Operational Strategy (Emergency Services)

Transcription

1 Paper 01 Appendix A Operational Strategy (Emergency Services) DATE APPROVED: APPROVED BY: IMPLEMENTATION DATE: REVIEW DATE: LEAD DIRECTOR: Director IMPACT ASSESSMENT STATEMENT: Document Reference Number: Craig Cooke - Emergency Services

2 Change Control: Document Number Document (Issued by Document Control Officer) OPERATIONAL STRATEGY Version (Issued by Document Control Officer) 0.6 Owner Distribution list Issue Date Next Review Date Author OPERATIONS DIRECTOR All TBC TBC OPERATIONS DIRECTOR Change History: Date Change Comment/Approved by DRAFT Operations Director Comments from MW, TM, JL Operations Director Updated with responses to TM, JL Operations Director, Chief Executive Page 2 of 22

3 Contents 1. Executive Summary Purpose Drivers for the Strategy Scope Operational Aims and Objectives Implementation Emergency Operations Centres (EOC) Emergency Response... 9 Rostering... 9 Resource type and split (RRV vs Ambulance) Make Ready and Operational Logistics Procurement and Stock Control Estate Management Acute Reconfigurations Staff Development Fleet Information Technology Community Response Community First Responders (CFRs) Automated External Defibrillators (AEDs) Community Engagement Emergency Preparedness and Specialist Operations Operational Information Operational Management Team Key Operational Projects Paramedic pathfinder Ambulance Response Programme Outcomes Risks Monitoring and Evaluation Delivery Plan Appendix 1 Strategic Framework Page 3 of 22

4 1. Executive Summary West Midlands Ambulance Service (the Trust) is committed to delivering an efficient, cost effective, high quality health care service which fully integrates all the threads of clinical quality, performance and governance as detailed in the Trust s values, which can be found our website here: Values.aspx The Trust s Operational Strategy for the Emergency Service supports this commitment by setting out its delivery plan for the following key areas of operation: Emergency Operations Centres Emergency Response Fleet and Make Ready Emergency Preparedness Operational Information Community Response As part of the Strategic Framework, this Strategy is an enabler for the Trust s Five Year Strategic Plan. This will provide the basis for monitoring and evaluation, the results of which will be reported through the pillar committee structure as outlined on the Strategic Framework (Appendix 1). 2. Purpose This Strategy supports the Trust s Vision through the provision of a well led, safe, effective, caring and responsive service in partnership with providers and commissioners. The Trust will continue to provide a sustainable high performing emergency response system, ensuring rapid response to patients whose needs require it, whilst ensuring the needs of each patient are met effectively. Resources need to be utilised effectively through effective dispatch and control services. The Service must have robust arrangements in place to meet the needs of a significant or major incident. Operational delivery will be supported by effective support services. 3. Drivers for the Strategy The NHS Constitution places a duty on NHS services to aspire to the highest standards of excellence and professionalism, keeping patients at the heart of everything we do, working across organisational boundaries in order to provide cost effective healthcare. The NHS Outcomes Framework domains are pivotal to this clinical strategy, they are: Domain 1 - Preventing people from dying prematurely; Domain 2 - Enhancing quality of life for people with long-term conditions; Domain 3 - Helping people to recover from episodes of ill health or following injury; Domain 4 - Ensuring that people have a positive experience of care; and Domain 5 - Treating and caring for people in a safe environment; and protecting them from avoidable harm. Page 4 of 22

5 WMAS Five Year Strategic Plan outlines the strategic context and key drivers which affect the Trust s overall strategy. A summary of this document can be found on the Trust website. For Emergency Service provision, it is important that the Trust has the capacity and capability to respond rapidly to all emergency calls, regardless of location or other factors. The requirement to provide reliable and rapid responses to emergency calls requires careful and detailed planning and continual review and revision. 4. Scope As an enabler for the Trust s Five Year Strategic Plan, this strategy details the overarching behaviours, structures, systems and process that will support the delivery of the Trust s organisational objectives through delivery of the key areas of operation. Emergency Operations Centres Fleet Make Ready and Operational Logistics Community Response Emergency Preparedness and Specialist Operations These will be managed through the Trust s management arrangements under the remit of the Resources Committee: Operational Management Team Divisional Area Management (5) Given that the overall operational delivery of the service is also influenced and guided by decision and policies which reside in other areas of the Trust, it is important to recognise the connection to the Strategies and detailed work taking place in the following areas of the Trust: Clinical Education and Training Quality People Commissioning Finance (and Efficiency) 5. Operational Aims and Objectives The Trust aims to ensure that patients receive the highest standards of clinical care at the right place at the right time in partnership with the local health economies. The Trust will achieve this through the following objectives: Achievement of national performance and clinical standards Achievement of local performance standards Efficient use of resources Paramedic on each responding emergency vehicle Maintain Frontline Emergency fleet age below five years Technology and use of information Implementation of new clinical models Public Safety / Prevention Page 5 of 22

6 6. Implementation The primary functions of the emergency ambulance provision for West Midlands is as follows: Answer 999 calls within 5 seconds, effectively triage those patients into a priority response order, and provide pre-arrival advice to the caller Respond rapidly to emergency calls with a physical resource in the majority of cases under the following priorities and response standards (nationally defined): o Red 1 o Red 2 o A19 Respond rapidly to other emergency calls and those placed by health care professionals where patients require urgent transport (local defined standard) o Green 2 o Green 4 o Health Care Referrals Clinically assess and provide appropriate medical treatment to patients Decide upon the most appropriate onward care for the patient through o Transport to an appropriate Hospital A&E department or specialist unit eg Major Trauma Centre, Cardiac or Stroke Centres o Co-ordinate care and referral to an alternative medical provider eg GP, Diabetic Nurse, Falls Prevention Team etc o Provide definitive treatment at the scene, with no onward transport or referral Provide an effective and co-ordinated response to a serious or major incident in the West Midlands or provide mutual aid nationally to another UK Ambulance Service Annual demand for ambulances within the West Midlands has shown significant increases for many years. Over the last five years, the number of people calling 999 for an ambulance has increased by 4 to 5 per cent per annum, as demonstrated in the table below. This is consistent with the national trend. Financial Year Assigned Incidents Annual Growth 2009/ / / / / / , , , , , , % 3.9% 2.0% 6.2% 3.3% 4.4% Average over 5 years 3.9% In the first half of 2015/16 the demand profile has changed, and growth per annum is more difficult to predict what the future trend might look like currently. To deliver these functions, there are robust management arrangements covering: Page 6 of 22

7 6.1. Emergency Operations Centres (EOC) The Trust has two Emergency Control Centres, both of these facilities are live environments with Millennium Point providing control of resources in Birmingham, Black Country and West Mercia divisions, whilst Tollgate controls Staffordshire and Coventry & Warwickshire divisions. The Control Centres work on a single technology platform which means operational resource can share seamlessly between control centres regardless of geographical location and call-taking services are load balanced to ensure sudden high peaks in 999 call demand be easily shared. The estate and technology infrastructure is resilient at both sites, and also has redundancy built-in. In addition each control centre can take the entire Trust workload of the service at one site, should a total failure occur. Within each Control Centre, the Dispatch function (management of resource and workload) and the call taking function (receiving, triaging and processing of 999 calls) is separated. This ensures that dedicated and highly trained staff can focus on these important functions. The Trust utilises the NHS Pathways triage system to provide the primary calltaking triage and advice to 999 callers, this system was put in place June The triage system is managed and continually updated by a central NHS team, to ensure the protocols are safe, relevant and effective, based upon research, trends and clinical feedback. This arrangement will remain current for the period of this strategy. The technology and IT platform utilised to manage this complex control operation is a key enabler. The current CAD system (Computer Aided Dispatch) was implemented in 2009, and has under gone continual development and upgrade both for operational functionality and keeping pace with technology. This arrangement of continual development on the current system will remain for the period of this strategy but the EOC team will monitor emerging technologies to inform future decisions which would enable new ways of working to be implemented (two examples, the use of traffic sensitive routing for response planning and video conferencing with callers). There is a recognition that there is an increase in usage of 999 from patients whose first language is not English or who have communication disabilities. The EOC team are currently exploring better ways of utilising technology to communicate with this group of callers/patients so that help is not delayed and a full clinical triage is available without delay over the telephone. Each Ambulance Trust in England has been asked to commit that, within the next 12 months, they will be able to pass emergency calls between all Ambulance Services electronically, meaning that the CAD of each Ambulance provider is able to communicate with each other and pass cross border incidents without delay. WMAS through ongoing development with the CAD supplier are well placed to meet this requirement and have already tested this functionally with success between North East Ambulance Service. The main communication system utilised between EOC and the mobile resources will be nationally re-provisioned in 2019 (for WMAS). The current system is based on national infrastructure which provides mobile communication for the Police, Fire, Page 7 of 22

8 Ambulance and other Category 1 responders. The technology currently utilised is based on trunked-radio system which is very resilient but ultimately has limited functionality compared to modern 4G mobile communication. The re-provision of the system will affect, Control Room equipment (ICCS), network carrier 4G communications based, vehicle based and handheld radio equipment, and the mobile data terminals (MDT) in each emergency vehicle. The full scope of this national project is still being finalised and refined, it is most likely that detail will become clear in The Dispatch function is not only key in the delivery of care to patients but is also a vital component in improving efficiency and productivity in operational emergency resourcing. Dispatch will continue to ensure that every patient requiring an emergency response gets the most appropriate response available to meet their clinical needs whilst also remaining focused on performance delivery. In terms of overall efficiency, the focus will be to only use one resource for the large majority of incidents. The Clinical Support Desk (CSD) is staffed by highly trained paramedics whose main role is to triage Green 4 incidents, support call-taking staff with clinical expertise and to support operational resources in decision making and utilisation of alternative care pathways. The CSD contribute to Hear & Treat along with the call assessors and ensure that, for the lower acuity patients who phone 999 and do not require an ambulance response, the directory of services (DOS) is utilised to good effect in providing the right care for these patients. The Regional Co-Ordination Centre (RCC) plays a pivotal role in managing incidents where specialist Trust resources are deployed and utilised to incidents and specific patients that require more than just a paramedic response. The Incident Command Desk (ICD), Hospital Desk and Regional Trauma Desk are responsible for the deployment of Doctor Medics, Air Ambulance assets and specialist HART operatives that are tasked to incidents where their additional skills make a significant difference to patient care and patient outcomes. The ICD staff are trained to deal with large scale incidents and are proficient in the Joint Emergency Services Interoperability Programme (JESIP) principles, major incident management and form close links with the Emergency Preparedness team and On-Call Command Teams. In addition to the above, the Strategic Operations Cell (SOC) and Hospital turnaround desk also reside in the RCC and is a function that works side by side with commissioners and Acute Trust colleagues in the management of hospital turn around for emergency ambulance crews. The SOC is vital in ensuring that WMAS resources are not delayed in handing over patient care in the hospital setting so that patients out in the community who have called for emergency help get the appropriate response without delay. As capacity pressures within acute hospitals continue to grow the SOC and the Hospital Ambulance Liaison Officers (HALOs) play a vital role in ensuring WMAS resources are able to respond to patients out in the community without delay. Page 8 of 22

9 6.2. Emergency Response The West Midlands operational area is organised into five divisions, Staffordshire, West Mercia, Black Country, Birmingham and Coventry & Warwickshire. There is an appointed General Manager for each division, and they are responsible for all matters which take place within that area (excluding Fleet and Make Ready), they have responsibility internally for staff, performance and resource arrangements, and externally for communication and engagement with NHS organisations, other providers and statutory bodies. Rostering The rostering arrangements which exist in the Trust following the transformation changes in 2012 are not fully harmonised or particularly easy to manage and administer. In the period of this strategy, a full analysis of rostering arrangements will be undertaken. This is not a signal for all staffing rosters to be changed and that all staffing patterns will change, however it is recognised that the rosters could be simpler to operate and administer and by implementing some improved system processes, staff could benefit from access to the roster system on their mobile devices, for example. In making changes to the rostering arrangements, a better alignment of operational demand and resource can be achieved in a more sustainable manner (for example adequate hours for evening and weekends) along with possible options for staff to achieve an improved work-life balance. A primary objective of the Trust is to ensure every emergency vehicle has a paramedic on board. The reasons for this are well understood, ensuring: all patients responded to have appropriate assessment and treatment plans implemented the best clinical care is provided on scene the patient is either transported or discharged on scene to an appropriate alternative care. better utilisation of resource because paramedics on RRVs will not be required to travel with a patient, ensuring the highest level of clinical safety for the patient. Resource type and split (RRV vs Ambulance) in recent years the Trust has utilised a one third RRV and two thirds ambulance split of total resource on duty. To improve efficiency and reduce responses per incident further, by reducing the number of RRVs in the system, would reduce the double resourcing per incident and allow acceleration of the 100 per cent achievement of a paramedic on every vehicle. Each of the divisional resource arrangements will be examined and a plan set for the appropriate changes to take place to reduce RRVs to circa twenty per cent. Page 9 of 22

10 6.3. Make Ready and Operational Logistics The Trust implemented a full Make Ready system a number of years ago. This provided modern and fit for purpose hub locations, where the bulk of resource books on-duty and collects a fully cleaned and stocked vehicle (Ambulance or RRV) for each operational shift. With that system, there is a dedicated workforce which is responsible for cleaning, stocking and checking each operational vehicle. This system ensures the highest level of vehicle cleanliness in the clinical area, and also provides a high level of assurance regarding equipment checking, servicing and consumable replenishment. This process ensures an auditable procedure which is operated to set standards, and ensures compliance to both internal and external regulatory requirements. Each operational vehicle will go through the Make Ready process once per shift, and every 24hours (every 48hours for an RRV) for a resource which books on-duty away from a hub location. Additionally each ambulance is taken through a deep clean process every 28 days. The process is undertaken at the Hub locations and operates on a 24/7 365 basis. The internal fleet workshops team works closely with the Make Ready teams to ensure vehicles are maintained and repaired in a timely manner with minimal impact on operational availability. Procurement and Stock Control The manpower employed to operate the Make Ready system are also utilised to support other logistical functions such as vehicle moves, hub stores, stock maintenance and the response to a major incident or specific planned specialist events (such as New Year s Eve operations or V-Festival). The Trust s Procurement Strategy identifies the efficiency improvements that have been made to date, in conjunction with the Make Ready infrastructure and the additional planned improvements over the coming two to three years. The final important function which Make Ready oversee is the management and servicing of Medical Devices and planned preventative maintenance (PPM) checks. The staff undertake daily checks for serviceability and battery management, and arrange third party repair and PPM checks to be undertaken inline with each individual requirement. Estate Management To provide the appropriate infrastructure for the Make Ready process, the Trust has fifteen hub locations which are strategically placed to optimise the operational requirements of each division. The Trust s Estates Strategy assesses the operational and non-operational estate requirements, together with the associated financial and environmental implications. At the current time, the hub located in Stoke (Staffordshire) is the only location which has neither been re-provisioned with a new facility nor received a complete refurbishment. The Trust has agreed in principle that in 2016/17 the old hub at Stoke will be replaced with a new modern facility, this project has been underway for twelve months and the final business case will be presented for approval by the Board in early Page 10 of 22

11 Each operational hub is managed by an Area Manager, who has responsibility for all matters which take place at that site, including the management and leadership of the operational staff and effective resource planning. We currently have a number of single ambulance and larger Community Ambulance Stations (CAS), for example West Bromwich, Kidderminster and Aston. These sites are crucial to supporting the operational delivery across a wide geographical area, which resources use, once booked on-duty. Following a review of utilisation, the total number of CAS sites will be reduced to less than ninety over the period of this strategy, this will ensure the retained sites are fully utilised and support the response requirements in the most efficient way. We will explore opportunities to maximise the volume of double crewed ambulances which operate from a hub at the start of each shift. Local geographic considerations will form part of this review, such as ensuring optimum market town cover. Acute Reconfigurations In the last two years there has been considerable discussion in local areas about changes to hospital configurations. These changes are primarily about centralising specialist services in fewer locations, and consolidating services where the sustainability of clinical services in each individual hospital is in question. The changes have started to occur now and it is clear that local health economies and commissioners need to fully understand the impact on the Emergency Ambulance Service provision in that area. There is a requirement to fully fund the additional ambulance cover to undertake the physical change (ie travelling further to transport the patient to the newly consolidated service) but also to fund the additional geographical cover which is left un-resourced whilst the vehicle is away from its natural response area. These changes significantly impact on the Trust. The General and Area Managers and the Commissioning Director will ensure engagement and ongoing dialogue takes place to remind local health economies that changes can only occur where appropriate resource is provided in a sustainable manner. For example, where an ambulance travels a further thirty minutes to provide the patient with appropriate definitive care, the overall impact is at least double, in respect of both financial and operational cost. Staff Development The Trust will continue to develop the operational staff and also maintain and improve the base clinical skills for the benefit of patients. Each member of operational staff will receive an annual personal development review and identify their future training needs, this process will become progressively more relevant as the summary-data held within EPR (electronic patient record) will be utilised to review areas of training development. Staff will receive a mandatory training module each year, which will be delivered by a clinical tutor to ensure key areas of learning and assessment are undertaken annually. Page 11 of 22

12 To further support clinical staff working on the frontline, each clinician will undertake a shift working with a clinical team mentor (CTM), this will allow staff to be observed in the live environment by CTMs annually and therefore staff can access support for areas of further development in future years to ensure that skills remain appropriate to the needs of the patients. The People Strategy identifies the varied approach the Trust utilises to encourage and support staff development, including coaching, professional qualitifiacations, e-learning, secondments etc. The People Strategy also identifies the importance of staff engagement to improve future staff development opportunities Fleet The Emergency Ambulance and Rapid Response Vehicle (RRV) fleet replacement cycle has been reviewed in conjunction with the Trust s financial plan and will continue to be a rolling replacement at five years (maximum). This provides the most cost effective operating model, based on: total life running costs. Medical equipment - compliance with changing demands and safe installation of medical equipment Ambulance base vehicles will continue to be based on the Fiat Ducato (4250kg chassis). The new model of this vehicle was introduced in 2014 and will remain current for approximately 10 years with a mid-life face lift at 5 years. The front wheel drive, low floor, low angle ramp access configuration provides an operationally efficient patient loading arrangement and the van based product continues to provide cost effective operating costs. The Ambulance fleet will continue to contain a percentage of 4x4 capable assets to provide inclement weather resilience. All rapid response vehicle (RRV) stock is based on 4x4 platforms, the market will continue to be monitored for suitable variants. Changes to the resource type mix in operations will facilitate reductions in the RRV stock which will leverage operating cost savings. Work in 2016/17 will consolidate down some of the major incident assets onto more efficient space platform, whilst increasing the overall capability. The ambulance conversion is being retendered in quarter for a 4 year contract, this procurement process is being managed internally and will be open to all European converters to ensure best value is achieved. The ambulances will comply with all regulations under both CEN (Ambulance standards) and European Vehicle Whole Type Approval (EVWTA). Diesel will continue to be the single choice fuel, the Trust has heavily invested in bunkered fuelling at Hubs in recent years due cost savings on literage compared to retail forecourts. It would be an undesirable situation to have a split fuel strategy for cars (where some opportunity might exist) and currently there is no viable alternative on the large van products in the UK. The Trust will however continue to monitor emerging markets for alternate fuels. Maintenance of the front line fleet will continue to be delivered in-house due to the specialist nature of this part of the fleet and operational importance operating cost reduction will continue to be a focus area in conjunction with key suppliers and manufacturers. Page 12 of 22

13 6.5. Information Technology Development of the vehicle CCTV and Telematics systems on the emergency fleet assets will continue, this will provide data to inform operational efficiency and savings. The Trust is transitioning from the Zoll E series Defibrillator unit to the Zoll X series Defibrillator/Patient Monitor. This new device employs advanced battery technology which is easier to maintain and provides three times the duration time of the current product. The device is also a patient monitor device which is able to stream live vital signs information to the newly implemented EPR system. The transition has commenced and by April Zoll X series will be in use. The Trust will need to identify the funding to support further roll out of these devices over the next two years if the rollout is to be accelerated ahead of the natural five year vehicle replacement programme. The Trust s Information Technology strategy will review the Trust s approach to engagement with regard to procuring and maintaining innovative equipment and systems which are consistent with planned operational and clinical developments. The Trust has previously procured a specific uniform for its operational staff. This uniform is branded for the Trust, whilst also providing a clear identification as an ambulance employee. A national procurement exercise has been undertaken to provide a common uniform for all NHS ambulance staff within England. The Trust will benefit from access to supplies without the committed to holding stock, reduced costs, and garments which have been tested rigorously to a set standard. This uniform rollout will commence in 2016, taking several years to fully transition Community Response Community First Responders (CFRs) CFRs are volunteers who are mobilised to provide medical support while an ambulance is en-route to a patient. They operate mainly in rural areas of their local community or place of work. Their local knowledge enables them to access lifethreatening medical emergencies promptly. The key purpose of the CFR role is to get a defibrillator to a patient in a cardiac arrest within minutes. There are approximately 750 CFRs amongst just over 100 schemes within the region. The number of CFR schemes continue to expand through successful retention and recruitment of volunteers. All CFRs receive full training to ensure they have the relevant skills and confidence in their role. All CFRs are checked by the Disclosure and Barring Service (DBS). Next year, the aim is to increase the number of CFRs within our rural communities and review the CFR training programme in line with a national standard through the National Ambulance Service Responder Managers Forum. Automated External Defibrillators (AEDs) Within the last year the trust have invested in 500 Automated External Defibrillators (AEDs) which were located across WMAS in key locations and busy areas such as shopping centres, sports centres, schools, council buildings and golf clubs. Page 13 of 22

14 Currently, WMAS have 3500 AEDs on our CAD system. This include AEDs that are based at set sites, known as Static Defib Sites and also AEDs based within the community, available 24/7; often located within cabinets. Early defibrillation with immediate ambulance back-up, provides the best possible chance of survival following a cardiac arrest. Community Engagement Volunteers support the ongoing training of Cardio Pulmonary Resuscitation within our communities, often within schools and community groups through a British Heart Foundation initiative called Heartstart. Heartstart training is region wide and 60% of the individuals trained are children. One example in the Herefordshire division is over local people trained and a number of trainees have reported using the skills learnt to help towards saving a life in a cardiac arrest event 6.7. Emergency Preparedness and Specialist Operations Emergency Preparedness and Specialist Operations remains very much an integral part of the Trusts core functions. The Emergency Preparedness team continue to ensure the Trusts plans have been reviewed in light of the Joint Emergency Services Interoperability Principles (JESIP) and that they remain current, robust and able to meet the needs of not only the organisation but also its partners across the region. Training of staff and managers remains a key priority for the Trust with all modules designed and incorporated into clinical staffs mandatory training and all managers will undertake a 4 day residential commander s course to be completed across period. Work continues to ensure the major incident fleet and assets remain serviceable and deployable at no notice. The fleet replacement for the Incident Support Units has commenced ensuring we remain in a positon to provide staff and patients with the very best assets and equipment in response to a major incident will see us ensure we remain focused on providing world class care and event management for a number of public and private contract holders to ensure public events remain safe and where possible generate further income to support the wider Trust. The Trust remains compliant with its Business Continuity requirements with all departments having a plan that is reviewed and exercised every six months. Air Operations are now heavily focused on uplifting the clinical capability to ensure that by the end of 2017 all Paramedic staff on aircraft are trained to Critical Care Practitioner status and we begin the process of recruiting more Doctors to enable a 2nd Midlands Air Ambulance to deliver Doctor led care. We will maintain the excellent working relationships with our charitable partners. HART continues to provide a substantial uplift in the capability. We will continue to develop staff practicing in this role to ensure they remain robust and resilient in the delivery of patient care in the most hazardous of areas. Although already started Page 14 of 22

15 the HART fleet replacement will be completed through quarters 1 and 2 of 2016 not only bringing a robust fleet but with replacement state of the art technology Operational Information Over the last six years the Trust has developed a comprehensive and robust understanding of operational information. The level of detail relating to demand, performance and resource use is wide-ranging and available at a high level or granular through a suite of web-based reports. The data and analysis available is primarily derived from the CAD incident and resource data. There is a team of staff dedicated to the management, assembly and analysis of this data and associated reports for both internal and external organisations. The primary system which is utilised to undertake this detailed data analysis has been updated in 2015, and this system will provide greater flexible access to the data and report outputs (which can be configured by the user). The data is used to plan and forecast overall demand patterns and therefore the Trust is in a position to understand the future resource requirements and undertake analysis of system changes (such as reconfiguration of hospital services). The other key function of the reporting process is enable operational managers to visualise performance and trends, and therefore decisions made are based on real live performance. Looking forward, the key change will be full access to EPR data link. 7. Operational Management Team The core operation of the Trust is managed through a robust process of management, control, assurance and risk management under the remit of the Operational Management Team. An important function of the overall operational planning function, is to ensure adequate workforce and resource is planned to meet the future demands of the service. Whilst these demands primarily focus on the forecasted and contracted levels of 999 call demand over the coming years, but it also accounts for the increasing level of clinical and professional support our workforce requires, to ensure they are adequately trained for the changing health environment. This planning process utilises the highly developed demand analysis reference above, but also now increasingly needs to factor in matters such as hospital reconfigurations, changes to population and health demographics and other regulatory requirements. A key future of Ambulance operations is to ensure the Trust has strong and appropriate command and control arrangements in place to manage both daily operations but also to robustly manage serious and major incidents which occur in the West Midlands. There is a 24/7 365 Operational On-Call roster which provides leadership and management of all operational elements of delivery, these On-Call teams are headed up by an Assistant Chief Ambulance Officer (Gold Commander). These command teams are required to be trained and exercised regularly to ensure readiness and they are also used to manage demand pressures operational. Page 15 of 22

16 In 2015 the Trust commenced the rollout of the new Electronic Patient Record system for West Midlands Ambulance Service, this is a new and innovative system which has been commissioned to ensure maximum user interface flexibility and intuitiveness (which is important in time critical frontline work). The system will guide the clinical staff through the completion of each clinical record and also provide links to additional supportive information such as the live Directory of Service and referral systems such as Vulnerable Adults reporting. Whilst there will be a bedding down period, as operational staff become familiar and confident with the system, there will likely be efficiencies to be gained. For example, the referrals which take place electronically won t require lengthy handover dialogue and will occur automatically, and it is likely less back office staff will be required to manage and process the PRFs and some referral functions. What will become increasingly important, is the background data and analysis of patient demand and physical treatments provided. Currently the service relies heavily on data anaylsis of incidents information only, and little live analysis is available about the actual patient and treatment we provide clinically. Once the system is fully rolled out, the Trust will quickly start to build a depth of clinical data. This information will be analysed in a similar manner to the incident data, and the service will be able plan future developments based on powerful clinical information, making decisions more relevant to individual patient groups. The rollout of this new system will be completed in 2016/17. In 2012 the Trust took a decision to increase the operational capacity for the safe transport of bariatric patients. In fact, at the same time the Trust also introduced equipment to aid the safe transport of paediatric patients too. Following a review in 2015 there is recognition that processes and equipment for the safe transport and handling of bariatric patients can be improved further. Further capacity will be added to the ambulance fleet in 2016 to provide a wider geographical spread of these specialist ambulance types whilst also improving the training and equipment that staff have available to manage this patient group appropriately Key Operational Projects Paramedic pathfinder Paramedic Pathfinder is a national award winning initiative developed by North West Ambulance Service as a tool for practitioners to determine the most appropriate destination for their patients first time. The tool will give clinical practitioners the guidance to ensure they are referring patients to the most appropriate service and helping to deliver a world class service to the patient. The Pathfinder project is intended to improve the delivery of care to patients, support clinical practitioners in signpost patients to the most appropriate care, increase efficiency and productivity of the clinical practitioners and support the local health community services. Full system implementation will require: training of all clinicians in the use of the tool identification of an operational project lead in each area to support continued use of the tool Page 16 of 22

17 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST a commitment from the Clinical Commissioning Groups around the region to provide the appropriate urgent care facilities to match the profile of clinical need Ambulance Response Programme During the summer of 2015 the Trust was invited to express an interest in the participation of the Ambulance Response Programme (ARP). This pilot is an NHS England project that is reviewing the categorisation of 999 calls and the associated response targets to ensure that each patient needing help receives an appropriate response, in the right time frame provided by the right resource. WMAS began actively participating in ARP on 19 th October 2015 and immediately saw a reduction in the number of responses deployed per incident. The pilot also saw the introduction of Nature of Call (NOC) where very early on in a 999 call the Call-Takers are asking key questions in order to identify patients with life threatening conditions such as cardiac arrests, chocking, and unconscious patients with airway compromise. The pilot requires the Trust to submit various different data samples that will provide evidence to reform response targets and ensure that the patients who need a response as a priority, receive the most appropriate response quickly, without delay. This work is likely to conclude in 2016 with an estimated full implementation of findings in Outcomes The delivery of the Operational Strategy will provide the following: Achievement of Red 1, Red 2, A19 and call answering standards at national target level Influence emerging response standards for the future through participation in Ambulance Response Programme Achievement of locally agreed targets according to emergency and urgent contract Increase hear and treat (% tbc) Increase see and treat / referral to alternative care (% tbc) Continue to build upon the Directory of Services (DoS) and implement its use within the electronic patient record Further reduction in responses per incident, where a single resource is dispatched to the majority of incidents Reduction of cost per incident Operational skill mix meets profile and type of demand Each patient assessed and treated at scene by a Paramedic Fleet meets standards for cleanliness and CQC compliance, reduced failure rate and vehicle life costs Improved use of available data (including clinical data) for planning resource and future models Technology to provide services to mobile users Improved quality of service to patients Continued emergency preparedness / specialist response Page 17 of 22

18 WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST engagement with community through increasing defibrillation and resuscitation programme, including Community First Responders 7. Risks Risk management is a key component of enhancing patient care and is therefore central to the Trust s Operational Strategy. It is the process whereby the Trust methodically addresses the risks attached to its activities with the goal of achieving sustained benefits to patient care within each activity and across the portfolio of all Trust activities. The identified challenges that are relevant to the Operational Strategy are captured within the Trust s three Significant Risks: Significant Risk 1: Failure to achieve Operational Performance Standards Significant Risk 2: The Trust fails to manage its Finances appropriately Significant Risk 3: The Trust fails to comply the Regulatory Body Standards and Quality Indicators The associated risk assessments for these significant risks are influenced by clinical, operational and quality risks, which are reviewed on a regular basis through the Trust committee structure. 8. Monitoring and Evaluation The resources Committee will be responsible for monitoring delivery of this strategy. Exception reports will be established and escalated to Board of Directors as appropriate. The Resources Committee s Schedule of Business will identify key review dates to ensure the strategy remains up to date and reflective of the Trust s ongoing plans. Page 18 of 22

19 9. Delivery Plan WEST MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST No Deliverables Measure of success Timescale 1. Achievement of national Achieve standards for call answering ambulance quality indicators Achieve standards for operational performance (Red1 and Red 2) Achieve improvements in clinical performance Influence emerging response standards for the future through participation in ambulance response programme Submission of data samples as required by national team & Implement March Achievement of local performance Quarterly achievement of the locally agreed target for Green 2 calls (90% in standards 2015/16) Quarterly achievement of the locally agreed target for Green 4 calls (90% in 2015/16) Quarterly achievement of the locally agreed target for Healthcare Referrals calls (90% in 2015/16) Achievement of annual CQUIN schemes relating to Operations 3. Efficient use of resources Increase hear and treat (%tbc subject to national changes to response time targets) Increase see and treat / referral to alternative care (%tbc subject to national changes to response time targets) Reduce RPI (%tbc subject to national changes to response time targets) Reduction of cost per incident Agreement and delivery of replacement for Stoke hub within timescale and budget Q4 2016/17 Review of West Bromwich hub options Q2 2016/17 Reduction of Community Ambulance Station sites according to demand and resource profile Complete full analysis of rostering arrangements March 2017 Increase number of Community First Responders in rural settings 4. Paramedic on each responding Operational skill mix meets workforce plan and profile for demand volume and type emergency vehicle Page 19 of 22

20 No Deliverables Measure of success Timescale 5. Maintain Frontline Emergency fleet Fleet meets standards for: age below five years cleanliness and CQC compliance reduced failure rate vehicle life costs Monitoring of market for suitable fuel variants to ensure optimum efficiency of RRV fleet Re-tender of ambulance conversion contract March 2016 Replacement of HART vehicles June 2016 Additional bariatric fleet provision to provide wider geographic coverage March Technology and use of information Evaluation of new technology to inform future decisions: use of traffic sensitive routing for response planning Video conferencing with callers Capability to pass emergency calls electronically between all English ambulance December 2016 Trusts Identification of requirements under national radio replacement project Q Real time use of clinical data from electronic records According to EPR Project Plan Technology to provide services to mobile user - linked to EPR TBC Development of CCTV and telematics system on emergency fleet 2017/18 Transition to Zoll X Series defibrillator / patient monitor April Implementation of new clinical Delivery of operational requirements of Clinical strategy models Compliance with key requirements to facilitate implementation of Paramedic According to Pathfinder Pathfinder tool Project Plan Each clinician will undertake a shift working with a Clinical Team Mentor All Paramedic staff on aircraft trained to Critical Care Practitioner status March Public Safety / Prevention Engagement with community through increasing defibrillation and resuscitation programme Continued provision of event management for key commercial contracts A Commence implementation of nationally procured uniform Commence 2016 B Compliance with business continuity requirements, all departmental plans reviewed every six months Page 20 of 22

21 STRATEGIC OBJECTIVES 1. Achieve Quality and Excellence 2. Accurately assess patient needs and direct resources appropriately 3. Establish our market position as an emergency healthcare provider 4. Work in partnership Operations Strategy on a Page Purpose Objectives Outcomes Key Areas Continue to provide a high performing emergency response system which is sustainable. Ensuring a rapid response to those patients whose needs require it, whilst ensuring the needs of each patients care is met effectively. Resources should be utilised effectively through effective dispatch and control services. The Service should have sound arrangements in place to meet the needs of a significant / major incident. This will be supported by effective operational support services. Achievement of national performance standards Achievement of local performance standards Efficient use of resources Paramedic on each responding emergency vehicle Maintain fleet age below Technology and use of Implementation of new five years information clinical models 1. Achievement of Red 1, Red 2, A19 and call answering standards at national target level 2. Influence emerging response standards for the future through participation in Ambulance Response Programme 3. Achievement of locally agreed targets according to emergency and urgent contract 4. Increase hear and treat (% tbc subject to changes in national response time targets) 5. Increase see and treat / referral to alternative care (% tbc subject to changes in national response time targets) 6. Continue to build upon the Directory of Services (DoS) and implement its use within the electronic patient record 7. Further reduction in responses per incident, where a single resource is dispatched to the majority of incidents 8. Reduction of cost per incident 9. Operational skill mix meets profile and type of demand 10. Each patient assessed and treated at scene by a Paramedic 11. Fleet meets standards for cleanliness and CQC compliance, reduced failure rate and vehicle life costs 12. Improved use of available data (including clinical data) for planning resource and future models 13. Technology to provide services to mobile users 14. Improved quality of service to patients 15. Continued emergency preparedness / specialist response 16. engagement with community through increasing defibrillation and resuscitation programme, including Community First Responders Emergency Operations Centres Emergency Response Fleet Make Ready and Operational Logistics Community Response Emergency Preparedness and Specialist Operations Public Safety / Prevention Operational Information VISION - Delivering the right patient care in the right place, at the right time through a skilled and committed workforce in partnership with local Health Economies Values World class service Patient centred Dignity and respect for all Skilled workforce Effective communication Teamwork

22 CLINICAL STRATEGY 2015 TO 2018 Appendix 1 Strategic Framework

23 Equality Impact Assessment Screening Form Title of proposal: Clinical Strategy Person Completing Form: Pippa Wall Craig Cooke Directorate: Role in Organisation: Head of Strategic Planning Emergency Services Director Service Area: Operations Date Submitted 14 December 2015 Main purpose and aims of the proposal and how it fits in with the wider aims of the organization. (Please note, the WMAS Business plan and Strategy) The Trust maintains its vision and strategic objectives as follows: Vision Delivering the right patient care, in the right place, at the right time, through a skilled and committed workforce, in partnership with local health economies Strategic Objectives Achieve Quality and Excellence Accurately assess patient need and direct resources appropriately Establish market Position as an Emergency Healthcare Provider Work in Partnership These objectives seek to promote positive attitudes and strive to achieve the best patient outcomes across all nine protected groups within the Equality Delivery System. This Strategy supports the Trust s Vision through the provision of a well led, safe, effective, caring and responsive service in partnership with providers and commissioners. The Trust will continue to provide a sustainable high performing emergency response system, ensuring rapid response to patients whose needs require it, whilst ensuring the needs of each patient are met effectively. REF: WMAS 256 Page 1 Version: March 2013