-recurrent costs are excluded
from this assessment.
The current costs saved represent the smaller of the two areas. It is
estimated that the closure of Bransford and Shrewsbury EOCs would result
in accommodation savings of about £90,000 per annum. In addition, the
disposal of the Staffordshire HQ property at Stone Road, Stafford,
following its transfer to Tollgate, a property that the Trust already
occupies, would save a further £100,000 per annum.
The rationalization also seeks to avoid future costs. The Trust is
currently seeking confirmation from BT, of the costs of developing a
resilient private network for the management of the dispatch system. The
cost of a network excluding Bransford and Shrewsbury is expected to be at
least £250,000 per annum lower than a resilient network including those
two locations. The Trust is also advised by independent experts retained
by the Trust's commissioners that the cost of implementation of Call
Connect (new standards applying to ambulance services with effect from
1st April 2008) will be in the region of £320,000 per annum lower, if
activity is managed through fewer, larger locations. It is important to
note that the Trust plans to recruit significant numbers of new call
centre staff over the next eight months.
The current system of operating five EOCs is affordable but they are not
safe. In order to make them safe and achieve all the benefits we have set
out we need to reduce the number of controls to achieve the improvements
for patients as well fund the required upgrades as I do not have the
additional funding to cover the extra costs of the required upgrades.
None of the EOCs can interact or network with each other and it is not in
the public interest for them to work in silos and with the
ever-increasing demand and rising patient expectations mean that 'no
change' is not an option. Call numbers have increased at an astonishing
rate; nationally they are up by almost 70% in the last nine years alone;
this is reflected locally too. With such changes it is simply not
possible to keep things as they have always been. To ensure we meet
patient expectations and reach them more quickly than ever before we have
to embrace change. This can range from more and better trained staff,
newer and more capable vehicles, technological advances and new
treatments.
The Trust has a legal requirement under the Civil Contingencies Act to
ensure that there are adequate and appropriate arrangements in place to
ensure continuity of services should any of its control rooms cease to
function. The Trust has to ensure that the control rooms have sufficient
capacity to accommodate the failure of any single centre. In addition,
the control rooms need to have the capacity to manage a major incident
within the region and to have the ability to control and monitor the
resources from a central point. Rather than these proposals putting lives
at risk, we believe it will save lives.
I hope this clarifies the position of the Trust but please do get in
touch if I can assist further.
Regards
Anthony C. Marsh
Chief Executive Officer
The information contained in or attached to this email is
intended only for the use of the individual or entity to
which it is addressed.
If you are not the intended recipient, or a person responsible
for delivering it to the intended recipient, you are not
authorised to and must not disclose, copy, distribute,
or retain this message or any part of it.
It may contain information which is confidential
and / or covered by legal professional or other privilege (or
other rules or laws with similar effect in jurisdictions
outside England and Wales).
The views expressed in this email are not necessarily the
views of West Midlands Ambulance Service NHS Trust, and
the Trust, its directors, officers or employees make
no representation or accept any liability for its accuracy
or completeness unless expressly stated to the contrary.
This e-mail has been checked for viruses but this does not
guarantee that it is virus free.
Subject: WMAS EOC Reconfiguration
Dear Mr Marsh,
You claim that cost saving is not an objective, nor funding an issue in
your proposal for EOC reconfiguration in the West Midlands.
Other than by withholding investment for technological upgrades in
Bransford and Shrewsbury, or procuring sub standard systems for Brierly
Hill, Stafford and Leamington Spa, how can three control rooms be more
resilient than five?
R. N Prosser.
Dear Sir/Madam,
I have read with interest but also increasing concern the Consultation on the Proposed Reconfiguration of the Emergency Operations Centres in the West Midlands by West Midlands Ambulance Service NHS Trust which would result in the closure of Bransford and Shrewsbury EOCs.
As I understand it we currently have 5 EOCs with locations across the whole region. In this way communities, be they in Birmingham, Warks, Worcs, Herefds, Salop or Staffs, can have confidence that their nearest EOC is equipped with local knowledge when answering calls and liaising with similarly local ambulance crews. I'm sure this is a more robust system than the proposal to reduce the number of EOCs to 2 plus 1 support centre.
Also I cannot believe that having so few centres in the region as is proposed can be safe. The report itself makes provision in the exceptional circumstance that one of the proposed EOCs should be out of action. Surely then 5 centres is more failsafe than just 2 and 1 support centre.
Clearly, as the report says, it should be advantageous to the service to have the best communication / IT systems in common to all EOCs.
I have no specific knowledge of the emergency services or associated technology and perhaps I'm being too simplistic but surely the whole point of a radio system is 'communication' and so it should operate across a number of centres as one of its primary functions without the cost being prohibitive.
Also IT development has seen a reduction in the cost of some technology so could this factor be used to the advantage of WMAS in developing the system while being able to retain the assets it already has in its 5 EOCs.
These are crucial decisions which will be taken later on this year and it is no surprise to see the strength of feeling your proposals have generated.
I hope in considering the proposals and responses you are receiving that you will give priority to keeping Bransford and Shrewsbury EOCs.
I await your reply with interest.
Yours faithfully,
Rachel Smith
Liz
Thank you for your e-mail. My responses to your questions are in red font below, which I hope are helpful: -
Please may I have evidence of costings and the breakdown of costings for the ARP and telephony in each EOC including Tollgate? May I also have evidence of savings to be made by the proposed closure of Bransford EOC, savings to be made by the proposed closure of Shrewsbury EOC, and all financial planning costs outlined on page 13 of the proposed reconfiguration document?
The financial figures will be presented to the Trust Board on 9 October which will include all the options determined for assessment at the 9 October meeting. As I have also stated we intend to post the financial details on the Trusts website.
How have the demand rate figures in 1.2.2 of the Business Case been worked out when the call taker role differs so greatly between Bransford and Millennium Point EOCs?
The figures have all been calculated in the same way with the number of calls / number of call takers.
How many voting Members of the Trust Board have contributed to the proposed reconfiguration document?
Two of the five ‘Executive’ Directors have contributed to the consultation document, but only one is a voting member.
How many voting Members of the Trust Board are non-executives?
Six.
Please will you forward me the Mason report in full? Also the Varney report?
See attached.
Can you estimate the cost to the Trust of voluntary redundancy ie a figure that could range from nothing at all if no staff wish to apply for it, to whatever the top figure might be if all eligible staff chose to take it up?
There will be no redundancies.
Please can a breakdown of the figures in 9.0 Conclusion be provided?
These figures will be available at the Trust Board meeting on 9 October.
Should the proposal to reconfigure EOCs in WMAS not have been undertaken by an independent body such as the PPI?
The PPIF are also engaged in the consultation process but it is unlikely they will have the required extensive technical expertise nor the experience and expertise of national best practice. Of course, if they possess these atributes then that will of course help.
Please can you forward me a copy of Catalyst's report to WMASTB when you are in possession of the same?
This will be presented to the Trust Board on 9 October and will therefore be made available as per all Trust Board papers.
I hope this clarifies the current situation.
Regards
Anthony C. Marsh
Chief Executive Officer
RE: EOC reconfiguration proposals
From: Anthony Marsh
Sent:05 September 2007 08:55:39
To: S Kabani
Dear Ms Kabani
Thank you for your e-mail and for your subsequent one to the consultation address. The Trust Board will consider all proposals including the ones mentioned in your e-mail, including the one from Mr Richard Burt. However, the Trust has not received a proposal from Ms Harriet Baldwin up to and including today. In relation to theconsultation period, the Trust has clearly laid out a timetable after taking legal advice which will be adhered to and any final decision willbe taken after all the alternative proposals are examined and will beresponded to in turn. Thank you once again and please do get in touch if I can assist youf urther.
Regards Anthony C. MarshChief Executive Officer
Subject: EOC reconfiguration proposals
Dear Mr Marsh, I have been following with interest the development of the EOC reconfiguration proposal but was concerned that the limited time scale given for public consultation would prevent the required in-depth analysis of all public suggestions. Therefore I am writing this email to request either the prompt publication of a business plan for the impressive Alternative Proposal written with the aid of the Liberal Democrat Parliamentary Candidate Richard Burt, or an extension of the consultation time period in order for a business plan to be drawn-up and made public. As has been stated in the WMAS press office letter:"The Trust welcomes a debate about the future of EOCs; you will recall the pledge from the Chief Executive that if anyone can come up with a better solution that meets the needs of the Trust, the Board will be happy to examine it in detail" I assume you are seriously considering this Alternative Proposal and as such would also need to write a business plan for this scenario, so that you can compare both proposals. I also understand that the business plan must be independently audited. I also believe that at least one more Proposal is being drafted by the Conservative Parliamentary Candidate Harriet Baldwin. It is my concern that as business plans and auditing must be time consuming processes, the proper consideration of these alternative proposals will not take place due to your self imposed time restrictions. I would request that you extend the time limit for the consultation period in order to fully analyse and independently audit the alternative proposals, so that when it is time for the final decision to be made, all the proposals can be lined up and judged fairly and comparably. If however, you are able to complete these extensive investigations into the alternative proposals within the time frame set by you, then I would like to receive both the business plans and independently audited reviews of all alternative proposals, before the final decision is reached. Yours sincerely
Sarah Kabani
Pls PLEASE don't close it I work in Worcestershire and know the confusion about place names and directions that can occur without local knowledge (SATNAV type solutions NOT enough)
Beech Cottage
The Downs
Bromyard
Herefordshire
HR7 4NY
Mr A C Marsh
Regional Headquarters
Millennium Point,
Waterfront Way,
Brierley Hill,
West Midlands,
DY5 1LX
CC:
Sir Michael Spicer
House of Commons
London
SW1A 0AA
Healthcare Commission
FREEPOST NAT 18958
Complaints investigation team
Manchester M1 9XZ
and for posting on: http://saveourambulancecontrol.blog.co.uk/
and: http://saveyoureoc.co.uk/default.aspx
26/08/07
Dear Mr A C Marsh
PROPOSED EOC RE-ORGANISATION IN THE WEST MIDLANDS
I received a letter from you recently, care of Sir Michael Spicer, in response to a letter which I had sent to Sir Michael Spicer detailing to some extent my concerns about the proposed re-organisation of EOCs in the West Midlands. You will see that I have copied this letter to Sir Michael Spicer, raised a complaint through the Healthcare Commission and have e-mailed it for posting on http://saveyoureoc.co.uk/default.aspx, and http://saveourambulancecontrol.blog.co.uk/, in order that the complaint is officially registered and that Sir Michael Spicer and the general public are aware of how unhappy I am with the response which I have received and the derision and irrationality which you have shown.
I was distressed to find my concerns treated with contempt and impertinence. Not all my concerns were addressed, those that were have been addressed inadequately and I have been dealt many answers with spin and subjectivity. This is not good enough. I require my concerns, which I will elucidate in more detail below, to be addressed promptly, fully, directly and objectively, with each issue, aspect or question being given individual attention and an individual answer.
I was originally at a loss to comprehend why the individual aspects of my letter were not answered fully. I later found that the letter, which you had sent to Sir Michael Spicer, who in turn forwarded it to me, addressing my concerns, had not been bespoke. It had been copied to at least 2 other people, people who I am sure had specific concerns of their own that needed addressing and which subsequently have not been addressed. I am exceedingly angry at the disrespect shown to us, and it serves as further proof that you do not take the opposition seriously. I am not asking these questions to be difficult or vexatious; I am very concerned about the procedural impropriety that has been shown by your consultation and the adverse affect that this will have on people in the community. Your attempt to broadly answer our concerns with one letter has meant that you have answered them all inadequately and has meant that they have not been considered with their due individual regard. This makes a mockery of the consultation. We expect our concerns to be individually considered and addressed. That they are not being so addressed is proof that concerns raised by the public are not subject to serious consideration by you.
As a result, I, and I am sure the others affected have had to write letters such as this to ask questions and express concerns which should have been dealt with originally. This could be an intentional underhand tactic, but whether it is or is not, it has had the same result. This has wasted our time, and as the consultation period is so short, has had a severely adverse effect on the situation of the opposition to the proposal. I therefore ask to have the consultation period extended to make up for the time lost which would include the time taken to draft letters, time taken for them to get to you in the post and time taken for a reply to be received and considered. 20 working days would suffice to cover this.
You seem to think that my concerns, and the concerns of others opposed to your proposals, can be dismissed without recognition. You are very wrong. You have a legal responsibility to the general public, which you cannot dismiss with arrogant spin doctoring, which requires a proposal such as this to be administered professionally and a public consultation on the issue to be undertaken 'properly'.
I would like to bring your attention to the case: R v North and East Devon Health Authority, ex p Coughlan [2001] QB 213. In this case the Court of Appeal determined that:
"To be proper, consultation must be undertaken at a time when proposals are still at a formative stage; it must include sufficient reasons for particular proposals to allow those consulted to give intelligent consideration and an intelligent response; adequate time must be given for this purpose; and the product of consultation must be consciously taken into account when the ultimate decision is taken."
My understanding is, that as there is only one proposal under consideration (that detailed in the Consultation Document) and as the consultation period only opened once this Consultation Document had been released, the consultation has been undertaken only after the proposal was finished, and not whilst they were at a formative stage; this is highly irregular and constitutes procedural impropriety.
A decision suffers from procedural impropriety if in the process of its making the procedures prescribed by statute have not been followed or if the 'rules of natural justice' have not been adhered to. Laws J, in the case R v Somerset CC ex parte Fewings [1995] 1 All ER 513 stated that the rule of law demands that a public authority can only make a decision, or adopt a course of conduct, if it can find positive law to justify it. Making a decision, or following a course of conduct (such as the proposal, Consultation Document and the consultation as you have administered it) in breach of the relevant statutes and guidance and the ruling in Coughlan (which you have breached with the proposal, Consultation Document and the consultation as you have administered it) is therefore procedurally improper, and demonstrates a breach of the principals laid down in Fewings, and is therefore not a course of conduct that you are lawfully able to take, and a decision based on such, is not one that you are lawfully able to make.
The product of the consultation has, in part, been the responses it has drawn from the general public. The reply which I received to the concerns I outlined showed that my concerns had not, in the slightest, been taken into account or been given their due individual attention. You have gone no further than to re-iterate the proposals in the Consultation Document in what resembles an attempt to fob me off. You have turned what should have been a collaboration into a war, trying to defend your proposal from criticism when the point of a consultation period is to take concerns on board and address them in the proposal and final decision. My concerns, as with those of other members of the public, are completely relevant and highly legitimate. They highlight major failings in your research for the Consultation Document, into which I expected further research to be carried out and amendments to the Consultation Document to be made as a result. My fears and concerns have not been taken into account at all, you evidently have not addressed them and have not attempted to put right what you have done wrong. The consultation and subsequent decision, it seems, is a sick joke. They do not take into account the product of the consultation period and as a result this constitutes further procedural impropriety and unlawfulness because the principles set out in ex p Coughlan and Fewings has been breached.
You will be aware that the Code of Practice on Consultation sets out clear guidelines on how to administer a proposal, consultation, consultation period and the results of the consultation period. You seem to have breached this on several occasions. Consultation Criterion 1.1 states that:
"Consultation is a continuous process that needs to be started early in the policy development process."
Your proposal was released barely before any consultation period was opened, this is not 'early in the development process' at all, it is at the latest possible stage before a decision is reached.
Consultation Criterion 1.2 states that:
"It is important to identify proactively relevant interested parties and those whom the policy will be likely to affect. These groups should be contacted and engaged in discussion as early as possible in the policy development process."
The general public, EOC operators and their unions, paramedics, hospitals, doctors' surgeries and many other groups would be considered as 'relevant interested parties' and 'those whom the policy will be likely to affect' yet these groups were not contacted or engaged in discussions early on in the policy development process, they were engaged at the last possible moment, barely before the start of the consultation period (which occurs immediately before the decision is to be made) and after the proposal had been made, they had not been involved in the drafting of the proposal in the slightest.
Concerning the late start to the consultation period, which renders it almost impotent, I was even more affronted when I saw a comment from the Regional Head of Communications who stated (in a letter published on http://saveyoureoc.co.uk/wmaspo.aspx) that you:
"have chosen to consult for 13 weeks rather than the month that we were legally obliged to carry out"
Criterion 1 of the Code of Practice on Consultation states that you must:
"Consult widely throughout the process, allowing a minimum of 12 weeks for written consultation at least once during the development of the policy."
You have opened the consultation period for only 1 week more than the code of practice decrees, and only after the proposal was made, not during the drafting period. To say otherwise is misleading and underhand and seemingly done to make the public think that you are being fair when you are actually giving only slightly more time than you are obligated to give, and have opened the consultation period at a later time to the time when you were obligated to open it.
I wrote in my original letter that I had reason to believe that Bransford EOC out performed the EOC at Brierley Hill (I do not want to belittle the good work of any EOC, but much of your proposal is based on claims that Bransford is underperforming but you have provided no real evidence of this). You did not dismiss this claim, only giving me a quite irrelevant table that compared the number of calls delayed between Brierley Hill and Shropshire. Please tell me categorically if I am right and that Bransford EOC outperforms that of the EOC at Brierly Hill (that is when you consider Brierly Hill on its own, not their performance when combined with that of Shrewsbury), and please provide relevant figures that show the performances of Brierly Hill (that is when you consider Brierly Hill on its own, not their performance when combined with that of Shrewsbury) and Bransford for at least the past 18 months.
You have failed to sufficiently answer my concerns about the financial viability of the proposal, or to provide me with all the relevant financial information surrounding the proposal. You just replied that the proposal would be subject to an audit. This re-organisation is very large and involves a very large amount of money. It is very important that the financial implications are properly assessed throughout. That the proposal will be audited does not achieve this. The proposal, by this admission, has not been audited, and has not had a complete financial assessment. The public have not seen such a complete financial assessment and neither have you. The public, therefore, do not know if the financial statistics that you have provided are accurate, and neither do you. Nobody therefore knows if the proposal is viable or not. This is very irregular, it means that your decisions are being made irrationally and without any real basis and that your statistics and statements, which pretend that this is not the case, are incredibly misleading. It means that your proposal is incomplete and that any figures you have given are purely speculative and may not be accurate or complete, and yet by putting this information into the Consultation Document, without explaining that it has not been proved accurate, you have led the public to believe the information is wholly true when you are aware that it may not be so. This invalidates the consultation because the public cannot contribute effectively because they have not been provided with all the facts and details of the proposal. Please address this issue and please provide me with all the relevant financial information that affects this proposal, and the sources of such information, plus information regarding who will carry out the audit and how they will do this.
Also, when I first read the Consultation Document, the cost of the proposal was priced at half a million pounds. You then released an updated Consultation Document. The proposal in this was priced at £1 million. Nothing else was changed in the Document and no explanation was given for this 100% increase. I can only presume that you do not consider half a million here and there to be an issue, which is very hypocritical because the proposal is backed up by arguments grounded on its financial superiority to other possibilities. Please provide me with a reason for this increase and all the relevant financial details and statistics.
I also questioned the use of reports such as the 'Varney' report, because they were relevant to call taking in offices that dealt with tax, pensions and student loans and not with the critical and life saving emergency call taking in an EOC. It is dangerous, incompetent and irrational, when researching a proposal, to rely on a report that relates to something irrelevant to the particulars of the proposal. The 'Varney' report regularly stresses aspects such as 'every level involved being behind a change', and 'bottom-up staff input'. Aspects which you do not mention or take into account, and in fact are ignoring, because you are not listening to the people on the shop floor and have not got a situation where every level is behind the change. You pick and choose the parts of the report that suit your argument, rather than basing your proposal on the reports themselves. You did not address these aspects in my original letter. Please do so now.
You rely heavily on the findings of the 'Mason' report, but fail to mention that it stresses: the importance of optimum local knowledge; that there are a series of options to consider, rather than just the one; and that "…one size does not fit all…" You have not mentioned these aspects in the Consultation Document, and have certainly not acted upon them, and as a result they has been hidden from the public. Again, rather than basing your proposal on the report, you have irrationally picked and chosen aspects of the reports, out of the context of the document as a whole, in an attempt to bolster your weak Consultation Document and in the hope that this would not be subject to close scrutiny.
I also mentioned that the reports you relied upon are not without dissenters. It took me 3 minutes of searching the internet to find that there are many professionals and academics who have made objections to the 'Mason' report, and a similar amount of time to find dissenting views on the 'Varney' report, and yet you referred to the latter as "widely accepted". It is also widely rejected. Why have you made this comment when it is misleading and hides the truth? Could you please now address my concerns that you have not researched these dissenting views and that you have, irrationally, made your proposal based only on the reports themselves, without even considering the views of the many bodies who object to their findings, and that you have tried to give the papers more credence by exaggerating about how accepted they are.
The case Wheeler v Leicester City Council [1985] 2 All ER 1106 decided that it was illegal for a public authority to ignore relevant considerations, or take irrelevant considerations into account when making a decision. Your misuse of both the 'Varney' report and the 'Mason' report has both ignored relevant considerations and taken irrelevant ones into consideration, and to make a decision based on this misuse would be illegal.
A large concern of mine, that I addressed in my original letter, is that there is only one proposal. You rail on about this being better than 'no change' but you hardly give a mention to the possibility of upgrading all the existing EOCs, or any other possibility for improving EOC performance. It is very shortsighted not to have considered other options, especially the option which is open to upgrade all existing EOCs to all have the latest technology, thereby retaining existing resources and increasing their efficiency, rather than attempting the latter whilst losing the former. By offering just one proposal you have invalidated the consultion period. You have a proposal which is better than 'no change', so a consultation period, in which you do not consider the proposal in comparison to any other, basically achieves nothing. There should be several other proposals, each researched and evidenced properly, so that a consultation can be had upon them and a victor chosen, bearing in mind worthy aspects of the other proposals and the amendments that arise out of the consultation period. As it is, you constantly argue that your proposal is better than 'no change'. It is easy to assume that you have only submitted one proposal, on purpose, so that you can defeat any argument that it is not a good proposal by saying 'but it is the best we have got'. If it has not been done intentionally, then it has had the same effect; and should be remedied by serious research into several other proposals, in order to make a fair comparison with the one you have already put forward. There are already a number of alternatives which are being researched, such as one from Sir Michael Spicer MP in conjunction with Parliamentary Candidate Harriett Baldwin, and there is one that has already been published on http://saveyoureoc.co.uk/default.aspx. Finding and developing several new and alternative proposals, it seems, is not impossible and yet you have failed to achieve this.
Consultation Criterion 2.3 states that:
"As far as possible, consultation should be completely open, with no options ruled out."
In the Consultation Document there are many other options that you do not put forward as possibilities and ignore completely. You dismiss the other options which you do mention almost out of hand, when they should have been developed fully and properly in order for you to make comparisons effectively. The consultation period will be unsuccessful in collecting the opinions of the public on the other options because they have not been developed fully enough to be able to assess their effectiveness; the only proposal that can be assessed is the only one you have put forward. This has been a straightforward breach of Criterion 2.3 in two areas: the other options have been ruled out; and as the consultation period can only assess the one proposal you have made, the consultation can not be considered 'completely open'.
Consultation Criterion 4.2 states that:
"Particular attention should be paid to…possible new approaches to the question consulted on"
This Criterion has also been breached because instead of paying 'particular attention' to the other approaches, proposals and suggestions, hardly any attention has been payed to them and they have been dismissed very curtly without any of them being given their due regard.
Consultation Criterion 6.6 states that a consultation must:
"seek to ensure that the Principles of Good Regulation are followed whenever policy is being developed. These are: proportionality; accountability; consistency; transparency; and targeting."
Considering the scale and importance of the proposed re-organisation of EOCs, releasing only one proposal is not a proportionate response, several should have been fully considered; criterion 6.6 has therefore been breached too. Lord Diplock, in the case Associated Provincial Picture Houses Ltd v Wednesbury Corporation [1948] 1 KB 223, stated that, to be legal, a decision by a public authority must be proportionate to the aim that it seeks to achieve. A disproportionate decision was defined as one that demonstrates irrationality in the form of what has been termed 'Wednesbury unreasonableness', and such decision (such as any decision based on the proposal, Consultation Document or consultation as you have administered it), it was stated, would be illegal.
This notion that the decision (to move forward with the only proposal that you have put forward) has already been made, and may have been made before the consultation period even opened, gains validity when one reads it in conjunction with comments made by the non-executive director to the Chairman and Chief Executive of WMAS Trust (on http://saveyoureoc.co.uk/wmaspo.aspx) where he repeatedly refers to the proposal as a "decision". The idea forms that this "decision" was made before the consultation period was opened, and was not even the result of extensive research and evidence, but that after the "decision" was made, there was a vague attempt to legitimise it with an inept Consultation Document, which would explain all the irregularities and references to documents that are unrelated, in an effort to give it credibility. This again is in breach of Consultation Criterion 1.1 and the decisions in ex p Coughlan and Fewings.
I have asked many questions about the possibility of your proposal being a bad choice compared to other possible proposals but you have consistently answered a different question. You have consistently answered saying that your proposal will be better than 'no change'. I am not advocating 'no change', I agree that a change is required. My concern is that your proposal is not the best change, that it falls far short of what is necessary, that it has been inadequately researched and evaluated, and that no other proposals have been put forward for it to be compared against.
You make a statement to the effect that the Trust "…has a legal requirement under the Civil Contingencies Act…" to ensure there are facilities available if a control room ceases to function, and you go on to say that they need the capacity to manage a major incident. You then write, in juxtaposition, that you "believe" your proposal will save lives. You have not stated whether or not your proposal achieves the criteria you mention in the statement, or given evidence of how it achieves them. That your statement (that you have legal requirements to cope with major incidents and control rooms going off line) is true, does not mean, and is not evidence, that you are fulfilling the criteria in the statement, and yet the juxtaposition of the statement and what you "believe" would suggest that this is so. This juxtaposition is vague and misleading.
Aside from this, your statement is a very poor argument for your proposal, and only serves to argue that it is better than 'no change'. I am not advocating 'no change', but the production of different proposals and many of them, all produced competently and properly. Any proposal put forward would have to be aligned with the provisions of the Civil Contingencies Act, have facilities for if a control room ceased to function and have the capacity to manage a major incident. There are many proposals that could be put forward which are different to your proposal and still fulfil those criteria, yours is not the only possible one. That 'your proposal fulfils those criteria' does not mean that 'your proposal is qualified, or legitimised, because it fulfils those criteria', it certainly does not mean that 'your proposal is the only possible proposal that is qualified, or legitimised, because it fulfils those criteria'. These are all very different notions. Every possible proposal would have to fulfil those criteria, that yours has done so does not make it special. The statement does not mean anything and it is also purely speculative because you have not stated if, nor shown proof of how, your proposal is aligned with the criteria you mentioned, you have just tried to give the appearance that it is.
One of my main concerns about the proposed merger is the loss of local knowledge that it brings with it, local knowledge that can and has saved lives. This merger, therefore, could cost lives, and I raised the issue in my original letter. Your reply stated that:
"Rather than these proposals putting lives at risk, we believe it will save lives."
You failed to show me the results of research done into how many lives could be lost or saved as a result of the merger, you failed to show me evidence of how many lives will be lost or saved if there was 'no change'. More importantly you failed to show me the research and evidence which shows how many lives will be lost or saved, in comparison with any other proposals to which you have given serious consideration. Your subjective ejaculation that it will save lives means absolutely nothing without proof. It is not objective and there is no evidence to support it and relying on such a statement to make a decision would be considered as 'taking irrelevant considerations into account', in breach of the decision in Wheeler, and would be illegal. It, as with so much of your Consultation Document, is speculation and this is akin to a lie. I do not want you to weasel out of giving answers with empty rhetoric and unsupported opinions. Please show me the research that you have done and the evidence gained from it that shows how many lives will be lost or saved by the merger, and please show me the comparisons with the amount of lives, that your research has been found, which will be lost or saved through the enaction of other proposals, such as technological improvements, back ups and intergration for all existing sites. If no such research has been done, this is evidence of gross misconduct and I hope you will address the issue immediately.
You state that there will be no loss in local knowledge. This, again, is pure conjecture (which constitutes taking irrelevant considerations into account) and is, in other words: a lie, because there is no evidence of research done into the number of call takers from Bransford EOC who will be moving to be call takers in Brierly Hill. In fact, as call takers were not told about the proposed merger until the last possible moment, until after the proposal had been released, there would have been no way you could have done such research and found out how many people would move with the merger, and so find out much local knowledge you would be retaining. Making such claims that local knowledge will be retained, and that lives will be saved, without research and evidence demonstrates irrationality and again is unlawful. In fact, Consultation Criterion 6.6 states that a consultation must show transparancy. Making claims in a Consultation Document that are not based on evidence constitutes a total lack of transparancy; adding such subjective comments clouds the issue and hides the truth. You have managed here, with this speculation, to breach this Criterion as well.
Although some call takers from Bransford EOC may be relocated to Brierley Hill EOC, not all will be able to, the ones that will shall be significantly watered down meaning that the odds that a caller from Herefordshire or Worcestershire will speak to a call taker who has knowledge of the same is very slim. You have stated that you will retain local knowledge but that is misleading. You have not done the research to find out how much you will retain and your comments which allude to this and which make it sound like there will be no loss of local knowledge are, again, speculation, because although there may be a few people who have moved with the merger, they will not necessarily be taking the calls from the areas of which they have local knowledge. In the future too, there is no reason to believe, and you have showed no evidence to prove, that recruitment drives will be made in Herefordshire or Worcestershire for call takers in Brierley Hill. Call takers will in all likelihood be recruited from the Brierley Hill locality, which means that in the future, very few people from Herefordshire and Worcestershire are likely to be recruited at Brierley Hill, which means that in the future, local knowledge of those counties will be lost. You have, again, 'ignored relevant considerations'.
You have consistently underlined the virtues of new technologies. Technology plays a vital part when getting ambulances to incidents. You seem to argue, however, that there is either an option to have only local knowledge, or there is an option to have only technology. This is not the case. It is entirely possible, for instance by maintaining current EOCs and expanding them and improving the technologies within them, to have both. To say anything else is deceptive and yet you do not seem to have taken this consideration on board.
You stress that technology can somehow make up for a loss of local knowledge. This is purely an assumption. Nowhere have you given statistics, or any proof at all, that the new technology would make up for such loss, neither has it been considered that a systems failure could occur rendering local knowledge invaluable.
You even state, in your reply to my original letter:
"Very often [ambulance crews] will back the technology up by asking if the caller can see local landmarks, which will confirm locations."
Saying this, in juxtaposition to comments about the lack of a requirement for local knowledge is a complete dichotomy. You have shown, yourself, the importance of local knowledge, and still maintain that it is not important. A pool of local knowledge, by your own admittance, is essential; to lose local knowledge, by your own admittance, would be a disaster. You state that the local knowledge will be maintained with ambulance crews, but you have not assessed the amount that would be lost. Simply put, you do not know the effect that this will have. Considering the views I have read from paramedics, who I am told rely heavily on the local knowledge of the call operators, the effect of this loss would be very significant, and yet you have not provided researched for this conjecture, have not given it consideration, and have tried to claim that it is not an issue. The extent of this attempt to gloss over the issue is amplified when you consider, as I do later in this letter, that by deploying ambulance crews to cover larger areas (as, it has been recently admitted, is the intention) ambulance crews will, significantly, not be operating in areas of which they have local knowledge. If in such a situation, there were no call takers with local knowledge, then a major asset would be lost and a very dangerous situation created. You even state:
"The EOC staff do not know every single location within their county and we should not pretend otherwise."
By that same argument, neither do the ambulance crews, yet you speculate that by retaining them the EOC staff are unnecessary. What is important is a pool of local knowledge from EOC staff and ambulance crews, but your proposals will see that pool drained.
You have not, in the Consultation Document, given any of these aspects their due consideration.
The document also states that there will be no job losses from the merger. However the Brierley Hill EOC is situated a fair distance from the Worcester EOC. Taking the shortest route, the Birmingham EOC is within a distance from the Worcester EOC which is considered, when a company relocates, to be a legal extra distance that workers should be expected to travel to their new jobs. This means that you feel that you do not legally have to let people go or make any redundancy payments.
However, the shortest route is famously not the quickest, due to traffic volume, and the quickest can still take a ridiculous amount of time due to the same. This can make a very long journey time, more so for those who have already travelled from Hereford. For a normal job, this would be considered reasonable but for people who work 8 or 12 hour shifts, whose sleeping patters are changed weekly and who have to stay alert for their whole shift as a matter of urgency, such people would in all likelihood be too exhausted to stay awake on long shifts or be such effective call takers. This is very dangerous. Even if they can, and then even if they are taken by bus or similar arrangement from their old place of work to their new one, it cannot be reasonable to expect them to risk their lives and those of others on a drive home, when they are too tired to drive due to the extra journey time. In short this is stupid and dangerous too.
As a result many people will leave their jobs and all you will have achieved is a saving on redundancy payments, rather than retaining local knowledge, but your Consultation Document passes this off as a good thing. Furthermore, although the law does give a maximum distance that a relocation can be to avoid redundancies, the case law surrounding it (an example being Aparau v. Iceland [2000] 1 All ER 228) talks of "reasonableness". There are cases that set and support the principle that "reasonableness" should be taken into consideration when considering a relocation and redundancy payments, rather than a set distance. This distance, when considered alongside the time it takes to drive it, and the exhaustion call takers would suffer from the extra commuting time, the nature of the work and the shift patterns, would not be considered "reasonable", and such relocation therefore would cause job losses and these would be considered redundancies.
Furthermore, the case HSBC Plc v. Mrs C Drange CSRC vol. 27 iss. 17/3 EAT/369/2003 stated that the only way a relocation could happen without redundancy payments or payments for constructive dismissal was if "no reasonable employer would have concluded that there were no business reasons for the transfer". If this was not the case, such relocation would cause a "total breakdown of trust and confidence between the parties", and any staff that left would have to be given redundancy payments, or, if they had already left, be given financial compensation. Here, with the business case for the merger so legally and procedurally flawed, a reasonable employer would have to conclude that there are 'no business reasons for the transfer', and this would cause a 'breakdown of trust and confidence' and render you liable for redundancy and compensation payouts.
Even without considering the relocation itself, and just considering the proposal and consultation there are grounds for constructive dismissal. In the case Morrow v Safeway Stores [2002] IRLR 9 the Employment Appeal Tribunal (EAT) held that if there has been conduct by the employer likely to destroy or seriously damage the trust and confidence relationship this will mean, inevitably, that there has been a fundamental breach going to the root of the contract and entitling the employee to resign and claim constructive dismissal. The way in which you kept the plans for the merger secret from your employees until the last possible minute, your unwillingness to listen to any proposals other than the one you have forwarded and your unwillingness to listen to, and take into account complaints and recommendations about your proposal and the consultation, along with the illegalities and irregularities of the proposal, Consultation Document and consultation, would alone be enough to create a 'breakdown of trust and confidence', meaning that anybody who resigned would be entitled to compensation under a claim for constructive dismissal.
Nowhere in your document has this been considered. The possibility of such redundancy payments has not been mentioned anywhere, and yet you claim to have carried out "extensive research". This is absolutely preposterous. There is legislation that states that it is vital that an employer informs the workforce of which people will be made redundant and why, as soon as possible and that where redundancies occur, consultation with employees and their representatives should begin as soon as possible, within a timeframe given by statute. If an employer has failed, in any way, to meet the consultation requirements, there are legal sanctions. You have not considered the possibility of any redundancies which although you do not intend, could well be forced upon you, you therefore have not assessed the legal or financial implications that you could face as a result, they are not detailed in the Consultation Document, and so your proposal and the Consultation Document must be considered inadequately researched.
Neither have you considered that the relocation, if it caused women to quit, could also constitute indirect sexual discrimination. When the higher earner in a family has his job relocated, the family will generally move to where the job is. If it is a lower earner who gets relocated, then the family will not move because this is not usually financially viable. Women generally earn less than men. When a woman's job is relocated, as they are more likely to be the second earner in a family, they are unlikely to move to the area that their job has been relocated to. EOC operators are generally on not too high a salary (the benefit being the job satisfaction and not the money), which will mean that women who are in this post and who have a partner or a husband are likely to be the second earner in a household and therefore more likely to be unable to relocate, meaning that such a relocation could constitute sexual discrimination. This principle has been set in the case Mrs Meade-Hill & National Union of Civil & Public Servants v. British Council Court of Appeal [1995] IRLR 478 under S.1(1)(b) of the Sex Discrimination Act 1975 and yet does not seem to have been researched by you, any financial implications resulting from this have not been assessed and it is not mentioned in the Consultation Document, which you claim has been extensively researched.
You have also stated that in situations where it is too far for people to travel to their new jobs, there will be jobs created closer to home. The Consultation Document does not say what jobs these will be. This could be the catalyst for a claim for constructive dismissal. People do this job because they love it and are passionate about it. To demote them, even on the same pay, to a job without the excitement, the drama, and the feeling of having saved lives, would, for them, constitute debasement. It would be akin to demoting a busy barrister from courtroom battles to filing, or a general practitioner to receptionist, or a journalist to deskwork. Most EOC operators would consider most other jobs as unsuitable; although they do not have professional qualifications, they do their jobs for a personal reason. A removal of this would cause most to leave their new jobs, or not take them up, as a result of a 'breakdown of trust and confidence', and this could be considered as constructive dismissal.
This, along with the possible redundancy payments, and possible claims for sexual discrimination, have not been considered anywhere in the Consultation Document, and yet they could have serious financial and logistical implications. They may also impact on the amount of local knowledge that you retain. To have ignored such important possibilities is highly negligent and means that you 'have ignored relevant considerations' which would render a decision based on the Consultation Document, which does not take these aspects into account, illegal.
The Consultation Document heavily relies upon what might happen in natural disaster or terrorist attack. You are on record as stating that, concerning a terrorist attack: "…it is not a matter of 'if' but 'when'." The document states that Birmingham, as England's second city, is a major terrorist target and that if there were such an attack, it would be necessary to have a bigger unit, with more people manning it, more people available at short notice and other EOC units available in case of failure of the main ones, in order that an emergency can be effectively coped with. This emotive issue is highlighted in a completely disproportionate manner. It certainly is not a manner of 'when' and if it were, there is also a consideration of 'how bad would it be'. Many terrorist attacks in foreign countries hurt few people, it is a rare tragedy that one causes much damage, and it is very unlikely that one such would happen in Birmingham. Removing the regular ambulance services at the expense of thousands in Hereford and Worcester is a disproportionate response to limiting the damage from a possible disaster in Birmingham.
Furthermore such a contingency plan is based on flawed logic. The idea that there are more people available at short notice in the case of an emergency is just silly. In an emergency, Birmingham would be in gridlock, it would be very difficult for people to rush into work. If, however, there were an EOC in Worcester (which I doubt would be considered under any threat from a terrorist attack) then, as Worcester would barely be affected, people would be able to get into work in an emergency, and at short notice be able to act to continue services in the event of a failure of the main EOC in Birmingham. Here you have again 'ignored relevant considerations'.
Although, as I already have mentioned, the Bransford EOC is in need of upgrading, the comments which the document makes, and which have been made in the press, regarding this are subjective and over sensationalised. As you are aware there has recently been severe flooding of the Severn and its tributaries in the area. This caused massive chaos, with ambulances needed everywhere, severe grid lock and flooded roads. There are anecdotal reports that Birmingham's EOC, including its back ups, being forced, or taken, off line and that it was working pen to paper as a result. Worcester's EOC on the other hand had no problems and continued functioning as normal, their local knowledge praised by many people who were very happy with the way the ambulances negotiated the obstacles due to guidance of local EOC operators. Bransford EOC is accused of being less effective and not 'fit for purpose' when it seems, objectively and in light of the evidence of the recent emergency, it is actually more 'fit for purpose' than the EOC at Brierley Hill. Why has the opposite been sensationalised when it is not true, and why have the actual statistics that show how effective Bransford EOC is in comparison, not been made obvious? These statistics are incredibly important when re-organising a system on such a scale as this and should be given great consideration when making the proposal and within the Consultation Document. It is again negligent, and shows further incompetence, to ignore facts and statistics such as these.
The WMAS have a ratings system, whereby they rate the severity of an incident, the most severe being termed a "disaster" or similar term (I do not know the jargon used). Most people would consider the flooding to be a disaster, but the WMAS only ranked it as something akin to "almost a disaster". If the Birmingham systems had gone down in a "disaster", it would have looked awful for them. As it was not classified as such, no issue has been made out of it. Also, the Worcester EOC coping so well with a "disaster" would have looked very good for them. It is very suspicious and underhand that such an occurrence should not be clarified under the terms it deserves, just to save the blushes of the WMAS.
I have also heard that a few people from the Shropshire EOC had been suspended, and one eventually resigned, accused of leaking information of ambulance deployment in the Midlands. I was made aware that the person who was resigned was suspended because he breached the Data Protection Act. This Act protects sensitive information about the general public, and not information relating to the performance of a public service. Could you please furnish me with the facts of this suspension and the grounds for it, and if it is the case that he was suspended under suspected breach of the Data Protection Act, even though he had not breached it, could you please make the person, and myself aware of this.
The information released especially related to details of emergencies in Shropshire that have had to wait due to vehicles being urgently deployed to Wolverhampton and Dudley, which is Birmingham's territory. This is very injurious to WMAS because it highlights the fears of Hereford and Worcestershire residents that they will become second class citizens because ambulances that used to serve them only, are being stretched to cover emergencies over a larger area, and due to high demand in the cities, leave the countryside with a diminished service. It also shows that the Birmingham EOC is not so efficient as it is being made out to be. I imagine this will be very embarrassing for the WMAS.
This looks like it is a very separate issue to the proposed merger, but, in the meeting in Hereford recently, a member of the Trust Board admitted that alongside the new merger, there is a plan to pool ambulance depots, so it will be easier for ambulances in rural areas to be deployed into the cities. The plan probably intends to be reciprocal but there will be fears that this will not be so, that there are more emergencies in the cities, so ambulances will be taken from the surrounding countryside more often, and, through the number of calls and relative positioning of ambulances, stay there. I have heard cities being referred to as 'black holes', because the ambulances have a difficult time coming out of them, back into rural areas, once sucked in. This could leave the countryside with a severely reduced service. Why has this not been mentioned in the report? It is incredibly relevant, and would have required being taken into account when the proposal was made, and for the public to dwell upon during the consultation period. If it was not for the call operator at Shropshire EOC releasing this information, the issue may not have been broached at all. The suspension of the call operator and the issue of ambulances being sent to other territories is very relevant to this proposal and yet you do not consider them together, again you 'ignore relevant considerations'. This lack of clarity also breaches Consultation Criterion 6.6 which demands transparency.
There is a breach of Criterion 2 which states you must:
"Be clear about what your proposals are"
Your proposal omitted to mention possible pooling of ambulances. This materially affects the proposal and hiding such relevant information means that clarity has not been achieved.
Keeping this information away from public scrutiny means that a consultation cannot properly take place because the public are not aware of all the facts; if the public do not know everything, the effectiveness of a consultation is completely negated because they cannot give opinions based on the facts because the facts are not given to them. This requires serious redress.
You have also breached Criterion 4.2 which states that:
"Particular attention should be paid to…further evidence of the impact of the proposals"
This pooling is a major impact of the proposal, which you have not considered at all, and have in fact tried to hide from the public. You should be praising, not suspending, the call operator who leaked this, because you had a legal duty to release it yourselves as part of the development of the Consultation Document. You should not be hiding important and relevant statistics from the public, it was your mistake that this was kept secret. It is you who are legally culpable for not releasing the information, not the call operator for doing so, all the call operator did was highlight your incompetence. It is you who should be being punished and not the call operator.
This pooling of ambulances asks further questions of your statements in the Consultation Documents about the limitations to losses of local knowledge. You state:
"It should also be recognised that crews will remain based in exactly the same locations as now, thereby maintaining local knowledge."
Wherever they are based, if they are operating outside of their local areas, which due to this pooling they are more likely to be, ambulance crews will have no local knowledge of the area they are operating in at all. Local knowledge will be completely lost, and yet you have made no mention of this, or the pooling that from which it will result and are actually making comments to the opposite effect (once again 'ignoring relevant considerations'). Your evasiveness makes this comment seem like local knowledge will not be lost, whereas you have not put all the facts in, you have omitted very important ones and so the comment is only a half truth. You have clouded the issue; that ambulance crews will be based in the same locations as they are now does not mean that the local knowledge will be any use in the areas where they will be operating. Whether intentional or not, this comment is misleading as to the local knowledge that will be retained. You certainly, and quite improperly, have not given any aspect of this issue its due consideration; I can find no reference to the issue in the Consultation Document.
You were recently quoted as saying:
"This trust will not do anything that will put patients' lives at risk"
This comment is purely speculative and is dangerous. It allays peoples' fears and stifles debate when you should be trying to obtain peoples' opinions and take peoples' fears on board. It serves to moderate the effectiveness of the consultation period, and a consultation period that is not effective may mean that important points are omitted that should have been considered and this, ultimately, can cost lives. You have provided no evidence in this document that enables you to make this statement. You have done inadequate research into the risk to life that it poses. You have, again, 'ignored relevant considerations', and you have insufficiently and falsely addressed many of the aspects that you have considered, which constitutes 'taking irrelevant considerations into account'.
You are not in a position to know whether your proposals will put patients' lives at risk or not.
How you can possibly think that a monumental shake up of these proportions can be significantly dealt with in the mere 6,460 words of the Consultation Document is beyond me, and it shows massive ineptitude. I have written more than this in this letter (which serves only to point out concerns and errors based on the document and highlight issues that you have not taken into consideration within the Consultation Document) alone. I am aware there are other people who have different concerns about the proposal, which I do not know the particulars of and which I have not broached here. The fact that I have been unable to pen my concerns in response to the Consultation Document in fewer words than the Consultation Document itself contains, stresses that there has clearly not been enough research that could be considered adequate enough to have led you to the conclusions which you have outlined in the proposal.
This proposal and Consultation Document are severely flawed, both procedurally and in content. They require serious redrafting and should be taken back to the drawing board. A consultation period, months longer than the minimum required, needs to be opened in which to obtain the opinions of experts, relevant parties, and the general public and, taking all this on board draft not one, but several complete and well researched proposals on how EOCs could be improved (there are a number of relevant bodies who are willing to contribute, including MPs, members of the public, relevant unions and call takers from many EOCs). At the end of this, a proposal should be chosen amended by reference the product of the consultation period, and taking into account the best aspects of the rejected proposals. Another consultation period should then be opened in which this proposal is itself subject to scrutiny by experts, relevant parties and the general public. The proposal should be amended and tweaked with reference to the product of this consultation period and only then should the decision be made to go ahead with this.
Throughout this whole period: every relevant statute, regulation, direction, guideline and decision from case law should be obeyed; every aspect should be researched in detail by relevant experts; no information should be held back from the public; people should be given time and support to voice their concerns and aided by swift responses from the WMAS; nothing should be voiced or proposed by the WMAS unless it is based on evidence which is available to the public; anything and everything relevant should be taken into account; the comments and concerns of the public and relevant bodies should be considered in detail; there should be clarity and transparency; and nothing should be ruled out until the consultation periods are over and the final decision is made.
I repeat my requirement that my concerns be addressed promptly, fully, directly and objectively, with each issue, aspect or question being given individual attention and an individual answer.
Yours faithfully
Leo Hughes
FUTURE CONTROL CONFIGURATION FOR WEST MIDLANDS AMBULANCE SERVICE
ROGER THAYNE OBE
PREVIOUSLY CHIEF EXECUTIVE OF STAFFORDSHIRE AMBULANCE SERVICE NHS TRUST FROM JANUARY 1992 TO APRIL 2006
INTRODUCTION
The West Midlands Ambulance Service has issued a consultation document detailing its intention to reconfigure Emergency Ambulance Control Centres from the current 5 Controls based in Hereford & Worcester, Leamington Spa (Warwickshire), Shrewsbury (Shropshire), Stafford (Staffordshire) and Brierley Hill (West Midlands) to three Controls through the closure of the Controls in Hereford & Worcester and Shropshire and the provision of a new and enlarged Control Centre in Tollgate Stafford.
The consultation document on the formation of a single Ambulance Service for the West Midlands, published in December 2005, stated that “this (reorganisation) would be based upon local management and operational structures to ensure current high standards in specific areas were not reduced” and went on to reinforce this local message by saying that the “considerable benefits” of a single service will only be fully realised if:
a. A large degree of locality focussed drive, management and pride is maintained and locked into robust local delivery units.
b. The intention is to benefit from an efficient region wide Trust focussed and delivered locally.
These Local Delivery Units would provide:
a. Day to day delivery of clinically high quality safe services.
b. Focus on greater partnership and integration with local NHS.
c. Development of a greater range of services.
d. Influence and develop with Commissioners (PCTs) and emergency and urgent pathway.
e. Improve performance and clinical outcomes.
f. Build upon the local reputations for excellence.
The new single Trust would therefore manage the strategic development of the whole Service but the daily operational management and delivery would remain local.
It was this clear promise to the rural Counties of the West Midlands that they would retain local control over the delivery of emergency ambulance services within their areas. Such an undertakings persuaded the majority to support the creation of a single regional Ambulance Service. There was never any intention to create a single Regional Service operating from the centre in Birmingham although the consultation document now states that “The Trust operates in a Regional capacity; it must surely make sense to run it in a similar manner.”
Staffordshire, however, whose Ambulance Service was recognised as providing world class response performance, impressive clinical outcomes all at less than average cost was alone in being overwhelmingly opposed to such reorganisation.
The Ambulance Services in the West Midlands Region have consistently out performed other NHS Regions in the UK for response times over many years. Unlike other NHS Regions the West Midlands did not, before July 2006, amalgamate any of its ambulance services and maintained its 5 control centres. Over the last year such Control Centres have been retained and thus response times have remained high. Traditionally, over the last 5 years, the Control Centres of the Ambulance Services of the Shire Counties have always provided a faster emergency response to their patients than that achieved by the West Midlands Ambulance Service Control, evidence that larger Control Centres usually result in slower response time performance.
It is questionable as to whether the criteria, on which a major change has been proposed and accepted, following public consultation, can legally be overturned some 15 months later without allowing the public to overturn the original proposal to form a single Regional Service.
AIM
The aim of this paper is to discuss the proposal to reduce the number of Emergency Ambulance Control Centres within the West Midlands.
THE PROPOSALS FOR THE RECONFIGURATION OF EMERGENCY (AMBULANCE) OPERATIONS CENTRES IN THE WEST MIDLANDS
The proposals are based on a Business Case prepared by Mason’s Communications, an organisation with expertise in IT and Telecommunications management but no experience in emergency control centre design and operation. Masons Communication were commissioned by the Department of Health in January 2007 to produce a report, published in May 2007, on “Operating Models for NHS Ambulance Trust Control Rooms in England.” Subsequently, they have also been commissioned by a number of Ambulance Trusts, including the West Midlands, to produce local Business Cases on reconfiguration of Control Centres within the new Regional Ambulance Services.
In the provision of their report for West Midlands, Mason’s appear to have forgotten some of the key conclusions voiced in their national report, in particular:
a. Trust control rooms made up of both emergency and non-emergency services form a critical component in the provision of unscheduled care.
b. The emerging models that best met the agreed evaluation criteria are trust-based hubs. These are defined as a small number of multiple sites that have a fully integrated, workload balanced, call delivery plan, and are supported by common operational systems.
c. They will operate with the support of skilled and dedicated staff that use the common set of systems and processes, and supported by a trust-based supporting infrastructure that includes management information and workforce planning staff and logistics support functions that enable call takers, dispatchers and supervisors to focus on their core activities.
d. The trust-based operation should work to a set of common principles and standards, which should be monitored and supported by an overarching corollary organisation that monitors and advises on standards.
The above conclusions would auger for the retention of existing Control Centres operating with common equipment to common protocols and systems but based in local areas.
The proposal rules out maintaining the current 5 Control Centres but gives no good reasons for doing so. It links the Option of retaining the current Controls with “doing nothing” when such an Option could be linked to common systems based in Brierley Hill and backed up in Stafford but allowing the use within local Controls. This Option was the one accepted by the Strategic Health Authority after much debate and research by previous Chief Executives of the Regional Ambulance Services and used to justify the creation of a single Regional Ambulance Service in 2006.
The Consultation Document does not state why it has chosen the preferred Option of two Control Centres over and above the other Options.
Only one Option, the Option preferred has any costs shown. The limited financial information does not identify staffing and other recurring revenue costs in detail. Estimates for sale of existing Property are ambitious and unlikely to be achieved. Staffordshire Ambulance Service cannot fit both the existing services housed in the Tollgate Depot and existing Ambulance HQ at Stone Road Stafford into the space available at Tollgate. No costs have been shown for additional accommodation required.
The closure of the existing Control Centres will lead to the waste of substantial investment that has been made to provide purpose designed buildings and specialist communication and information technology systems within the existing Control sites. The costs of transferring staff from their current bases in Worcester and Shrewsbury will increase travel and employment costs but such additional negative costs have not been disclosed. It is unlikely, due to the low pay of many of the Control staff, that many of such staff will be able to pay for their own transport to cover such increased daily mileages or that future recruits will be found from Shropshire and Hereford & Worcester.
The data provided for call volume for Staffordshire is incorrect and should read 660 per day with an average per hour of 28 with a variance of between 39 peak and 12 minimal against the provided figures of 300 per day and 14 per hour, an inaccuracy of 50%. Doubt is also cast over the call volumes provided for West Midlands (Brierley Hill) as the call volumes provided for national statistics show an average of 1,160 calls per day and therefore 48 per hour against the figures provided of 867 a day and 36 per hour. The data provided for staffing levels and available emergency operating positions for Staffordshire is also incorrect.
WMAS has stated that they wish to achieve the following by reducing to two Control Centres:
a. Better patient care through further improvements in response times.
b, Ensure that the Trust has the capacity to meet future regional and divisional demand requirements.
c. Improve operational effectiveness e.g. managing activity peaks.
d. Implement common operational procedures and processes across the Region and in each division.
e. Implement common regional systems infrastructure.
f. Provide regional coverage but still with a divisional focus.
g. Meet duties under Civil Contingency Act, e.g. terrorist attack / mass public decontamination / natural disaster.
It is argued that maintaining the existing Control Centres but adopting common systems and infrastructure would achieve all the aims above. However, there is good evidence within the NHS that operating from larger Control Centres results in longer response times due to the complexities of scale.
Maintaining the current Control Centres would not be expensive. Costs of software systems are generally based on the number of operating users whish would not significantly rise above current total proposed user facilities. Modern software allows a virtual control centre to be operated with the servers based in Birmingham and a “thin client” operation in the local centres. Thus such Centres operating on similar systems would be able to manage serious and major incidents, the Trust would be able to monitor the whole and reallocate resources to demand as required. In the event of one control being disabled the others could take on the additional demand.
Much is made of the need to maintain “business continuity” in the event of a loss of a Control and particularly the main Control at Brierley Hill. Greater sustainability and continuity is achieved by retaining all 5 Controls than the reduction proposed provided all Controls operate using common systems and protocols.
Major incidents are likely to be controlled best in the local area where the incident takes place and where there is good liaison with the Police (Gold Control) and the Fire & Rescue Services.
A further reason for reducing the Control Centres is given as the requirement to “improve patient care across the Region through the use of more clinicians in the Emergency Operations Centre setting.” Such a desire, whilst commendable, does not fit with the current reduction in the employment of Clinicians within the Regional Ambulance Services able to provide advice to emergency crews from 14 to 2. Such advisers would be better placed in the existing 5 Control Centres rather than in one Control trying to advise crews across the whole of the West Midlands.
THE REASONS FOR LOCAL OPERATIONAL CONTROL
LOCAL COMMISSIONING THROUGH LOCAL PRIMARY CARE TRUSTS.
The NHS allows local Primary Care Trusts, the purchasers of healthcare, to decide on its own local priorities. In doing so the PCTs are required to liaise closely with the Local Authorities through the Health Scrutiny Committees. It is essential that Providers of healthcare – GPs, Hospital Trusts, Mental and Community Health Trust and Ambulance Services work to common clinical pathways and systems of care. Such local liaison and integration would become more difficult if Ambulance Services were directed from one or two Control Centres which would have to operate to procedures and systems common to the Region not those required locally.
THE VALUE OF LOCAL KNOWLEDGE.
The following procedures, requirements and systems are common efficiency requirements for emergency ambulance controls world wide:
a. Close “physical” links between operators answering the emergency call and dispatchers tasking the emergency ambulance.
b. Ability to task and ambulance to an emergency within 30 seconds of an emergency call being received Speed of response is closely linked to speed of dispatch.
c. A knowledge and understanding of the pronunciation of local place names, local dialects, local medical facilities, traffic disruption at particular times of the day, knowledge of the crews and volunteers being tasked to emergencies. (Hereford and Worcester and Shropshire have lengthy borders with Wales where pronunciation of place names can be difficult. Both services regularly respond into Wales.)
d. A knowledge of local ambulance facilities for repair, recovery, restocking of equipment and call out of additional personnel.
e. Good contact with local Fire, Police, Local Authority Emergency Planners and local volunteer control centres or contacts.
STAFFING REQUIREMENTS AND CONTROL CENTRE PROCEDURES AND ORGANISATION
The staffing requirements for emergency Controls are on a ratio of:
a. One Dispatcher for up to 500,000 people with an average deployment of 15 to 20 emergency vehicles.
b. Up to three Emergency Medical Call takers per Dispatcher.
The radio requirements for emergency ambulance services normally require a dedicated net or frequency for each Dispatcher. However, emergency calls arriving in to an emergency ambulance Control are routed to any of the Emergency Call Takers available.
Direct Communication Between Dispatchers and Call Takers.
Experience has shown that direct voice communication between Emergency Call Takers and Dispatchers is difficult as the number of Dispatchers and Call Takers increase such that the maximum number of Emergency Dispatchers is two and therefore the maximum number of Call Takers is six. Thus Emergency Control Centres should not normally exceed a staffing of 2 Dispatchers and 6 Emergency Call Takers and therefore will be restricted to managing emergency ambulance services for maximum populations of one million people. Experience shows that, where modern radio, telecommunication and computer aided dispatch technology is installed, those Emergency Control Centres providing Services for populations of less than 500,000 are generally the most efficient.
Thus the large Ambulance Services with single Ambulance Controls e.g. Scotland, London, New York, Washington, Sydney, Melbourne, Brisbane all are expensive to operate and deliver poor response performance.
Deployment of Ambulance Resources.
The operation of emergency medical response from fixed “ambulance stations” with dedicated resources has been proven to be the least efficient use of resources and will not provide response time reliability of achieving an 8 minute response to 90% of life threatening emergencies, a standard recommended by a Department of Health report in 1996.
Response resources should be provided and positioned to a Plan which aims to provide sufficient resources to meet the expected demand and to position such emergency responses by priority dependent on where life threatening emergency call history determines the most likely areas that an emergency will occur.
Rural areas present particular challenges to achieving fast response. Rapid response to emergency villages is achieved by volunteer Community First Responders based in such areas. They are backed up by Paramedic in response cars based in market towns, emergency ambulances are positioned to arrive within 20 to 30 minutes of the emergency occurring where patients need to be transferred to Hospital. The Operation of such Plans is based on populations of 500,000 and an average of 12 to 25 response vehicles not including community responders.
It is essential that emergency response vehicles are dispatched within 30 seconds of the arrival of an emergency call entering a Control Centre, it therefore follows that a basic location, post code or address is required to determine which call is sent to which Dispatcher without any delay. The initial emergency medical response should be deployed prior to all the call information being received and entered into the computer. There may be a requirement for the Dispatcher to receive information verbally from the Call Taker during dispatch thus reinforcing the need for close physical contact of such operators.
In many Ambulance Services senior ambulance officers are provided with marked ambulance cars and are available from home to deal with incidents, including attendance at emergencies if required. This system would not operate effectively if directed from Birmingham.
It is accepted that there are a good many emergency ambulance journeys a day from the rural Counties to Birmingham to take patients to regional centres providing specialist care. However, such journeys, except those of an immediate nature, would be better more effectively provided by emergency ambulance based in the West Midlands than those based in the surrounding Counties. Immediate journeys to West Midlands Hospitals would be better provided by the Air Ambulances.
Delay in Mobilising Emergency Response Resources Where Calls Takers and Dispatchers Operate Separately.
The average emergency call length when using call triage and advice systems is 2.5 minutes, if calls are not passed to Dispatchers until call completion the delay can delay emergency response by 30 to 45%. Centralising the emergency call taking function in two main Controls and allowing call taking to be separated from the Dispatcher function will cause a real time delay in responding to emergencies and will, where such emergencies are confirmed as life threatening, reducing the likelihood of successful resuscitation.
Where emergencies happen in a public place it is likely that the nearest emergency ambulance control will receive numerous calls for the same event. In smaller Controls this is much easier to spot and deal with than in larger Control Centres.
Call Takers & Dispatchers as Ambulance Managers.
Experience has shown that the best Dispatchers have had experience as emergency call takers and also those who have practised as Paramedics. The training provided for both emergency call takers and Dispatchers is rudimentary and the career path for both is somewhat limited. There is always a Dispatcher on duty and it is these Officers who actually manage (task) the ambulance staff providing the emergency response. This important management function is not generally acknowledged by Ambulance Services who also employ a large number of field officers to also manage the operational service. However, such field officers generally work normal 9 to 5 hours on weekdays.
Services which do recognise this management role of Control Staff make it a requirement of all operational managers to have worked in the emergency control and for the senior officers to have experience as Dispatchers. Staff that joined the Service to work in the Control are provided with an opportunity to train and work as Paramedics if they wish to gain promotion. Such systems appear at face value to be expensive but do allow organisations to minimise the risk of high sickness or to increase the control capability during major incidents. However, such organisations would not be practical where Control Centres were based outside the local Service areas.
Collocation of Non Emergency Patient Transport (PTS) Ambulance Services Control
Providing local Control Centres allows for the non emergency ambulance service control to be collocated. This has a number of advantages:
a. PTS ambulances are often closer to an emergency than an emergency response and should be trained and equipped to first respond.
b. PTS ambulances are required to attend most major incidents to transport minor injured and walking patients to Hospital or first aid centres.
c. PTS ambulances can, on occasions, carry out transfers of patients between hospitals or take “Doctors Urgent” cases to hospital thus relieving pressure on emergency resources.
Provision of the Local Area Health Emergency/Urgent Control
Local Ambulance Controls have long been recognised and used as the local 24/7 Control and information centre for the local (County) NHS. During major incidents such local Control Centres provide the required coordination for all local NHS resources.
Such Controls could be expanded to take on GP out of hours, urgent care call handling, District Nurse Control and Coordination, an out of hours message handling Centre for NHS organisations and act as a hub of NHS Direct thus providing a much needed local NHS function cost effectively.
CONCLUSIONS
The current proposals for reconfiguration are contrary to the undertaking provided in the consultation document proposing the establishment of a Regional Ambulance Service which promised that such a regional service would maintain local operational control.
The reconfiguration proposals do not follow the conclusions of the national report on emergency ambulance control centres which stated that the best solution was the operation of “a small number of multiple sites that have a fully integrated, workload balanced, call delivery plan, and are supported by common operational systems.”
No satisfactory operational or financial reasons have been given for not retaining the existing Control Centres.
Insufficient financial information has been provided on either the proposed reconfiguration or alternative options. The information provided on call activity is inaccurate.
Modern technology allows computer based despatch and communications systems to be located centrally but operated at many different sites. Indeed the Trust proposes to operate such systems for their non operational IT networks.
Evidence from the UK and around the world shows that the large Emergency Ambulance Control Centres are expensive to operate and provide poor emergency response performance.
The proposal to operate emergency call taking separate from the Dispatching function would have serious consequences of delaying response and placing lives at risk. Emergency call takers are required to have direct verbal contact with emergency Dispatchers.
The most effective and efficient method of providing emergency ambulance services is to operate a plan (one per 500,000 people covered) which provides sufficient resources to meet demand and which places these resources, by priority, in the locations where emergencies are most likely to occur. The proposals do not envisage such a Plan but rather to retain a central ability to redeploy ambulances as required. Such action may benefit the centre but would be at the expense of the periphery.
The minute by minute operation management of Ambulance Services is provided by the Control personnel. The removal of local Controls removes local management from an area and the ability of local staff to progress their careers.
Emergency and Non Emergency (PTS) Ambulance Controls should be collocated. PTS Ambulances must be able “to first respond” to emergency incidents.
The local Ambulance Control is an essential asset for the local NHS providing a local communications hub which is vital during major incidents.
RECOMMENDATIONS
The current proposals for the reconfiguration of emergency ambulance operations centres should not be approved.
Action should be taken to adhere to the undertaking given in the original consultation to establish a single Ambulance service for the Region and therefore retain local control of the operation of ambulance services. However, such Controls should use similar software systems and operating procedures and should be mutually supporting.
Roger Thayne OBE
Previously Chief Executive of Staffordshire Ambulance Service NHS Trust from January 1992 to April 2006
LIB DEM PRESIDENT BACKS CALL TO SAVE BRANSFORD EOC
President of the Liberal Democrats, Simon Hughes MP today visited the closure-threatened Ambulance Service call centre at Bransford to back the 'save your EOC' campaign run by the local EOC staff and the Lib Dem Parliamentary Candidate for West Worcestershire, Richard Burt.
Simon, who was accompanied by Mr. Burt, met with call centre staff and a representative of the West Midlands Ambulance Service NHS Trust to discuss the future of the site.
Simon Hughes MP, who grew up in Herefordshire, commented:
“It is vital the public has confidence in our ambulance emergency call service. The Control Centre at Bransford has a wonderful reputation and has done a fantastic job".
"The plans of the Trust seem to ignore local knowledge, local commitment and local views. I am convinced that any closure of the call centre here at Bransford would be to the detriment of emergency ambulance cover in Herefordshire and Worcestershire".
"Not only would the two counties lose the crucial local knowledge of the staff, but would be at real risk of having ambulances swallowed up by Birmingham and the Black Country".
"It is a shame that local NHS managers are appointed and not democratically elected. If they were, they may be more receptive to the concerns of local people".
"I urge the Trust to listen to the people of Herefordshire and Worcestershire and to look again at other options - I’m sure there must be a better alternative and call on the Trust to respond positively to this constructive and effective campaign".
"I shall take this campaign to my colleagues in the Parliamentary Party, and promise that we will do all we can to help the staff and Richard to safeguard Bransford EOC."
Richard Burt, who speaks for the Liberal Democrats on health matters across the West Midlands region said:
"I am confident that with increased pressure on the Trust in these final few weeks, we can save Bransford, and look to a brighter future for ambulance cover across the West Midlands region."
ENDS
Notes to Editors:
The post of President of the Liberal Democrats is equivalent to the Party Chair in either the Labour Party or the Conservative Party
THE REQUIREMENT FOR LOCAL CONTROL
From: ROGER THAYNE
Ambulance Consultation.pdf (413.5 KB)
David Nicholson, the NHS Chief Executive, when CE of West Midlands Region clearly accepted that if Ambulance Trust were to be merged into a single regional service that there needed to be some local autonomy. This was enshrined in the Consultation document attached and spelled out that local control of operations and delivery of the Service would be maintained.
The Chiefs argued successfully that the Region could not be managed effectively from one two or three Controls but should retain all 5. That situation had ensured that Ambulance Services in the West Mids collectively provided the best response to emergencies on any Region in the NHS.
Evidence shows that Ambulance Services worldwide providing control for populations over one million performed poorly and at a greater cost than those providing for less than one million. The most effective were those providing for 500,000.
I do hope you find this helpful in your cause and if I can be of any further assistance please let me know.
Best regards
Roger Thayne OBE
Retired Chief Executive of Staffordshire Ambulance Service
To augment the opposition to the WMAS proposal, an alternative proposal has been submitted to the Consultation Board
MPS’ BACKING FOR BRANSFORD EOC PROPOSAL
West Worcestershire’s Liberal Democrat Parliamentary Candidate, Richard Burt revealed more support for from Worcestershire and Herefordshire MPs and candidates for his joint proposal with staff to save Bransford EOC, submitted to the West Midlands Ambulance Trust this morning.
Mr Burt said he was delighted to be able to add the names of Hereford MP, Paul Keetch and Hereford and South Herefordshire Liberal Democrat Parliamentary Candidate, Sarah Carr to the proposal.
“We now have strong support from across the two counties and it is up to the board to listen. I have not spoken to a single politician or member of the public that supports the Trust’s closure plans,” said Mr Burt.
“The campaign to save Bransford does not stop here. More work will be done during the final five weeks of the consultation as I continue to receive more information to strengthen our case from campaign supporters.
“Michael Foster MP responded by saying that he supports the retention of Bransford, but thinks Shrewsbury EOC should be closed. Sir Michael Spicer MP said he was “broadly sympathetic” to our proposal, but along with Parliamentary Candidate Harriett Baldwin, would be submitting their own proposals at a later date.
YOU CAN ADD THIS TO THE WEBSITE FROM BRANSFORD 007At the Worcester public consultation meeting on Wednesday, Mr Marsh, CEO, stated that all resources will be 'pooled'. This means that when a vehicle comes clear of an incident, it could be the next viable resource available to respond to the next 999 call. This could mean that resdidents in Kidderminster find that their local crew are on an emergency in Stourbridge or Halesowen when they dial 999. In the Hereford Times recently, West Midlands Ambulance Service commented on the fact that Herefordshire, Shropshire and Worcestershire were now one locality. They also stated that these rural counties differ in the in the type of emergency cover needed compared to urban areas and cities. It was said that rural communities have special needs that must be catered for. Why then, you should ask, are the controls in these very counties being closed?
Mr Marsh claims that his motives are not financial. However, every obstacle put in the way for updating/saving Hereford and Worcester EOC is monetary. Staff at Bransford welcome change and initiatives that bring about the best patient care. The decision to close Bransford has nothing to do with patient care and will only serve to make rural areas receive an inferior service. Government figures will still look good though - red calls in city areas will be hit making the percentage high. The red calls missed in rural areas will not affect figures -only patients!
Ms Baldwin is correct;preserving and maintaining local knowledge will be extremely difficult. Retaining the current level of staff will prove challenging for WMAS- these staff have many, many years of experience with the ambulance service (some over 25 years) and during this time they have developed a full and comprenhensive level of local knowledge of our 2 counties. Over time, if the proposal goes ahead, this local knowledge will be lost as the task for some staff, of spending well over two hours commuting followed by a 12 hour shift, takes its toll on them and they eventually leave. It would be unlikely that WMAS would be able to again recruit from YOUR local area. Other agencies, as previously mentioned, do rely on Hereford and Worcester EOC for directions - for exmaple alternative routes to a rural location for a homebirth during the recent flooding. H&W EOC is a local source of knowledge that should be applauded -not closed!