AIR AMBULANCE
RE-PROCUREMENT
PROJECT
Review of Consultation
Final Report
October 2010
Introduction
The Scottish Ambulance Service is a Special National Health Service (NHS) Board. It is a national service, with headquarters in Edinburgh, ad fie territorial operating divisions, three Emergency Medical Dispatch Centres (EMDCs), a National Risk and Resilience Department and a national airwing.
Air Ambulances augment and extend the service provided by land ambulances. Aircraft are used 24 hours per day, seven days a week, 365 days a year in response to emergency, urgent and planned requests across the whole of Scotland, predominantly, but not exclusively in remote, rural and island locations. Air transport is also used to transport specialist retrieval teams such as Emergency Retrieval, Neonatal and Paediatric. Over the last few years, demand has steadily exceeded projections: for example, in 2008/9 actual demand was 16% above predicted demand and in 2009/10 actual demand exceeded predicated demand by 11.4%.
The Scottish Ambulance Service Board at present contracts with one service provider for the provision of Air Ambulance services. The contract expires on 31 March 2013.
The Scottish Ambulance Service is committed to helping develop a mutual NHS. In order to develop a tender specification brief for the re-procurement of air ambulances which meets the needs of patients, the public, NHS and other partner organisations, it has conducted two phases of consultation and engagement to gather input.
Feedback on the Air Ambulance Service from patients, the public, NHS and other partner organisations was gathered during public and community meetings, through paper and online surveys, via e-mail and by letter. 92% of patients who filled in the patient experience survey were either satisfied or very satisfied with their experience as a whole. As a result of this consultation and engagement activity, the Scottish Ambulance Service has been able to build a clear picture of the desired next generation of the Air Ambulance service to inform the tender specification.
Approach to Consultation: Phase I
Stakeholders:
Phase I of engagement was launched on 14 October 2009. This included website pages containing a copy of an A5 explanatory document, electronic patient and clinician forms, postal and e-mail addresses to send feedback and details of public meetings. In parallel with this, a comprehensive distribution list of stakeholders was generated from the recent Future Strategy consultation activity undertaken by the Service. These stakeholders were sent information about the re-procurement process by post and by email. The communication included an introductory letter providing an overview of the re-procurement process, a paper copy of the questionnaire and a hard copy of the A5 leaflet which provided more detail and signposted Air Ambulance pages on the Scottish Ambulance Service website (see appendix a). The e-mail version linked an online questionnaire of the Scottish Ambulance Service website as well as a PDF of the explanatory document. This information was distributed to the following groups of stakeholders:
996 GP surgeries identified from the Future Strategy consultation
Chief Executives, Council Leaders and other key figures in local authorities Scotland-wide
MSPs
Senior colleagues from other emergency services in Scotland Members of the Scottish Health Council
Health leads in each of Scotland’s universities Patient Partnership Forum Coordinators All Councils of Voluntary Services in Scotland
Charities where we anticipated an interest in Air Ambulance provision: including: Epilepsy Scotland; Long Term Conditions Alliance Scotland; National Asthma Campaign Scotland; Scottish Intensive Care Society; St Andrew’s Ambulance Association; Gordon Renal Dialysis Project; Diabetes UK; British Heart Foundation; Stroke Association Scotland; British Red Cross; and Scottish Kidney Federation.
Community Health Partnerships, Managed Clinical Networks and Local Medical Committees
NHS Transport coordinators, and transport leads in local authorities across Scotland
Voluntary organisations where we anticipated an interest in Air Ambulance provision
Executive directors and medical directors across NHS Scotland
Aviation bodies, including the British Airports Authority (BAA) Scotland; Highlands and Islands Airports Limited; the Maritime and Coastguard Agency; and the Scottish Government’s Aviation, Ports, Freight & Canals Division.
Professional bodies such as the Royal Colleges, the British Medical Association (BMA), BASICs GPs
NHS Scotland strategic and regional planning groups
Out of Hours leads in Forth Valley, Grampian, Tayside, and Lanarkshire Scottish Government Health Directorate
The list was shared with the Remote and Rural Implementation Group and presented to the Air Ambulance Project Board for feedback. Some additional contacts were added to the distribution list on the basis of suggestions from these groups.
Patients:
Where deemed appropriate by air ambulance crew, patients who have been using the Air ambulance Service since the middle of October have been handed a letter and hard copy of the patient form, and asked to complete and return it.
Clinicians:
An online survey was developed and distributed to clinicians and healthcare partners who regularly use the Air Ambulance Service. In addition, a Clinical User Forum was established, and met regularly with Air Ambulance managers to discuss and design requirements for clinical users of the Air Ambulance Service. A Clinical Specification paper has been prepared to represent these views.
NHS Partners:
NHS Boards have been contacted regarding future development plans for healthcare provision, in order to predict demand trends for Air Ambulance use. This will contribute to an ongoing demand analysis based upon historical and present data.
Members of the public:
Eleven public consultation meetings were arranged across Scotland from November to the end of January, targeting areas that experience the highest concentration of air ambulance missions, as well as four of Scotland’s biggest cities. These locations were agreed in advance by members of the project team, and subsequently approved by the board.
Table 1: Meeting Dates and Locations
Venue Date
Stornoway Comhairle Nan Eilean Siar, Council Chambers 16th Nov 09
Campbeltown Town Hall, Main Street 17th Nov 09
Oban Corran Halls, Corran Esplanade 18th Nov 09
Isle of Barra Castlebay Community Hall, Castlebay 24th Nov 09
Kirkwall St Magnus Centre 26th Nov 09
Lerwick Lerwick Town Hall 2nd Dec 09
Stranraer North West Castle Hotel 16th Dec 09
Glasgow Novotel, Pitt Street 18th Jan 10
Aberdeen Holiday Express Inn, Chapel Street 20th Jan 10
Inverness Eden Court Theatre, Bishops Road 21st Jan 10
Edinburgh Best Western Hotel, Bruntsfield 25th Jan 10
Fort William* Council Chambers 15 Feb 10
Aviemore* International Starters 17 Feb 10
* Additional locations/dates added in response to feedback
All meetings were held from 7 p.m. until 9 p.m. The timing slot of the meetings was based on feedback from the Future Strategy consultation activity which was ongoing during most of 2009. Meetings were advertised in the press a week in advance and signposted further details of about Air Ambulance on the Service’s website. PR activity in each area generated editorial coverage in local press, local radio stations and websites. Paid for advertising was selected in press which delivered the greatest coverage in targeted areas (appendix I)
Map: Air Ambulance Use in Scotland by Health Board 2008/ 2009 379 378 250 760 217 27 38 4 29 162 44 89 41 16 Public meeting KEY Air ambulance callouts 2008/09
NB821 callouts to the Argyll & Clyde region not marked on this map, as the Health Board has been merged with Greater Glasgow. However, it is still considered an operational subdivision by the Scottish Ambulance Service
Responses from Phase I
A total of 150 people attended the various public meetings across Scotland during Phase I (table 2). Additional follow-up meetings were arranged on Orkney and Barra at different times that allowed more people from outer isles to attend.
Table 2: Attendances at public meetings
Area Totalattendees
Stornoway 2 Campbeltown 2 Oban 2 Isle of Barra 30 Isle of Barra (2)* 20 Kirkwall 5 Kirkwall (2)* 40 Lerwick 4 Stranraer 0 Glasgow 3 Inverness 6 Aberdeen 11 Edinburgh 4 Fort William 14 Aviemore 7 TOTAL 150
Further meetings were scheduled with groups of clinicians on Orkney and Barra. Presentations on Air Ambulance Re-procurement were delivered as an agenda item at the Islay & Jura Transport Forum and at a public focus group meeting of NHS 100 on Shetland.
153 patients completed online & paper surveys, whilst 63 completed the partner survey. A further 46 members of the public, patients, partners, and community groups submitted email or postal feedback during Phase I of consultation. In total, over 450 contributed to Phase I of Air Ambulance Re-procurement consultation.
Approach to Consultation: Phase II
Phase II of consultation commenced in May 2010. Phase II gave further opportunity to submit feedback and a chance to sense-check the information received during Phase I. Lessons from Phase I were built in to the consultation plan to ensure that there was sufficient opportunity to submit feedback.
Attendance at Phase I meetings had been variable due to a number of factors, including the winter weather. During Phase II, the Service sought to leverage
existing relationships with other NHS bodies and public health forums, as well as relationships that developed over the first phase of consultation.
Scottish Ambulance Service managers presented on Air Ambulance Re-procurement as part of the agenda at a number of meetings of existing groups and partnership forums. In the case of Dumfries & Galloway, information was distributed across the virtual PFPI network ‘Xchange’ with a request for written feedback. This approach utilised existing health networks for publicising meetings and helped ensure attendance of interested parties.
The groups presented to during Phase II is summarised in table 3 below:
Table 3: Approach to Phase II
Region Meeting Date
Stornoway Greater Broadbay and Stornoway Locality Planning Group, Ionad Stoodie, Isle of Lewis
22 June Argyll &
Bute
Oban, Lorn and Isles PPF 7 June
Barra Castlebay Community Hall 30 June
Orkney Scottish Ambulance Service Chief Executive’s Visit to Orkney
8 July NHS Shetland 100, Brevik house, Lerwick 14 June Shetland
Presentation, information and feedback form sent electronically to contacts
Grampian Aberdeenshire South PPF 16 June
Lochaber Local Health Partnership, Fort William Health Centre
24 May
Eden Court Theatre, Inverness 27 May
East Sutherland and Edderton Ward Meeting (Highland Council)
31 May Wester Ross, Strathpeffer and Lochalsh Ward Meeting
(Highland Council) 7 June
Caithness Ward Meeting (Highland Council) 14 June Highland
Portree Ward Meeting (Highland Council) 28 June Dumfries &
Galloway Presentation, information and feedback form sentelectronically via virtual PFPI network ‘Xchange’ BasedPhase onI, standalone meeting not appropriate Edinburgh &
Glasgow
Feedback by post and email to attendees Based on Phase I, standalone meeting not appropriate Scottish Ambulance Service representative unable to attend due to major incident, written
Each of the groups and individuals who had left contact details during Phase I were written to or emailed regarding information about Phase II. This included a number of partnership forums and community councils, on advice and assistance from Scottish Health Council. Written feedback continued to be received until July 2010. Air ambulance staff were also consulted during Phase II via an electronic survey, whilst the Clinical User Forum continued to meet regularly. It is estimated that between 550 to 600 different groups and individuals contributed to Phase I and II of the consultation.
Phase II helped ensure that awareness of air ambulance re-procurement was extended, confirmed the findings of Phase I and offered an opportunity for additional feedback into the future specification. The findings from these various sources were collated and analysed internally and are summarised in the following section.
Findings from Consultation
Comments have been divided into 3 main themes to be considered during the tender:
A national service to meet local needs Safe and effective care
Communications and contacting us
A national service to meet local needs
For many, there is a view that the Air Ambulance Service is a vital service to the community and that the specific needs of each should be reflected in the tender specification. This has been reflected in the feedback received around aircraft location, landing sites and partnership working
Location of aircraft
A recurring response to consultation has been views from various communities about where air ambulances should be situated. Many responses received from island communities, such as Orkney, Barra and Shetland are of the view that a locally-based islander aircraft is preferable to the existing fixed-wing and Eurocopter options. There was also a strong voice from Orkney favouring a locally-based Islander aircraft, as it is felt that local knowledge of weather conditions and landing sites would allow the service to make better use of short windows of opportunity and respond more quickly.
In addition to island communities, responses have been received about the possibility of situating aircraft at Grampian, Tayside, North Highlands, West Highlands and Argyll & Bute.
The location of aircraft will be determined by the response of the aviation market to requirements laid out in the tender specification, based upon a robust analysis of past, present and projected demand.
Landing Sites
Several have raised concerns over landing sites for air ambulances. It has been highlighted that sites are restricted on the isles for night flights or where there is bad weather. It is also felt that, when tendering for aircraft, consideration should be given to maximising the landing capacities in order to optimise access. There is currently a review underway to look at landing sites across Scotland in response to this feedback.
Partnership Working
Many respondents drew attention to the tender of UK-wide Search & Rescue services, which has been provisionally awarded to Soteria - highlighting this as a potential opportunity for efficiencies if resources could be shared. However, there was also feedback which expressed concern that the new contract could lead to a gap in provision due to military downsizing. Assurances have since been received from the Ministry of Defence that this will not be the case. At the time of publishing this report, the Search and Rescue Helicopter (SAR-H) contract is still being considered as a result of the Defence and Security Review by the coalition government. The Scottish Ambulance Service will continue to review the status of the SAR-H tender as it progresses the Air Ambulance Re-procurement tender specification.
Some of the respondents on Orkney have expressed that a locally based resource may have the potential to reduce the demand for Search & Rescue resources, as it has been suggested that these resources are no more responsive than a locally based aircraft would be. Furthermore, some do not wish to see inbuilt reliance on the Coastguard for air ambulance services. However, others on Barra have expressed that these resources are sometimes preferred, due to larger cabin size and ability to fly in adverse weather or at night time. Finally, some responses from Orkney have argued that the issues of patient transportation on the islands is not an issue for the Scottish Ambulance Service to tackle alone and that, for them, NHS Orkney and the Orkney Islands Council need to collaborate. The Scottish Ambulance Service is currently working in partnership with NHS Orkney and the transport manager for Orkney Islands Council on how we can continue to work together to identify a range of options. Joint action plans and meetings are ongoing
Safe and Effective Care Type of Aircraft
A recurring theme arising from public consultation was the desire for larger aircraft. Many were of the view that an aircraft with larger capacity would be better equipped for multiple transfers; bariatric patients; neo-natal patients; and patient escorts. This opinion was expressed by many members of the public and echoed by clinicians based on the islands of Barra, Orkney and Islay & Jura. There is also a strong opinion coming from the isles that an islander aircraft is preferable to the existing fixed-wing and helicopter options, as the EC-135 does not have de-icing capability, and there is a view that this would increase options for landing. As a footnote, a question has been asked by Orkney islanders whether an aircraft with a de-icing capability should be considered. The Service continues to seek advice from aviation advisor Mott McDonald and issues such as de icing are regularly discussed. Furthermore, the type of aircraft needed to meet the criteria which is considered to be essential and criteria which is considered to be desirable will be established thorough the evaluation criteria.
Access to aircraft
The most common comment across all meetings is the requirement for the air ambulance to permit safe and effective conveyance of a range of clinical conditions and emergencies. A number of separate points have been raised – often around patient escorts. These are listed below:
Mental health emergencies should be better accommodated, including provisions made for necessary escorts. Feedback suggests that currently, suicidal patients’ needs are not being met by the service for Barra.
Maternity cases should be better coordinated, with provisions made for escorts to travel with pregnant mothers
Escorts for children and accommodation of carers where necessary should be a priority
Access is required for speciality wheelchairs to travel with patients where necessary. This is uncommon but does happen
A question has been asked as to whether guide dogs can be permitted to travel in aircraft
One meeting attendee who is deaf has raised the issue of the difficulties experienced when trying to contact the service.
It has been suggested that the role of air ambulance in non-emergency care requires clarification e.g. priority of emergency and urgent cases. The Scottish Ambulance Service works closely with patient and public groups on an ongoing basis, to ensure that we have effective methods of conveyance for patients with a range of conditions or emergencies. We have already modified existing rotary aircraft to accommodate maternity cases and the team works closely with NHS Boards on particular patient needs. This partnership working and dialogue with patients and the public will continue after the air ambulance re-procurement consultation ends.
Response Times
Response times were an issue considered in depth by island communities. Respondents on Barra have particular concerns over the operational issue of shift changeovers which are perceived to affect response times. This concern is echoed by members of the Islay & Jura Transport Forum, specifically in relation to fears that a pilot may have to fly out of hours - though this is recognised as an ongoing issue that necessitates consideration outwith the procurement process. A response from Barra has suggested the use of standby pilots to reduce the impact of delays caused by ‘out of flying hours.’ These delays are caused when a pilot has reached the limit of hours he or she can fly within a given time period, but there is a need for the Air Ambulance to be in the air.
A suggestion has been made that response time standards should be framed contractually for all areas, and that are equally applicable to outlying island communities. It is felt that these should be both achievable and transparent. In addition, a suggestion has been made that the contract could be made more robust in order that the organisation receiving the air ambulance tender is able to be penalised for failure to meet its obligations. The Scottish Ambulance Service project team will consider how this is managed through the contract. We have taken guidance from the Clinical User Forum, which has stipulated robust clinical performance standards across all areas of Scotland.
Communications and Contacting the Service
Coordination of Communication across Healthcare Providers
Some were of the view that there could be greater co-ordination of communication between Air Ambulance, dispatchers, GPs and patients. Patients should remain prioritised according to clinical need, as defined by a clinician. Islay & Jura have raised that communication issues with EMDCs can be a source of frustration when organising transport – a concern supported by those on Barra, who received a user guide aiming to simplify the air ambulance request process. Furthermore, some clinicians, particularly on Barra and Shetland have highlighted that communication of the aircraft’s ETA and changes of plan should be communicated much quicker, whilst Orkney residents have asked for a clear definition of when an air ambulance should be used to be made available.
Some respondents said that they would prefer the Air Ambulance Service to be co-ordinated locally, particularly for Shetland, and that information of alternative methods of transport, such as ferries, is readily available. It has been stated that this would benefit understanding of the requirements of specific communities. The air ambulance team works closely with the Emergency Medical Dispatch Centres in the Service to ensure that the call takers have access to the ferry time tables and that they always ask the ordering clinicians if the local ferry is more suitable.
Conclusions
Overall, feedback can be themed into six main issues. These are not the only issues to be considered when tendering, only the most recurrent:
1. It is clear from the findings that there is a strong desire the service should foster effective partnerships and work towards integrated solutions for air ambulance. For example, there have been repeated calls to work more closely in communicating with receiving hospitals and health professionals.
and Rescue and with NHS Boards and Councils in order to make better use of public resources.
2. Many communities would like an aircraft to be based locally.
3. Many feel that the air ambulance aircraft should have a larger capacity than it currently does. It is believed that this would enable greater provisions to be made for the transport of escorts alongside patients who require them.
4. Some respondents wanted more clarity about who else can travel with them, as well as arrangements for wheelchairs and guide dogs
5. Response times and standards should be made more transparent between all parties involved in arranging air ambulance transport, as well as clearer communications about expected arrival times
6. Some clinicians would like to see a clearer definition of when it is appropriate to use the air ambulance to transfer their patients.
All of the feedback has been reviewed against the requirements set out in the Air Ambulance Re-procurement Board’s Project Definition Document. For more detail on the consultation findings and for information about how the comments received are being taken forward, please see the Consultation Feedback
Analysis document, which can be found online at
Appendix I: Newspaper Advertising - readership and coverage
aAscertained by phone call to newspaper b From newspaper website (http://www.stranraer-freepress.co.uk/about.asp)
Region Publication Circulation Readership Coverage
Stornoway Stornoway Gazette 11,470 13,000 (Stornoway's population is c. 9,000) Regional
Campbeltown Campbeltown Courier 7,165 17,912 Regional
Oban Oban Times 16,961 42,500 West Coast
Isle of Barra Barra News (Guth
Bharraidh) n/a All of Barra, population c. 1,000 Local
Kirkwall Orcadian 9,532 "Almost all households in Orkney"a Local
Orkney Today 5,312 "Every household on Orkney"a Local
Lerwick Shetland News online Shetland and International Web-based
Shetland Times 11,118 All of Shetland Local
Stranraer Stranraer & Wigtownshire Free Press
7,500 "92%of all adults within a 30 minute drive of Stranraer."b
Local
Inverness Inverness Courier 29,202 75,000 Regional
Aberdeen Press and Journal 78,121 298,000 North East of
Scotland
Glasgow Evening Times 63,803 179,000 Greater
Glasgow
