Wo rkin gto ge
The miracle twins Spring Twenty Nineteen
SCAS leads on vision for paperless NHS 18
International Womenâ€™s Day 24
Recruitment Open Days 2019 40
Tracey meets her lifesavers 50
Charity & Community Round-up 60
GEORGE AND OLIVER: THE MIRACLE TWINS On 22 February, some of the eleven members of SCAS’ frontline and clinical co-ordination centre teams who came to Nikki Fletcher and Mark Lawrence’s aid in Waterlooville in November 2018, were delighted to meet George and Oliver; the miracle twins.
Nikki went into premature labour around 3:30am on 16 November when she was just 25 weeks and two days into her pregnancy. She had been having stomach pains that night and had come downstairs for a drink. She called the maternity unit at the Queen Alexandra Hospital in Portsmouth who advised her to come in. However not long afterwards whilst still at home her waters broke and it was when she went to the toilet that she actually gave birth to George. In SCAS’ Clinical Co-ordination Centre in Bicester, a 999 call from the family home was answered by Emergency Call Taker, Kellie-Ann Blake.
“On the call there was a lot of noise”, remembers Kellie-Ann. “I spoke to Nan and asked questions and gave advice that would enable the family to help George before our arrival at the home and tried to keep everyone calm.” Kellie-Ann was supported on the call by Senior Emergency Call Taker, Lucy Stratford, whilst over in the Otterbourne Clinical Co-ordination Centre – where the Hampshire Dispatch Team is based – Control Shift Officer for Red Team, Urszula Dunne, along with Hampshire Dispatcher, Jon Brackpool and Dispatch Assistant, Katie Davies, as well as Midwife, Kathryn Burbridge, were all focused on making sure the right help was with the family as soon as possible (putting out an urgent broadcast message for available crews), along with supporting the family over the phone as SCAS’ staff raced to the scene.
“It wasn’t a distressing call to receive, but we all knew it was very touch and go as the twins were so little and had arrived so unexpectedly early.”
Paramedic Gilbert Hall arrived at the family home first in a rapid response vehicle. “There was a fair bit of pandemonium when I arrived”, he says, “which is what you would expect in a situation like this. Mark had basically fished George out of the toilet bowl and he was so small, he could fit in Mark’s hand with just his legs dangling over the end. Mark had done a great job with advice and support from all the guys in our control room and was keeping him warm as well as rubbing George’s back to try and get him breathing.”
Urszula Dunne & Jon Brackpool
George weighed just two pounds and his life, along with that of brother Oliver, was hanging in the balance. Arriving at the family home after Gilbert was an ambulance crewed by Paramedics, James Grant and Deneka O’Brien, followed soon afterwards by a second ambulance with Paramedic, Ray Connearn and Emergency Care Assistant, Chloe Adams. A plan had been made to get everyone to hospital as soon as possible, with George leaving first. “There can be so many complications with situations like this – for Mum as well as the babies”, adds Gilbert. “We needed people to potentially look after each patient. It felt like a long-time Chloe Adams
James Grant & Deneka O'Brien
at the home but you are just so busy with decisions you are 100% focused on dealing with the immediate situation in front of you.” James Grant added, “Gilbert had already done a great job when we arrived, keeping the situation calm. George’s umbilical cord was still attached so after that had been cut, Deneka and myself got George and his Nan onto our ambulance and carefully monitored and looked after him all the way to the Queen Alexandra Hospital – getting there as quickly as we could as we were fearful he wouldn’t survive or might stop breathing on the way; he was so tiny!” As James and Deneka left, the second ambulance with Ray and Chloe was arriving for Nikki, who was still in labour with Oliver. They also needed to be closely monitored by the team as they raced her to the Queen Alexandra Hospital too. “The chances of a baby of that age surviving when not born in hospital are so slim”, says Deneka. “Having handed over George and getting Nikki and Oliver into hospital safely too, I think the enormity of what we had just been involved with suddenly hit us all. There were understandably a few tears!” Around two and a half hours after arriving at hospital, Nikki gave birth to Oliver and the twins own battle for life began in earnest. Over the next three months, thanks to the skills and dedication of
Left to right: Ray Connearn, Deneka O'Brien, Gilbert Hall, James Grant, & Kellie-Ann Blake
the hospital consultants and team at the Neonatal Intensive Care Unit, the boys had a number of operations and overcame numerous challenges. Nikki and Mark were at their side the whole time, over Christmas and New Year, and Nikki remembers watching the New Year Fireworks from the hospital windows. Finally, at the end of January, the boys were well enough to go home – still well in advance of their due date of 27 February. “I wanted to get in touch with the ambulance service again”, says Nikki,
“as both Mark and I knew that without them all being there for us that night in November, there is no doubt that George and Oliver wouldn’t be here now. It was important for us to say thank you face-to-face.” On 22 February, Gilbert, James, Deneka, Ray and Kellie-Ann were delighted to visit the Neonatal Intensive Care Unit at the Queen Alexandra Hospital to represent the whole SCAS team and get a few well-deserved cuddles with George and Oliver. The boys were still on oxygen at that meeting to help the development of their lungs, but even that was a relatively
low dosage and planned to be stopped in the following weeks. The twins are expected to be able to enjoy a normal healthy childhood. The boys’ story had captured the attention of the local media and both the Portsmouth News and Wave 105 FM were at the meeting to also let their readers and listeners know about their incredible survival against the odds. Chloe Adams, who had become a student paramedic since the early birth in November and was unable to attend due to her studies, said, “It was incredible
news to hear that the boys had survived and were doing so well”, with her colleague Ray adding, “It was a fantastic team effort to get such an amazing outcome.”
“I think this has made my career!”, concluded Deneka; a sentiment no doubt that the whole team would agree with.
Kellie-Ann, Lucy, Urszula, Jon, Katie, Kathryn, Gilbert, James, Deneka, Ray and Chloe, as well as everyone at SCAS, would like to extend their sincere condolences to Nikki and her family after Mark sadly and tragically died in March.
Those we love donâ€™t go away They walk beside us every day Unseen, unheard, but always near Still loved, still missed and very dear
MENTAL HEALTH SUPPORT AVAILABLE 24/7 VIA NHS 111 HELPLINE
A 12-month pilot scheme offering expert advice, assessment and support for young people and adults experiencing mental health problems is running 24/7 across Hampshire and the Isle of Wight via the NHS 111 helpline. The new initiative being delivered by SCAS, Southern Health NHS Foundation Trust and Solent NHS Trust allows 111 callers who experience mental health problems to have direct access to specialised nurses in the new Mental Health Triage Service.
One patient contacted NHS 111 whilst experiencing a panic attack: “I was surprised how easily Vicky managed to calm me down from my panic attack, I was on the verge of calling an ambulance but thankfully after speaking to Vicky I no longer needed one and managed to calm myself down at home. Thank you Vicky!” Another caller who used the service commented; “It was my first time of using a service like NHS 111 and I was really impressed with how responsive the nurses were. When I phoned, I was quite nervous, but the call handler made me feel at ease.” Mental health nurses can also support GPs, other health workers and police officers who feel a person may require mental health support.
Specialised mental health nurses are able to support and give advice to people who call 111. This can range from arranging an appointment with a GP or community mental health team to an urgent crisis response. Mental health nurses also have access to patient records and crisis plans for any callers already using local mental health services. The project has received £350,000 funding from commissioners* and it aims to improve the experience for people with mental health concerns resulting in fewer ambulance calls and unnecessary hospital visits. *This encompasses the mental health programme delivery for the Sustainability and Transformation Partnership for Hampshire and Isle of Wight.
The service has already proved to be a huge success and in its first month, 95% of callers received the support they needed over the phone without the need of further interventions. The team of specialist mental health nurses who provide the service have been able to support patients by: »» Telephone consultations and offering self-help guidance »» Referring people to community mental health teams »» People being supported in their homes Before the new mental health triage service was in place people would have often gone to local emergency departments, or have been sent an ambulance and in some cases detained under the Mental Health Act by police officers.
Philip Astle, Chief Operating Officer, at SCAS, said: “This is a really important initiative which gives those with mental health issues a new, 24/7 route to specialist care but which also acts as a forerunner to the ambitions of the recent NHS Long Term Plan. We are grateful to all our partners in the health system who are contributing to this project.” Police and Crime Commissioner Michael Lane said: “Recognising how stretched police resources are it has been a primary focus of mine to invest in initiatives that reduce demand on policing, such as the improved access to mental health crisis support from trained mental health professionals rather than police officers. This latest initiative is excellent progress which will help reduce mental health deployments even further and, most importantly, provide those most vulnerable with the appropriate professional support they need.”
Chair of the Mental Health Sustainability and Transformation Partnership Programme and Chief Executive of Southern Health, Dr Nick Broughton commented: “I am delighted to be introducing this service alongside our colleagues from South Central Ambulance Service, our Commissioners and Office of the Police and Crime Commissioner. Allowing mental health professionals to be involved at such an early stage of a 111 or 999 call will improve access to our mental health services and make sure that people experiencing a mental health crisis receive the best care that suits their needs.” This project is a collaboration between Southern Health NHS Foundation Trust and South Central Ambulance Service. It is part of the plans across Hampshire and Isle of Wight to improve mental health care as part of the local NHS Sustainability and Transformation Partnership.
Referral routes via the NHS 111 Mental Health Triage Service Each call will receive enhanced clinical triage and undergo a risk assessment over the phone and dependant on whether they are already known to services and what their need is at the time they will be provided with appropriate intervention, support or advice or referred into:
John Smith is the Clinical Co-ordination Centre Mental Health Lead for the service and was seconded from Southern Health Foundation Trust to SCAS in June 2018. John was instrumental in setting up the new service, which went live in December 2018, and helped recruit the mental health nurses who, along with John, operate a rota to ensure that a mental health nurse is usually available 24-7 to anyone calling NHS 111.
»» Their GP for a next day appointment or directly booked into an appointment »» Psychological therapies services or alternative crisis services in the community such as the crisis lounge, crisis café or wellbeing centres »» Signposted to other voluntary mental health helplines e.g. SANE, Samaritans »» An alternative and appropriate community service such as debt advice, housing need, drug and alcohol services »» Community Mental Health Teams (CMHT) or Child Adolescent Mental Health Service (CAMHS) »» Crisis Resolution and Home Treatment Team (CRHTT)
“A large part of the service we provide is to listen to the caller; there are many calls when we don’t do a great deal of talking. We can of course use a range of distraction techniques and other parts of our training as mental health nurses, but quite often the opportunity for someone to be able to talk to a trained professional for 30 minutes can be all that they need to work through their issues and avoid a crisis. In addition we can ensure that those patients who do need further intervention and support can be seen at the earliest opportunity by the right mental health professional or team.”
Stephanie is a NHS 111 Call Handler based at SCAS’ Clinical Co-ordination Centre in Otterbourne and has been performing her role for four years. “We obviously do what we can for every caller, but we’re not mental health professionals. Sometimes the disposition that the NHS Pathways system might come to for a person with a mental health need would be a recommendation to visit A&E. We know that isn’t appropriate for many callers and quite often the help and support they actually need isn’t readily available at A&E either. The ability to be able to warm transfer a caller to a mental health nurse, or let them know that a mental health professional is going to call them back, is really valuable. It’s a great addition to the NHS 111 service and shows it working exactly how it should – getting access to the right professional help for every caller.”
Colin Bulpett is the Mental Health Liaison for Hampshire Constabulary and has already seen the value that the new service can deliver. “Quite often a person in a mental health crisis, or someone with them, might end up dialling 999 and asking for an ambulance or the police because they don’t feel there is anyone else that can help them. Whilst we do have powers under Section 136 to take people to a place of safety where they can get the immediate help they need, a police response certainly isn’t appropriate for every individual or instance. My officers are now also able to call in to this service and speak to a mental health nurse who will guide us to the most appropriate actions, and that can include not sending a police response to a patient with mental health needs. For example, we’re able to be informed about an individual’s care plan and can liaise with the right professionals or direct the patient to the right help.”
If anyone is experiencing a mental health crisis and is in need of urgent care or support, please dial 111 and ask to speak to a mental health nurse. If you are currently using mental health services, we would recommend contacting your Community Mental Health Team or out of hours service first.
SCAS LEADS ON VISION OF PAPERLESS NHS In Spring 2019, South Central Ambulance Service NHS Foundation Trust (SCAS) and Doc-works, a systems integration and software specialist company based in Buckinghamshire, were delighted to announce the launch of an integrated electronic patient record (ePCR) system to all of SCASâ€™ approved private providers.
â€œWith the paper-based records, we were constantly writing the same informationâ€?, says Elliot,
The launch means that SCAS is the first ambulance trust in the country to ensure that all of its approved private providers (six in total) now operate an electronic patient record system; eliminating the need for paper-based patient records. “This not only means that we as a Trust have delivered on our commitment to ensure that every patient in the South Central region receives the exact same high-quality care and experience whether they are treated by a SCAS crew or one from one of our private providers”, said Private Provider Contract Manager at SCAS, Vince Almond, “but it also shows how SCAS is leading the way on delivering NHS England’s vision of a paperless healthcare service.” The first private provider to go live with the new ePCR system was Jigsaw Medical Services who equipped all their vehicles with the Scribe Electronic Patient Clinical Record solution (ePCR) from Doc-works following a successful ‘proof of concept’ pilot SCAS conducted with two other private providers. The rollout enables Jigsaw, and all SCAS’ private provider partners, to keep up with increasing call volumes and significantly improve the care and treatment received by patients in their region. The Scribe system will be used by ambulance crews to complete patient records electronically using a ruggedized mobile tablet. The introduction of this innovative system will also help Jigsaw reduce the company’s carbon footprint as the Base Operations Managers will no longer spend up to 16 hours on the road delivering the paper versions of the patient records that the ePCR system replaces.
Jigsaw Managing Director, Julie Mercer, said “At Jigsaw we’re always looking at ways to deliver the best possible service and the Scribe ePCR solution from Doc-works will help us achieve this. It enables us to streamline the handover process with hospital emergency departments at the same time as reducing the amount of paper used and reinforces our position in the marketplace as an innovative leader and a company renowned for adopting new technologies where possible.” With an intuitive user interface which accurately models the layout of the existing SCAS paper form, Scribe has been designed in consultation with ambulance crews to help them capture real-time clinical information and provide them with better data, better reports, better audits and ultimately better patient care. Elliot Forman, Paramedic Clinical Mentor at Jigsaw Medical Services, has already seen the benefits of the ePCR Scribe system on his operational shifts working for SCAS. “With the paper-based records, we were constantly writing the same information”, says Elliot, “as one patient might require a number of different forms to be filled in based on the nature of their injuries or illnesses, whether we had any safeguarding concerns, if we needed to refer the patient on to other specialists or services, to name but a few. Then, only at the end of the shift, we would
have to make sure some of those paper forms were sent off to the right people, departments and organisations so they could then take over the next element in the patient’s physical, mental or social care.” With the ePCR Scribe system, Elliot and his colleagues now only need to input the key patient information once and it automatically populates into whatever forms are subsequently required. Furthermore, any forms that need to be sent to other organisations – such as to social services or a falls referral to an occupational therapy team – are automatically transferred electronically as soon as they are completed on the Scribe tablet during the ambulance crew’s shift. Darren Weston, a Paramedic with SCAS who was seconded to the Private Provider Contract team for 12 months to work on the ePCR project added, “To give you an idea of the paper and cost saving the implementation on ePCR Scribe is
going to make, I visited one of the bases of one of our private providers recently to collect the now redundant paper forms and they had 25 boxes worth: I couldn’t fit them all in my car!” There are also benefits for the receiving units and hospitals where patients are taken. “Clinicians can see live patient readings, such as an ECG output”, adds Vince, “and whereas previously the private provider crews would have had to hand over potentially a pile of papers, now everything that they need to give to the hospital is done with a simple press on a screen. The hospital teams get what they need more quickly, and ambulance crews are able to clear down from their patient sooner and be available to respond to the next call.” The company behind the system, Doc-works, are experts in ambulance software as well as having considerable experience and knowledge in the processes, documents (paper and
electronic), and audit requirements needed for compliance and reporting to staff, managers, CQC and commissioners. Doc-works has been working with South Central Ambulance Service for longer than SCAS has been in existence; having initially begun working with Hampshire Ambulance Service prior to the merger that created SCAS. Barry Clark, Director at Doc-works said, “We have utilised our 10 plus years NHS software experience to create an ePCR system that is accurate, intuitive and provides a paramedic with everything they need when responding to a time critical incident. It was part of the brief that we were given to design a system that required minimal, if any, training for private provider staff to be able to use. All the feedback from crews received so far confirms that it’s an intuitive, easy-to-follow process and one that both makes the administrative part of their role much easier and means they can give their patient better care and a better service.” The new ePCR system allows private provider ambulance crews to provide a prompt transfer of patient care to hospitals and other health organisations,
improve the security of patient records, create more legible records saving on paper and time, and increase data accuracy. In addition, the system meets all audit requirements needed for compliance and reporting to staff, managers, CQC and commissioners. The Doc-works ePCR back-end system uses standard Windows server technologies and client applications can run on iOS devices, both iPad and iPhone, in addition to Android devices such as Samsung Galaxy tablets. Following the launch of the new system with Jigsaw, a scheduled rollout plan was followed so that by early April 2019, all SCAS’ private provider partners had migrated to the new Doc-works ePCR system. With the eCPR system now live across all SCAS’ private providers in the South Central region, the next stage in the project is to create user groups so that vital feedback on the system from private provider ambulance crews, hospitals and other partners is captured. This will ensure that the system can be continually monitored and improved so that it keeps delivering exactly what ambulance personnel, hospital staff and patients need.
SCAS CELEBRATES INTERNATIONAL WOMEN’S DAY On Friday 8 March, SCAS – along with organisations and individuals across the globe – proudly celebrated International Women’s Day.
Historically, the ambulance service was a very male dominated environment, but today over half of our organisation is made up of female members of staff. Around 25% of the workforce of the Hazardous Area Response Team (HART) is made up of women; there are six women members of our Board of Directors and the male:female ratio on the frontline of both our 999 and patient transport service is nearing a 50:50 split. We also have an all-female operational management team. There are still some areas of the organisation that are predominantly male or female. Our Human Resources and Clinical Co-ordination Centres are predominantly female, whilst some areas of our commercial division and fleet services are predominantly male. Work will continue to ensure our workforce is equally represented in all areas and on 8 March we were happy to showcase some of the amazing women that we have here at SCAS on our internal communications and social media channels.
TRAINING ENHANCES CFR SKILLS It was certainly a busy night for some of our volunteer community first responders (CFRs) on 25 March; they had to cope with a difficult bath extraction, a collapsed patient in a nightclub and experienced what it is like to have visual, hearing and mobility impairments. Fortunately, it was all in the name of training!
The training took place at Health-Tec Thames Valley, part of the Buckinghamshire College Group, a health simulation centre in Aylesbury. The training suite at Health-Tec includes a realistic bathroom, bedsit, hospital bay, ambulance interior and an immersive classroom. Scheme Co-ordinator for High Wycombe CFRs, Robin Mugridge, said: “The training session was attended by volunteers from many schemes. During the evening we split into small teams to practice managing a generally unwell patient, age empathy, extraction from a bath and a cardiac arrest in a noisy and hot nightclub environment.” One of those attending, High Wycombe CFR Tim, added: “Whilst we are trained in using the Mangar ELK lifting cushion and carry one on the response cars, the bath scenario was new to us. It was a good way of demonstrating ELK's flexibility but also ensuring that the patient's safety and dignity can be maintained too. “The medical emergency in the nightclub was certainly different! This took place in the immersive simulation room and it was very hot and very noisy. The images around the room were distracting and it was an excellent way of replicating the different pressures that this type of situation would bring.
“The empathy activity gave us a real insight into what it is like for a patient with visual, hearing or mobility impairments - the challenges this brings, how it feels from their point of view to try and access emergency healthcare, to communicate with responders or healthcare professionals. It certainly made us think about what we need to do and say differently when responding." Thank you to the team at Health-Tec, along with Del Flint, Dave Cave and Richard Rolfe from SCAS’ Community Engagement & Training Team, for making the evening such a realistic, practical and enjoyable experience.
EAST SUSSEX PTS ON THE MOVE
When SCAS took over the patient transport service (PTS) contract is Sussex, part of the operation in East Sussex was based in Hellingly Hospital in Hailsham. Whilst the building was perfectly adequate, it was not the best location for the operational teams. A new unit was found last year on a Business Park outside Eastbourne, which was a much better location being closer to one of the main hospitals in the county and the local A-road network. Derek Stubbs, Estates Manager (North) at SCAS was the project manager for the planned relocation; despite being based in Bicester, Oxfordshire, he had lots of recent experience of similar projects and Derek worked closely with the PTS management team in Sussex during the relocation. In negotiation with the landlord, the roof was replaced on the new facility, the requisite planning permission was gained, and a business case approved to fit the units out as a PTS resource centre. The building was improved to now contain offices and meeting rooms to the front, along with the crew room and locker room with toilets and showers to the rear. In addition, the building allows for parking inside for the PTS vehicles plus a good amount of parking outside as well. SCASâ€™ Estates Team is also trialling a new above ground vehicle wash facility at the new East Sussex PTS base. This is considerably less expensive than the underground drainage system which normally has to be installed, and over the coming months it will be carefully monitored to see how effective it is and whether it can be used for future projects. The service moved into the unit in mid-March and staff are very happy with their new surroundings.
“It gets a thumbs up from me – it feels like we have a home now.” Linda Buckley
“Loving it!” Steve Shonk And what of the infamous Hellingly ghost that sent a few shivers down the spines of some team members – particularly on a late evening shift? “A couple of people have said they’ve heard whispering”, confesses Team Leader, Matt Atkins, “but that could be from one of the other units on the estate. However, I’d like to think that the ghosts at Hellingly liked us so much they decided to move with us!”
SCAS LAUNCHES NEW NHS 111 CONTRACTS
On 28 March, SCAS was delighted to launch two new NHS 111 contracts. Dental Advisory Service (DAS) extended to Dorset
SCAS NHS 111 expands to cover Surrey Heath
SCAS already provides the DAS for Hampshire and the Isle of Wight and replaced South West Ambulance Service as the DAS provider for Dorset. This service is for all NHS 111 callers with a dental enquiry, with the scope to book dental appointments for unregistered patients on a first come, first served basis. It is anticipated that such referrals to DAS from Dorset based patients will see an increase in call volumes of around 20,000 calls per year and staffing levels in SCASâ€™ NHS 111 team have been adjusted accordingly.
SCAS is replacing South East Coast Ambulance Service (SECamb) and Care UK as the provider of the NHS 111 service for Surrey Heath. We already provide the NHS 111 service for Hampshire and the Trust is currently working with partners to deliver improved outcomes for patients through the design and implementation of an effective Integrated Urgent Care Service (IUC). Surrey Heath Clinical Commissioning Group will be part of this IUC service and therefore need to be part of the current SCAS NHS 111 service. It is expected that the expansion into Surrey Heath will lead to an increase of between 13,000 and 18,000 calls per year and staffing levels have been adjusted accordingly.
POSITIVE REVIEW OF READINGâ€™S HEALTH AND SOCIAL CARE SYSTEM
Photo (left-to-right) Reading Council's Chief Executive, Peter Sloman; Seona Douglas, Reading's Director of Adult and Health Care Services; Kirsten Willis, Head of Operations, South Central Ambulance Service NHS Foundation Trust (SCAS); Cllr Tony Jones, Reading’s Lead Member for Adult Social Care; Mary Sherry, Chief Operating Officer and Deputy Chief Executive, RBNHSFT; Ian Trenholm, Care Quality Commission's Chief Executive; Cathy Winfield, Chief Officer of Berkshire West Clinical Commissioning Group; Cllr Graeme Hoskin, Reading’s Lead for Health and Wellbeing and Gerry Crawford, Regional Director, Berkshire Healthcare
Care Quality Commission (CQC) inspectors carried out a review of Reading’s health and social care system between 29 October and 2 November 2018. SCAS is one of the local partners delivering health and social care services, alongside Reading Borough Council, Berkshire West Clinical Commissioning Group, Royal Berkshire NHS Foundation Trust and Berkshire Healthcare NHS Foundation Trust.
Their report, which was published on 17 January 2019, found that Reading residents receive good quality, personcentred health and social care when they need it, from compassionate and dedicated staff. The CQC’s review focussed on how well older people move through the health and social care system, with a particular focus on the needs of people over 65 in their place of residence, in a crisis and when they are supported to return home following a hospital stay. The CQC looked at how the Council, hospitals, the ambulance service, community health services, GP practices, care homes and home care agencies work together to provide seamless care for people living in a local area and found many instances of good practice.
Professor Steve Field, Chief Inspector of Primary Medical Services and Integrated Care, said: “Our review of health and social care services in Reading found that older people had a positive, experience of health and social care services. People were treated with dignity, as individuals, and they found that services were provided in a timely and consistent way. “Our review found many examples of good practice, but we also highlight a number of areas where improvements are needed to ensure providers of health and social care services work better together. These areas have already been recognised by the local system leaders, including improving support for carers. Plans are being developed to ensure those improvements took place.” “We have presented our findings to the health and social care system leaders in Reading so that they can prioritise and continue to improve and work together in bringing joined up care to people living in the county.”
Paul Jefferies, Assistant Director of Operations at South Central Ambulance Service NHS Foundation Trust (SCAS), said: “We are pleased with the recognition of the high standard of person-centred care provided for older people by our dedicated operational staff on the frontline and the CQC’s acknowledgement of the hard work and dedication delivered on a daily basis by staff working in partnership with our colleagues across Reading’s health and social care system. “SCAS is particularly proud of the Falls and Frailty Response Service that we deliver in partnership with the Royal Berkshire Hospital which ensures more frail elderly patients can be assessed and treated in their own homes, reducing the need for hospital admissions and easing pressure on other parts of the local health system.”
Cathy Winfield, Chief Officer of Berkshire West Clinical Commissioning Group, said: “One of the key challenges facing the NHS is the provision of care for our ageing population, so it’s pleasing to see this CQC review has recognised the good quality and compassionate care we provide for older people. “There are many factors involved when helping older people, their families and carers navigate the health and social care system at a time when they are all feeling rather vulnerable. We’ve worked hard with partners including those at the Royal Berkshire Hospital, Reading Borough Council, Berkshire Healthcare Foundation Trust and South Central Ambulance Service, to make the transfer from hospital to home as smooth as it can be. “We’re now looking at what more can be done to further improve things and create renewed opportunities for joint working so we can address the areas the CQC Inspectors feel need more attention.”
ANNUAL RECRUITMENT OPEN DAYS DRAW IN THE CROWDS
The annual Recruitment Open Days held in January at both the Trust Headquarters in Bicester, and Southern House in Otterbourne, saw nearly 1,000 visitors through the doors keen to find out about the range of job vacancies and career opportunities available at SCAS.
Whilst the events are organised by the Recruitment Team, they would not be possible without the continued commitment, passion, friendliness and enthusiasm of the many members of staff and volunteers who give up their time to support these annual events. By the middle of March, almost 50 people who had visited one of the two Recruitment Open Days had been recruited to roles across the Trust, with more applications still coming in. èè NHS 111 call handlers 17 èè Ambulance care assistants 13 èè Emergency care assistants 8 èè 999 emergency call takers 3 èè Education team 2 èè Paramedic 2 èè Newly qualified paramedic 1 èè NHS 111 clinical advisors 1 èè Office administrators 1 èè Patient transport service contact centre 1
If you’re interested in finding out more about SCAS and the career opportunities available in the Trust, visit our dedicated recruitment website: www.scasjobs.co.uk
“The Open Days gave us an amazing and unique opportunity to showcase what we do best – look after our patients! The level of interest from the public was fantastic, and I am continually surprised how many people attend our Open Days. It was really great to see all walks of SCAS come together for this common goal – staff I’ve never met or worked with before all focussing on delivering our SCAS message. The video that was shown at the end of the SCAS Education presentation was titled ‘Proud’ – and everyone certainly showed a great degree of pride during the day!” Stuart Warner, Head of Education
Here’s what a handful of those visitors had to say about their experience: èè I loved the enthusiasm of the whole team which is what attracted me the most. èè It was fantastic to get the opportunity to talk to the people on the frontline. èè I’ve been thinking about making the move to the NHS for years and this day really helped me to understand the process, roles and experience working with SCAS. èè I am only 15 but wanted to find out more about the role of a paramedic and other roles within the ambulance service. It was amazing to be able to speak to people that I look up to, so thank you to everyone at SCAS for a great day and also all your hard work and dedication that is put into the NHS. Thank you! èè Thank you team for the amazing open day experience... SCAS is definitely on my application shortlist - love your ethos and service motto. èè It was an amazing afternoon and everyone was so friendly! Thanks so much for giving up your time to educate and inform others. èè I came thinking about applying for Patient Transport and left buzzing wanting to join as a 111 call handler. Thank you to everyone involved for a great open day. èè I enjoyed the tour of the control room. Everyone I spoke to was very knowledgeable about their area and were very detailed in their explanations of the role.
MEET OUR LATEST
AWARD WINNING STAFF
It hasn’t just been awards season in the TV and film industries over the first three months of 2019; SCAS staff have picked up a few awards for their professionalism, dedication and care too.
Care Award – Sam Nightingale Paramedic Sam, who is based at SCAS’ Stoke Mandeville Resource Centre in Aylesbury, was invited to the Buckinghamshire Healthcare NHS Trust Board Meeting on 30 January. Sam had been nominated to receive one of the Trust’s CARE Awards. The CARE Awards are held monthly by the Trust’s executive team and are chosen from nominations received from staff, patients and visitors in recognition of those people who provide exceptional care and support for patients and service users, by living and breathing the CARE values: »» Collaborate together as a team »» Aspire to be the best »» Respect everyone, valuing each person as an individual »» Enable people to take responsibility The executive team was particularly impressed by Sam’s nomination which highlighted his calmness and empathy in helping a patient experiencing a psychotic episode get to hospital without incident. He received the award, which included a £50 gift voucher, from Trust Chief Executive, Neil Macdonald.
High Sheriff Commendations Stoke Mandeville staff, Juliette McGill, Sarah Catchpole, Shane Turvey and Courtney Jones were awarded a High Sheriff of Buckinghamshire Commendation for the part they played in saving the life of a critically injured young man in Aylesbury on 14 June 2018. The four members of staff were part of the SCAS and Thames Valley Air Ambulance team that responded to the emergency incident. Juliette and Sarah arrived at the scene first in their ambulance, followed shortly afterwards by Shane and Courtney in their rapid response vehicle. Team Leader and Bronze Officer, Tony Aylmer also attended the incident scene, and HCP team member Graham Webb met the air ambulance team at their landing site and took them to the patient at Stoke Mandeville Emergency Department.
Team Leader, Sue Martin, also came to support the team when the patient arrived at the emergency department at Stoke Mandeville Hospital. Having taken the young man to Stoke Mandeville in their ambulance, Juliette and Sarah then undertook the transfer to the major trauma centre at the John Radcliffe Hospital in Oxford, supported en route by Thames Valley Air Ambulance HEMS Paramedic, Matthew Jarman who travelled in the ambulance too. The award ceremony was held on 18 February with the four representatives of the SCAS team who responded joining others recognised for the role they played in the patientâ€™s survival too. After the official ceremony, the award winners and their guests enjoyed an afternoon tea.
Exceptional Paramedic Manager Ambulance Leadership Forum Awards 2019 Head of Operations for Oxfordshire, Ross Cornett, received the Exceptional Paramedic Manager Award at the annual ALF Forum held this year at Chesford Grange in Warwickshire on 19-20 March. Ross’ nomination highlighted the many reasons for his success: “Ross is a relatively junior manager who has stepped up to fill a senior vacancy on an interim basis and the effect of his leadership has been transformational. He is an exceptionally supportive manager who demonstrates real drive, energy and determination to achieve what is right for the Trust as well as for staff. He is inspirational and creates the conditions for everyone to be the very best they can by leading by example. He has an exceptional work ethic and is fair and consistent in his approach to staff and managers alike. He not only believes in the core values of the Trust but ensures he demonstrates these in everything he does and does so with a great but appropriate sense of humour. He has a truly honourable character and inspires the confidence in his staff and managers to achieve their best.”
Well done to all our latest award-winning staff!
TRACEY SAYS THANK YOU FOR A LIFECHANGING VISIT BY LEAH AND ELLIS
On 6 February, Tracey Hayfield and her partner Fred visited SCASâ€™ Oxford City Resource Centre to say a heartfelt thank you to two members of the team, Leah Ellis and Ellis Mead.
Leah and Ellis were sent to the couple’s home in Thame, Oxfordshire, on 28 October 2018 after Fred had made a 999 call due to his concerns about Tracey’s deteriorating health. “We’d had to call 999 about five weeks beforehand”, remembers Fred, “when Tracey was being violently sick, feeling dizzy and she was a bit confused. She wasn’t taken into hospital that time and the crew arranged for a follow-up GP appointment. The GP thought that Tracey was probably suffering some type of food poisoning.” However, Tracey remembers that she had started feeling – if not unwell, then definitely not quite herself – a good five months before hand. She added, “I’d always been a very sociable person but I started to dread going out; I didn’t want to see any of my friends and even a night out with Fred wasn’t as preferable to me over those months as just staying in. I also noticed I was starting to feel anxious for no real reason and a few months further down the line the sickness and a couple of small headaches started.” Tracey thought it was stress-related, due to Fred’s mother passing away in June and also the beginning of a new job role. On the evening of 28 October last year, Fred had dialled 999 as Tracey had felt unwell whilst the couple were out for the day and been violently sick. After managing to get her back home, he was extremely worried as Tracey’s speech was slightly slurred and she appeared quite confused.
On arrival at the couple’s home, Leah began a cognitive assessment of Tracey following some initial health checks whilst Ellis was talking to Fred about Tracey’s previous symptoms. “Sometimes we can go to see a patient and it’s almost as if the patient is a stranger in their own home given the limited responses we get from friends or family members about their condition and why they’ve called us”, says Ellis with a smile. “Fortunately for Leah and I that wasn’t the case here. Due to Fred’s job and training, I’d have to say that was probably the most detailed patient background we’d ever been told.”
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Leah adds, “Fred’s ability to be able to give us so much detailed information on Tracey’s symptoms, not just that day but in the weeks and months leading up to it, were as valuable to us as the readings and assessments we were undertaking. Combined it gave a very detailed picture and raised a number of red flags that Ellis and I felt needed urgent attention.”
Whilst still at the couple’s home, Leah was able to call the on-call Medical Registrar at the Acute Assessment Unit at the John Radcliffe Hospital in Oxford. Leah briefed the Registrar on Tracey’s symptoms and history and discussed what would be the best plan of action. It was Sunday evening and the Registrar agreed that Tracey needed to be seen in the Acute Assessment Unit as an emergency referral the following morning. On Monday, the couple arrived for their appointment at 8:30am and a series of tests and scans were performed. In the evening after the tests had been carried out, the consultant arrived at Tracey’s bedside, pulled the privacy curtains together and delivered some devastating news.
It was a conversation neither Tracey nor Fred will ever forget “The consultant said ‘I’m really sorry, Tracey, but we’ve found a tumour on your brain which is very large and if we don’t remove it as soon as possible it is going to kill you’. Nothing can really prepare you for a shock like that”, recalls Tracey. Fred adds, “When you think of cancer and tumours you automatically assume radiotherapy and/or chemotherapy – but the doctors told us that wasn’t an option for Tracey due to the location and size of her tumour. It had to come out via surgery despite all the risks that entailed, and come out soon. There was nothing else they could do.” Tracey had to remain in hospital that night and she started treatment the following morning to prepare her for the operation. Her surgery occurred five days later and she was in theatre for nine hours. The couple felt the care delivered by the Neurosurgery Team at the John Radcliffe was absolutely faultless. Tracey was discharged two days after the surgery but remained on a debilitating drug regime for a further two weeks. Her recovery has, understandably, been slow but she has steadily improved and the week before she visited Leah and Ellis, Tracey had even been able to return back to work on a part-time basis.
“Despite everything I’ve gone through”, says Tracey, “I do consider myself lucky. I had a Grade 1 benign tumour and the surgical team were able to get it all out. I’ve not suffered any neurological problems which is a risk with the type of operation I had and I really feel like I’ve been given a second chance at life.” “And it’s all thanks to you”, adds Fred to Leah and Ellis. “You were amazing that night. You kept Tracey at ease, and I could tell you thought something was clearly wrong but you kept us both calm and didn’t increase our stress levels. You are absolute stars and so under-valued for what you do.” Both Leah and Ellis are unanimous in their response, that the greatest satisfaction and pleasure they get is seeing a patient like Tracey looking so well now.
PHILIP ASTLE APPOINTED CHIEF EXECUTIVE OF SOUTH EAST COAST AMBULANCE SERVICE He has led the development of our 999 and NHS 111 services, and through the development of new networks and enhanced working relationships with our partners, new models of care for our population have been co-produced. Philip has been a real champion for our volunteers and has been keen to ensure our ongoing support for our community first responders and coresponders, as well as successfully directed the formative years of South Central Fleet Services Limited.
On 28 March it was announced that SCAS Chief Operating Officer, Philip Astle, had been appointed as the new Chief Executive of South East Coast Ambulance Service.
As ever, we have ambitious plans and Philip will continue to drive us forward in his current role for the next six months during which time we will undertake a recruitment process. Though we are sad to lose him from SCAS, I am delighted that Philip is staying in our sector and no doubt we will seek to collaborate in the future.”
SCAS Chief Executive, Will Hancock, paid this tribute to Philip on the announcement of his new role:
Philip will take up his new post on 1 September 2019 and added: “I am greatly honoured to have been appointed to this role and look forward to working with an excellent team at SECamb.”
“Philip will be a huge loss to SCAS and in the three years that he has been working with us, he has achieved a significant amount.
He will replace Dr Fionna Moore who acted up as Chief Executive on an interim basis following the departure of Daren Mochrie. Dr Moore will remain at SECamb in her substantive position as the Trust’s Medical Director.
GLOBAL DIGITAL EXEMPLAR UPDATE In January 2018, SCAS was one of three NHS ambulance trusts to be invited onto the Global Digital Exemplar (GDE) programme to develop into world class digital organisations. In the three-year period from that date SCAS will receive an additional £1m from NHS England (which the Trust will match fund) to continue its pioneering work in digital transformation. GDE ASSURANCE MILESTONE REACHED On 23 January 2019, SCAS hosted an assurance visit from NHS England, where they reviewed the progress that we have made so far on the GDE programme. The main focus of the day was using an ambulance (driven by Dave Sherwood and Gary Gray) to demonstrate the ‘Vehicle as a Hub’ concept and electronic patient record (ePR) developments. Following the visit SCAS produced an Assurance Report detailing the overall progress made against specific programme milestones. NHS Digital approved the Report and awarded an ‘Amber Green’ status which triggers permission to release the next tranche of funding; meaning that SCAS will have received £1m this year. WHAT IS INCLUDED IN THE SCAS GDE PROGRAMME? The SCAS GDE Programme incorporates eight projects, each of which has been progressing over the past year. These are: 1. Vehicle as a Hub Providing Wi-Fi capability and a fast 4G on ambulances, improving communications and enabling better targeted patient care.
2. Livelinks Improving the video links between the Clinical Co-ordination Centres and other partners and patients. 3. ePR Acute Interface Developing ePR Acute real-time messaging to enable electronic patient records data to be transmitted direct to Acute systems. 4. ePR developments Continuing to improve ePR functionality. 5. Resource planning / business intelligence development Upgrading our system for resource planning for 999, NHS 111 and the patient transport service (PTS), and following research including more data to further improve our demand forecasting. 6. Integrated Urgent Care (NHS 111) and health systems integration Providing links to parts of the health system to enable seamless patient care. This further develops the virtual call centre regardless of organisational boundaries. 7. Automation Investing in improving automation. This is divided into three areas: • 999: improvements to CAD such as further developing dispatch automation • PTS: includes better rostering and efficiency within the control centre • Corporate: improvements in systems to increase staff efficiency e.g. e-learning 8. Telephony enhancements Enhancing and upgrading the SCAS telephony application to enable greater interconnectivity within SCAS and between organisations within the health system.
WORKING TOGETHER TO RAISE AWARENESS OF LARYNGECTOMEE PATIENTS
In March, Clinical Co-ordination Centre (CCC) North staff at the Trust’s Bicester Headquarters were visited by Tony Hudson, Vice President of the National Association of Laryngectomee Clubs (NALC). Tony is leading NALC’s campaign to promote awareness of the needs of patients who have had a laryngectomy when they require emergency aid and particularly resuscitation. Tony talked openly to staff about his laryngectomy which he needed to have following radiotherapy in 2009.
remember that it may not be immediately obvious that a patient is a neck breather because many patients wear clothing or jewellery over their stomas. Most laryngectomee patients will carry some kind of medical alert identification so it is really important to get aid givers to look for these.
Laryngectomee patients are relatively rare and many of the staff confessed to having very limited knowledge about the condition. Tony explained that laryngectomees are people that have had their voice boxes removed, usually because of cancer. He explained that he now breathes through a stoma in his neck and, like all patients who’ve had a laryngectomy procedure, cannot breathe through his mouth or nose. So standard mouth-to-mouth resuscitation would be completely ineffective for him. Tony is very keen to raise awareness of people like him and he has been working with SCAS for some time; a video has been created by NALC and piloted on some training courses for our volunteer community first responders and an emergency resuscitation leaflet can be downloaded from NALC’s website (details below). All members of the local Laryngectomee Club have been given the option to have an alert put on their home address so that CCC staff are aware that someone at the address is a neck breather. Work is also being done to provide more in-depth training and awareness for our volunteer community first responders and CCC staff. It is really important to
If you would like to find out find out more visit: www.laryngectomy.org.uk
Our charity team, staff, community first responders, volunteers and supporters work tirelessly all year round raising much needed funds for the South Central Ambulance Charity and other causes, as well as develop and strengthen the Trustâ€™s relationship with the local communities we serve. Hereâ€™s a small selection of what they have been up to between January and March 2019.
First responders return to Brockenhurst Local resident, Anita Whittle, completed her training and following a gap of several years, it’s fantastic to once again have a community first responder scheme operational in Brockenhurst, Hampshire. The relaunch of the scheme has been greatly supported by Bransgore CFR Scheme Co-ordinator, Mike Jukes BEM. “I really hope that we can get a few more people from this area to become community first responders”, said Anita, “because they can make a difference – in the worst cases – between life and death. The training is straightforward and no previous medical experience is necessary. You just need to be 18 or older, of good character and have use of a car.”
Anyone interested in joining the new Brockenhurst Scheme should call 0800 587 0207 or email email@example.com
Bracknell staff take part in extrication exercise with RBFRS On 17 January staff from Bracknell Ambulance Station were invited to attend an extrication exercise by Berkshire Fire & Rescue Service at Dinton Pastures, outside Reading. The incident was a mid-air collision of a private Cessna and a Microlight and involved live casualties with realistic injuries, including impalements, requiring rapid assessment, treatment and extrication. Two aircraft wrecks were also transported to site to add realism and allow everyone to establish how best to extricate from such an unusual vehicle. The purpose of the exercise was not only to allow the fire service to test their response to such an incident but to allow their medically trained staff to practice lifesaving skills as well as work alongside our staff in effectively managing the incident. There were a lot of learning points that came out of the incident and many staff from both services walked away with a new level of understanding and respect for each other’s roles and the need for greater communication and coordination at a dynamic scene.
Assisting the clinician training In early February, our Community Engagement & Training Team in Oxfordshire held a training session at Oxford City Resource Centre for local community first responders. The volunteer CFRs were trained on a theme of ‘assisting the clinician’. All the clinical kit was available for CFRs to look at and become confident in its use so they can help at cardiac arrests and be part of the circle of life treatment plan. It was an enjoyable evening and there was a lot of positive reaction and comments from frontline paramedics and staff on station too.
Enaging our GPs SCAS has been busy running training courses for the brand new out-of-hours GPs working in the Thames Valley and Wessex regions. These training courses are delivered at weekends and are aimed to encourage our GP colleagues to use our services appropriately. Events were held at Southern House on 23 February and at Northern House on 2 March. Mark Ainsworth-Smith (MaS) who leads this programme said “It is vital that our GP colleagues understand how the ambulance service works so that they use our services appropriately. During the visit they get to listen to real 111 and 999 calls, as well as looking around the back of an ambulance and doing a basic life support session. They also have a 90 minute presentation explaining how we triage our calls, the skills of our grades of staff, and the importance of using the correct booking procedures.”
MaS added “I would like to pass on a huge thank you to all the SCAS staff who kindly come in especially to help facilitate the day. In Thames Valley this includes Mark Begley, Debbie Moore, Louise Murray and the CFR team, and in Wessex this includes Keith Boyes, Eleanor Rutter and Steve Gooch. We couldn’t do this training without them and all the support from our 111 and 999 call takers who are always so welcoming to our GP visitors.” The evaluations from the days have been extremely positive with over 90% of the GPs giving the highest possible score of ‘excellent’ in their evaluations. Without exception, they all commented on the amazing service we provide and the fantastic staff working in our control rooms and out ‘on the road’.
Basingstoke staff receive lovely visit Our Basingstoke team received a visit on 20 March from the residents of Marnel Lodge Care Home. Paramedic Sophie Webb, one of our team at Basingstoke, added: "The lovely residents of Marnel Lodge Care Home made us some delicious cakes and said they wanted to visit us at Basingstoke to show appreciation for the work we do. Marnel Lodge staff also very kindly said that they would welcome all emergency services staff in for a cup of tea if we are ever passing by the home. Once again - THANK YOU - to the residents and staff at Marnel Lodge from all of us at Basingstoke Resource Centre. You really made our day!"
Donation gives Buckingshire CFRs a boost Thanks to a grant of £4,950 from the OneFamily mutual organisation, the SCAS Charity has been able to purchase four new Mangar ELK lifting cushions to help non-injury falls patients in and around High Wycombe. The cushions have been distributed to the co-responder vehicles at RAF High Wycombe and RAF Halton, as well as to the Amersham and High Wycombe CFR schemes. We are very grateful to OneFamily for awarding the grant and look forward to the benefits to the ‘one family’ of SCAS, SCA Charity, CFRs and co-responders, and of course, our patients.
Isle of Wight Trauma Conference Oxford Brookes University (OBU) Research Paramedic, Nick Groom, along with SCAS Consultant PreHospital Care Practitioner, Mark Ainsworth-Smith, and Education Manager, Paul Grant, delivered a Trauma Conference on the Isle of Wight at the end of January. The Conference included a practical element covering traumatic injuries and catastrophic haemorrhage, as well as airway management. This was a great example of OBU, SCAS and the College of Paramedics working in partnership to enhance the skills and knowledge of paramedics, students and non-clinical staff. And on the coldest day of the year so far, how did the team relax on the way back home whilst crossing the Solent? Why with an ice cream of course on deck!
SE22 team visit her majestyâ€™s naval base, Portsmouth On 31 January, a group of staff from team SE22 based at North Harbour Resource Centre visited Her Majesty's Naval Base in Portsmouth. The full day visit was very kindly hosted by BAE Systems Maritime and the base's safety team. Our first activity was to meet the Emergency Response Team (ERT) and we had the opportunity to observe some demonstrations and learn more about the team. The ERT are able to respond to any emergency within the base, whether this is a fire, explosion, water incident, or simply a casualty in a challenging location. The ERT have equipment and training similar to that of the Hazardous Area Response Team (HART), and are able to extricate a casualty from any location within the base or on a ship, from the lowest deck below the waterline all the way up to the mast for those working at height. The ERT also act as responders to clinical incidents in a similar way to community or fire responders. This was followed by a tour of HMS Diamond, one of the Royal Navy's newest Type 45 Destroyers. The team had the opportunity to step inside the operations room, bridge, and of course the sickbay (our host was the
crew's medic!). However, we had to negotiate some steep ladders on this tour and many of the team were thankful that we were not at sea. We were also granted access to the restricted berth to see HMS Queen Elizabeth up close. One of Britain's new aircraft carriers, she is the largest and most powerful ship ever built for the Royal Navy, and only the second ship to bear the name. After lunch we provided some first aid refresher training to some of the base first aiders, including simple but vital skills such as basic life support, treatment of heavy bleeding (with bandaging practice), choking, and seizures. The day concluded with a tour of HMS Victory: Admiral Nelson's flagship at the Battle of Trafalgar in 1805 and the oldest commissioned warship in the world. Our tour included not only notable historic information, but also a familiarisation on how we would extricate a casualty and how the crew can assist the ambulance service by opening up additional areas and exits not normally open to the public, if necessary. The day was enjoyed by all who attended and was invaluable in strengthening the value of team working between SCAS and the teams within the base.
Spring 2019 2019
How are we doing? Ambulance Response Programme
Apr 2018 -Mar 2019 What does it mean? Category 1
Life-threatening calls. Responded to in an average (mean) of seven minutes and at least nine out of ten times within 15 minutes (90th percentile).
Urgent calls. Responded to at least nine out of ten times within 120 minutes. You may be treated by ambulance staff at the scene.
Emergency calls. Responded to in an average (mean) of 18 minutes and at least nine out of ten times within 40 minutes (90th percentile).
Less urgent calls. Responded to at least nine out of ten times within 180 minutes. You may be given advice over the phone or referred to another service, such as a GP or pharmacist.
Category 1 Mean
07:01 (target 07:00)
02:01:58 (02:00:00) Incidents 172,434
02:54:17 (03:00:00) Incidents 12,908
Spring Twenty Nineteen Please send articles, or ideas to firstname.lastname@example.org along with any photos or images.
Copy deadline for the next issue of Working Together is 24 June 2019
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