South East Coast Ambulance Service NHS Trust

Transcription

1 South East Coast Ambulance Service NHS Trust Integrated Business Plan Page 1

2 FOREWORD Foreword from the Chairman and Chief Executive The ambulance service is on a journey of transformation; we have changed from a service that transported patients to treatment, to a service that is now bringing more treatment to patients. Demand continues to increase for our service by roughly five percent each year and the spectrum of patient need that we are now seeing is broader than ever before, ranging from critically ill and injured patients suffering from conditions such as trauma, stroke and coronary heart disease, to patients at the other end of the spectrum with less serious healthcare needs such as minor injuries and illnesses. We fully recognise that we must change and adapt in order to meet the changing needs of all of our patients no matter what their condition or healthcare need and deliver continuous improvements in patient care. South East Coast Ambulance Service NHS Trust (SECAmb) is committed to driving that change in order to deliver the best possible care, and therefore outcomes, for patients across Surrey, Sussex and Kent. Delivering world class outcomes for patients is what we aspire to do we want to be the best ambulance service; our patients deserve and expect nothing less. We are confident we will achieve this goal and becoming a foundation trust will help us. Foundation Trust status will give us the financial and operating freedoms needed to make the improvements that our patients need and expect at a much quicker pace, meaning higher quality care for all our patients. Martin Kitchen Chairman Paul Sutton Chief Executive Page 2

3 CONTENTS Table of Contents Foreword from the Chairman and Chief Executive... 2 Table of Contents... 3 List of Figures... 5 List of Tables Executive Summary Vision and Strategy Rationale for NHS Foundation Trust status Market assessment Performance overview Summary SWOT analysis Leadership and Management Trust Profile Overview Range of services Performance Contractual information Strategy Trust vision Strategy Measuring achievement of our Strategy Aim for NHS Foundation Trust status Consultation process Market Assessment Description of local health economy Key factors driving demand Objectives of the local health economy PEST analysis Trust performance Service Development Plans Overview...44 Page 3

4 CONTENTS 5.2. Our Trust s Strengths, Weaknesses, Opportunities and Threats Commentary on SWOT analysis Key service developments Leadership and Workforce Management arrangements Workforce key performance indicators Agency and recruitment arrangements Workforce and organisational development Human Resources Strategy Governance Arrangements Stakeholder interests Corporate governance and management Internal control Risk management Performance management reporting framework Financial controls and reporting Audit arrangements Compliance Framework IT systems...75 List of acronyms Glossary of terms Page 4

5 CONTENTS List of Figures Figure Summary SWOT analysis... 9 Figure Operational Dispatch Areas and Hospital Locations...12 Figure Management of 999 calls...14 Figure Strategy Focus...23 Figure Stakeholder analysis...27 Figure Emergency calls by month for Figure Emergency responses by month for Figure Number of emergency ambulance calls / conveyances Figure Calls by MPDS code 2007/08 and 2008/ Figure PEST analysis...37 Figure Return of Spontaneous Circulation (ROSC) on arrival at hospital...41 Figure Care bundle provided for STEMI...42 Figure MORI Survey: Satisfaction with SECAmb compared with wider NHS...43 Figure SWOT analysis...45 Figure Board and Team of Directors...53 Figure Trust Board and Committee structure...69 Page 5

6 CONTENTS List of Tables Table Historic Annual Health Check performance... 8 Table Proportion of income...13 Table A&E activity (by incidents)...14 Table PTS activity (number of journeys)...15 Table Annual Health Check ratings...16 Table Annual Health Check: Quality of Services performance 2008/ Table National Performance Targets: Existing Commitments...18 Table Annual Health Check: Quality of Financial Management Table Background of respondents...25 Table Issues identified during public consultation and Trust response...26 Table Population breakdown by PCT area...30 Table Workforce...60 Table Proposed governors...68 Table Committee roles...70 Page 6

7 CHAPTER 1 EXECUTIVE SUMMARY 1. Executive Summary This section: Outlines our vision and strategy and how we will achieve this Explains why we want to become a Foundation Trust and the benefits we believe this will bring Summarises the key elements from our Integrated Business Plan The key points from this section are: The Trust has a clear vision and strategy The Trust has the appropriate supporting mechanisms in place to deliver this vision and strategy 1.1. Vision and Strategy Our vision is to match and exceed international clinical excellence through embracing innovation and putting the patient at the heart of everything we do. Our strategy to achieve this is to strengthen and extend our core activities To implement our strategy, we have identified six strategic objectives underpinned by business implementation measures and key service developments. Our six strategic objectives are: Improve on the Trust s performance standards and reduce variation Deliver excellence in leadership and development Improve access and outcomes to match international best practice Improve satisfaction and experience for all stakeholders Be an organisation that people seek to join and are proud to be a part of Convert all available pounds / resources to maximise patient benefit 1.2. Rationale for NHS Foundation Trust status Foundation Trust status is a mechanism that enables us to deliver the system and cultural change required to become a world class provider of emergency and urgent care. There are many benefits to us becoming an FT for patients, local people and for our staff. Our key reasons for becoming a Foundation Trust are: Structural change Increased local ownership and accountability; The concept of high performance is based on four co-dependent pillars that focus on reducing waste by maximising efficiency. This supports the delivery of high quality, clinically focussed services for our patients and the local population. Investment in innovation Ability to reinvest funds to innovate to improve patient care; Commercial opportunities Ability to react promptly to opportunities within the marketplace. Page 7

8 CHAPTER 1 EXECUTIVE SUMMARY 1.3. Market assessment We cover a geographical area of 3,600 square miles, providing Accident & Emergency (A&E) services to the population of Brighton & Hove, East Sussex, Kent, Medway, Surrey and West Sussex and to selected geographic areas within Berkshire and North East Hampshire on the Surrey County boundary. We serve a resident population of c. 4.3 million people, however, on an annual basis there are approximately 15 million visitors who stay for one night or more, and 96 million day visitor, who may also call on our services. In 2008/09 we responded to more than 500,000 emergency calls; approximately a call every minute. In addition, we provide non-emergency patient transport services in parts of East Sussex, Kent and West Sussex. Our Commercial Services Department provides training, paramedic cover and a private ambulance service to outside organisations. We provide a portfolio of products that cover three distinct markets; Emergency care, Unscheduled Urgent Care and Non-Emergency Care Performance overview We have a history of strong financial performance since the Trust was formed in In 2008/09 we generated a surplus of 0.7m on a 149m budget. In 2008/09 we achieved a rating of Good for Quality of Financial Management and Fair for Quality of Services in the Care Quality Commission s Annual Health Check ratings. Our aim is to improve on this for 2009/10, by achieving a Good assessment for both components. Historic performance against the Annual Health Check rating is shown in Table 1.1. Table Historic Annual Health Check performance 2006/ / /09 Quality of Services Fair Good Fair Quality of Financial Management Fair Good Good We are working to develop our Quality Account that will become mandatory from 2010/11. This is a mechanism by which the Board can assess quality and address its improvement, and by which all NHS healthcare providers can be held accountable for the quality of care provided by commissioners, patients and the public. Page 8

9 CHAPTER 1 EXECUTIVE SUMMARY 1.5. Summary SWOT analysis Figure Summary SWOT analysis Strengths Available 24 hours a day, seven days a week Strong reputation and positive public image History of innovation Mobile healthcare provider Historic performance of category A and call taking standards Responsive to clinical change Robust, tested business continuity plans Weaknesses Higher than average costs Uni-professional workforce (limited skill mix of staff) Staff satisfaction Environmental impact Opportunities Urgent, unscheduled care provision Improving outcomes and experience Diagnostic technology Managing demand in the whole health economy Releasing cost improvements in the whole health economy Foundation Trust status will increase local ownership amongst patients, public and staff Community cohesion General health Management Threats Payment by Results could result in a disincentivisation to do the right thing for patients Competition from alternative providers Resistance/ difficulty delivering large scale cost improvement programmes Page 9

10 CHAPTER 1 EXECUTIVE SUMMARY 1.6. Leadership and Management We have a strong commitment to education, with an increasing focus on the professionalisation of the workforce. Our vision for leadership development aims to develop our staff to lead improvements through others and this is supported by a series of organisational development programmes, targeted at different groups of staff throughout the Trust. Page 10

11 CHAPTER 2 TRUST PROFILE 2. Trust Profile This section: Provides an overview of how the Trust operates Sets out the services the Trust provides Indicates the levels and trends of activities within the Trust The key points from this section are: The Trust is an innovative, patient focused organisation The organisation s portfolio covers three distinct markets 2.1. Overview South East Coast Ambulance Service NHS Trust is an innovative, patient focused organisation providing emergency, unscheduled urgent and non-emergency care. We respond to 999 calls from the public, urgent calls from healthcare professionals and, in Kent and Sussex, provide non-emergency patient transport services (pre-booked patient journeys to and from healthcare facilities). We currently provide services in Kent, Surrey and Sussex, and also to a small geographic area within North East Hampshire and in Berkshire. The Trust was formed in July 2006, following the merger of Kent Ambulance Service NHS Trust, Surrey Ambulance Service NHS Trust and Sussex Ambulance Service NHS Trust. We have a strong track record of improving patient services through the adoption and implementation of innovative clinical practices and equipment, the development of specialist clinical roles and the roll out of new technologies and systems; all aimed at improving patient outcomes, experience and safety, improving the quality of care for the patients we treat. We employ 3,138 members of staff, of which 83.5% are operational, either as front-line members of staff, or within our Emergency Dispatch Centres, with the remaining 16.5% providing support services and management functions. The Trust operates from 65 sites. Operationally, the services are divided into two divisions, East and West, and further into ten Operational Dispatch Areas (ODAs), which are served by three Emergency Dispatch Centres (EDCs). These divisions are based on patient flows into acute hospitals (see Figure 2.1). Page 11

12 CHAPTER 2 TRUST PROFILE Figure Operational Dispatch Areas and Hospital Locations 2.2. Range of services We provide a range of services to ensure that we best meet the needs of patients within the communities we serve. These are grouped as Accident and Emergency Services, Patient Transport Services, Commercial Services and Emergency Preparedness. The income generated from each of these, as well as the proportion this represents in relation to our overall turnover of 156 million in 2009/10 is shown in Table 2.1. Page 12

13 CHAPTER 2 TRUST PROFILE Table Proportion of income Income million Accident & Emergency service % Patient Transport Service 11 7% Commercial Services and other non-nhs income 6 4% Proportion of turnover Accident and Emergency Service Patients range from the critically ill and injured, to those with minor healthcare needs that can be treated at home or in the community. Calls are received in our Emergency Dispatch Centre via the 999 system, and triaged in accordance with the Advanced Medical Priority Dispatch System (AMPDS), to determine the most appropriate response based on clinical need. Calls are categorised as follows: Category A Life threatening conditions where speed of response may be critical in saving life or improving outcome for the patient e.g. heart attack or serious bleeding Category B Conditions which need to be attended quickly, but which are not immediately lifethreatening Category C Non life-threatening conditions that may be appropriate for referral to an alternative care pathway Figure 2.2 provides an illustrative example of the management of 999 calls through our systems. We currently provide four different products within our A&E service: 999 Call-taking The function undertaken within our Emergency Dispatch Centre of answering and initial triage (via AMPDS) of the call. Hear & Treat Those situations, generally Category C calls, where advice is provided directly to the patient over the phone by a clinically trained member of staff within the Emergency Dispatch Centre. This may include identification of an alternative care pathway. See & Treat Where a clinician attends and provides treatment to the patient, but there is no requirement to transport the patient to hospital (or other healthcare facility). See, Treat & Convey Our innovative approach to infection control, Make Ready won the 2009 Regional Best of Health Awards for patient safety As with See & Treat, the clinician attends and provides treatment to the patient, however there is the need to transport the patient to hospital (or other healthcare facility) for further treatment. Page 13

14 CHAPTER 2 TRUST PROFILE Figure Management of 999 calls 999 call or call from a healthcare professional received by the Emergency Dispatch Centre Call Taker uses the Advanced Medical Priority System (AMPDS) to triage the call and determine the condition of the patient Dispatcher allocates the most appropriate response, based on clinical need Clinical Desk (clinically trained staff) use PSIAM software to manage Category C calls effectively Clinician(s) receives information electronically and vehicle is mobilised Clinician(s) arrives on scene Clinical treatment is provided to the patient; no requirement for hospital treatment Clinical treatment is provided and the patient is transported to hospital or specialist unit Patient is referred to an alternative care pathway e.g. community nurse / GP In line with national trends, A&E activity is increasing year on year (NHS Information Centre, 2009). Analysis of trends relating to population, epidemiology and healthcare confirm that demand for ambulance services is likely to continue to rise in line with historical trends. Table 2.2 highlights increasing demand for our A&E service. We attended 532,893 incidents in 2008/09, an increase of 5.8% increase on 2007/08 activity. Table A&E activity (by incidents) 2006/ / /09 Projected 2009/10 A&E activity 483, , , ,538 Growth N/A 4.21% 5.80% 5.00% Page 14

15 CHAPTER 2 TRUST PROFILE Patient Transport Service (PTS) Non-emergency patient transport services for the movement of patients to and from NHS facilities includes the transportation of ambulant, wheelchair bound and stretcher patients, plus infectious cases. The types of journeys undertaken include inpatient admissions, out-patients and day patients from the patient s place of residence, including nursing homes, to NHS facilities and non urgent transfers between hospitals and discharges from hospitals to home. We employ Ambulance Care Assistants (ACAs), who operate either single or double crewed vehicles to transport these patients. Additionally, a volunteer-operated ambulance car service supports the Patient Transport Service. Within our Patient Transport Service, we provide two different products: High Acuity PTS The patient may require some degree of clinical care during transportation. Low Acuity PTS The patient does not require clinical care during transportation. Table 2.3 shows that demand for PTS services continues to decrease over time. However, evidence suggests that the level of acuity of the patients using these services is increasing. Table PTS activity (number of journeys) 2006/ / / / / /12 PTS activity 455, , , , , ,202 Growth N/A -0.88% -2.97% -1.00% -1.00% -1.00% Commercial Services In addition to the provision of front-line clinical services, we have developed a number of areas of expertise for commercial development opportunities. These include event work, insurance work, training, education and workshops. This work is currently co-ordinated by our Commercial Services department. The Private Ambulance Service (PAS) currently provides First Aid, clinical and pre hospital emergency cover to a range of public events across Surrey, Sussex and Kent and further afield, with the capability to provide HSE approved First Aiders, Paramedics and Technician crews, registered nurses, paramedic practitioners and the paramedic Cycle Response Unit. By attending events we are able to deal with injuries and illnesses on scene and ensure patients are discharged to appropriate follow-on care, preventing acute services becoming overwhelmed as a result of large public gatherings. PAS undertakes both private and NHS patient transfer work. In 2008/09 we undertook over We are currently developing our first ever community education programme which will see frontline staff educating the public about how to identify potentially life threatening conditions and what actions to take to save lives Page 15

16 CHAPTER 2 TRUST PROFILE 400 patient transfers commissioned by local PCTs, other NHS Trusts and private hospitals and patients. As part of our commercial training department we provide accredited First Aid at Work courses to a number of external clients, with the capacity to run bespoke courses for AED, oxygen and entonox and first aid emergency care training for specific needs such as cave rescue and fire and rescue. We are commissioned by Surrey Police to provide a 24/7 service for urgent and emergency care needs for detained patients located in the four custody suites across Surrey, which provides a source of non-nhs income. This model of care is considered best practice by both the Home Office and local mental health teams. In line with the current contract, we provide two response cars that can be deployed at any time to custody suites across Surrey, staffed by paramedics Emergency Preparedness We are a Category 1 responder under the terms of the Civil Contingencies Act 2004, and as such we have six statutory duties: Assess local risks and use this to inform emergency planning; Put in place emergency plans; Put in place Business Continuity arrangements; Put in place arrangements to make information available to the public about civil protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency; Share information with other local responders to enhance co-ordination; Co-operate with other local responders to enhance co-ordination and efficiency. The Patient Transport Service (PTS) is integral to the resilience of the Trust in terms of providing flexibility in the event of either a Major or Business Continuity Incident. PTS allows an additional pool of vehicles and staff to be available to support the core A&E activity in the event of a crisis Performance The Annual Health Check conducted by the Care Quality Commission assesses performance on two criteria; Quality of Services and Quality of Financial Management. Our performance against these two components is shown in Table 2.4. A detailed breakdown of our performance against the Quality of Services component is provided in Table 2.5. Table Annual Health Check ratings 2006/ / /09 Quality of Services Fair Good Fair Quality of Financial Management Fair Good Good Page 16

17 CHAPTER 2 TRUST PROFILE Table Annual Health Check: Quality of Services performance 2008/09 Quality of Services Existing Commitments Almost met 75% of Category A calls meeting 8 minute standard 75.2% (achieved) 95% of Category A calls meeting 19 minute standard 96.9% (achieved) 95% of Category B calls meeting 19 minute standard 94.6% (underachieved) Time to reperfusion for patients who have had a heart attack National priorities Experience of patients / users Management of acute myocardial infarction Management of asthma Management of hypoglycaemic attacks Management of patients with cardiac arrest Management of stroke and transient ischaemic attacks NHS staff satisfaction Core standards assessment Fair Achieved Fair Achieved Underachieved Achieved Failed Achieved Achieved Underachieved Fully met 42 core standards apply to ambulance trusts in Full compliance declared We were disappointed in the deterioration in our performance for the Quality of Services criteria, although this mirrored the trend across the ambulance sector, identifying some need for improvement in data analysis and reporting at a national level. We aim to improve on our rating in 2009/10, by focussing on the following areas: Existing commitments Category B performance: Work is ongoing to improve delivery of the Category B target. Analysis of the Category B incident level is reviewed daily as part of the operations management processes. National priorities Clinical indicators (including Management of acute myocardial infarction and Management of hypoglycaemic attacks): Work is underway at a national level to influence the approach used for analysis of the Clinical Performance indicators, and we are involved with these discussions with other ambulance trusts and representatives from the CQC. In addition, we are introducing a new Patient Clinical Record (PCR) to facilitate data capture relating to clinical outcomes. Our performance on the clinical performance indicator (CPI) relating to Return of Spontaneous Circulation (ROSC) shows that the Trust is performing significantly above any other trusts nationally (see Figure 4.6). National priorities staff satisfaction: We have established a working group to address areas of weakness within the staff survey, including staff satisfaction. The Trust has a good history of sustaining and improving performance against standards, as evidenced in Table 2.6. National performance targets are also monitored by the Trust at PCT level. Page 17

18 CHAPTER 2 TRUST PROFILE Table National Performance Targets: Existing Commitments Standard Target 2006/ / /09 75% of Category A calls meeting 8 minute standard 75% 75.1% * 77.2% 75.2% 95% of Category A calls meeting 19 minute standard 95% 97.6% 97.6% 96.9% 95% of Category B calls meeting 19 minute standard 95% 93.8% 95.2% 94.6% * The 2006/07 figure for Category A performance uses a different method for measurement Table Annual Health Check: Quality of Financial Management Quality of Financial Management 2007/ /09 Financial Reporting Level 3 Level 4 Financial Management Level 3 Level 3 Financial Standing Level 3 Level 4 Internal Control Level 3 Level 3 Value for Money Level 3 Level Contractual information A&E services are commissioned on a consortium basis from the eight PCTs in the South East Coast region, along with Hampshire PCT and Berkshire East PCT for a small geographic area within Berkshire and North East Hampshire on the Surrey County boundary. The PCTs have financial and risk sharing arrangements in place, which are overseen by the Specialist Commissioning Group (SCG) Board, which has senior representation from all the commissioners. Day to day management of the contract is via a lead commissioner, which is hosted by West Kent PCT. The contract is managed through monthly meetings between the trust and representatives from all the commissioning bodies. We also work with individual commissioners on a number of local initiatives and developments which reflect individual commissioning priorities. A Commissioning Strategy for Ambulance Services has been developed and was signed off by the SCG in December Alongside this strategic document there is an In line with our workforce and fleet strategies, last year we recruited more than 200 new frontline operational staff as well as additional Emergency Dispatch Centre staff, including emergency call takers. We also deployed 37 new ambulances and 26 new rapid response vehicles more staff and more vehicles responding to local patients annual commissioning plan, linked to the PCTs Local Delivery Plans. This defines the activity and specific changes required for the service to enable a contract to be agreed by the lead commissioner (NHS West Kent), through the SCG Board on behalf of all parties. PTS has historically been commissioned by other health service providers such as acute, mental health and community trusts. From April 2009 responsibility for the commissioning of Page 18

19 CHAPTER 2 TRUST PROFILE PTS moved to PCTs and is aligned with the introduction of a national contract for both A&E and PTS services. There are no plans for ambulance services to become subject to tariff arrangements at the present time. We are working with commissioners to develop the framework that will allow the introduction of variations to price paid based on type of patient, clinical outcome and appropriateness of the response. With PCT Commissioners taking over the funding for PTS from hospital trusts from April 2010, it is expected that PTS contract management will be placed higher on commissioning agendas. Commissioners have committed to continue to fund PTS until March 2010 and PTS is likely to be put out to tender during The trust engages with a range of stakeholders to develop services that meet the needs of patients, and support government and commissioners priorities. We are uniquely placed as a provider which, on a daily basis, interfaces with all elements of health and social care. Commissioners are placing greater emphasis on our role in leading change across the healthcare system. This can be on specific issues, such as the development of new patient pathways for dealing with conditions such as cardiac, stroke and trauma, and also on leading the health services response in emergency planning and preparedness. Alongside these specific issues, it is increasingly recognised that the trust has a pivotal role in developing and supporting wider-ranging strategies that will change the provision of urgent healthcare. Other procurement arrangements In our procurement activities we take advantage of collaborative procurement through the Office of Government Commerce (OGC), national and local procurement hubs, and other collaborative framework contracts to achieve best value for money. Payroll and pension services from the three legacy ambulance trusts have been merged following market testing, and this has been outsourced to Equiniti ICS, who hold a strong market position and provide services to many NHS organisations. NHS Shared Business Services is a 50:50 joint venture partnership between the Department of Health and Xansa, a leading provider of shared financial and accounting services from the private sector. NHS SBS combines knowledge and experience of the NHS with best practice processes and experience of world class technology from the private sector. This combination enables operational processes to be delivered more cost-effectively, thereby enabling the Trust to save money over the true cost of its in-house operations. Joint venture information The Trust currently has no formal joint venture agreements but active partnership working is an important feature of the Trust s way of working. Meeting peaks in demand In order to support peaks in demand that cannot be resourced appropriately from regular frontline resources we have arrangements in place with the Voluntary Aid Societies including British Red Cross and St John Ambulance. Their services can be flexed to support PTS provision, transfer of pre-assessed patients to hospital and front-line emergency responses. Formal arrangements are in place to ensure that clinical governance standards are met for all partnership arrangements. Capacity Management System (CMS) The Capacity Management System is a service that is hosted by SECAmb, and provided to NHS partners. This is funded by Service Level Agreements and each organisation funds this on Page 19

20 CHAPTER 2 TRUST PROFILE a capitation basis, with a total annual turnover of 794,627 for 2009/10. It is governed by a strategic board, which is constituted of five Executive Directors from the 11 ambulance trusts. This board reports to the National Ambulance Trust Chief Executive s Board. There is a consortium agreement to ensure that the risks to SECAmb are minimised. Page 20

21 CHAPTER 3 STRATEGY 3. Strategy This section: Articulates our vision and strategy Outlines the systems we have in place in the Trust to deliver our strategy Explains why we want to become a Foundation Trust and how this will effect how we operate Describes the outcomes of our FT consultation process The key points from this section are: We have a robust strategy to support delivery of our vision Our strategy is to strengthen and extend our core activities The principles of high performance are understood and embedded in the organisation We have undertaken a comprehensive public consultation, and now have a public membership of 2, Trust vision Our vision is to match and exceed international clinical excellence through embracing innovation and putting the patient at the heart of everything we do. Match and exceed international clinical excellence Patient outcomes for life threatening conditions such as stroke, trauma and heart disease are not as good as they could be in this country when we compare to centres of international clinical excellence. This is unacceptable for our patients. We therefore aspire to compete with the best healthcare organisations worldwide to deliver world class outcomes for our patients. Embracing innovation Matching and exceeding international clinical excellence means changing the way we work now. We need to embrace innovation; learn from the best, adapt it to make it better, be the best. Putting the patient at the heart of everything we do We exist to serve our patients; everything we do must have them at the core. In five years time, we will be: The first point of contact for the majority of patients seeking unscheduled urgent healthcare advice or treatment; Changing the way services are commissioned with an emphasis on payment for results; A key player in the delivery of whole health economy savings by reducing the duplication of healthcare offered Strategy Our strategy to achieve our vision is to strengthen and extend our core activities. Page 21

22 CHAPTER 3 STRATEGY 92% of our income funds A&E activity and the three services that we provide in this area; Hear and Treat, See and Treat and See, Treat and Convey are our core activities. Our strategy is to strengthen these services by adopting the principles of high performance: Response time reliability responding to the patient quickly Clinical effectiveness providing them with the right advice, making them better, or taking them to someone who can Customer satisfaction providing them with a service that is easily accessible, treating patients with dignity and respect Economic efficiency achieving all of this whilst delivering whole health economy savings by reducing duplication of effort To implement our strategy, we have identified six strategic objectives underpinned by key service developments. Figure 3.1 details the relationship between our vision, strategy, strategic objectives, and service developments. Due to Make Ready Depots A&E staff are no longer required to clean, stock and refuel their vehicles at the start of every shift it is estimated that this takes 72 minutes per shift. This has a massive impact on UHU and drives our cost efficiency programme. Page 22

23 CHAPTER 3 STRATEGY Figure Strategy Focus Strategy: Our strategy is to strengthen and extend our core activities Response time reliability Clinical effectiveness Customer satisfaction Economic efficiency Strategic Objectives Improve on the Trust s performance standards and reduce variation Deliver excellence in leadership and development Improve access and outcomes to match international best practice Improve satisfaction and experience for all stakeholders Be an organisation that people seek to join and are proud to be a part of Convert all available pounds / resources to maximise patient benefit Service Developments Improving IT systems Make Ready Development of Hear & Treat Implementation of the Front-Loaded Service Model Page 23

24 CHAPTER 3 STRATEGY 3.3. Measuring achievement of our Strategy The concept of high performance is based on the principles of Total Quality Management, and focuses on converting the public s expectations into something that is tangible to manage and deliver. High performance seeks to create a system that delivers efficiency and simultaneously enables quality to be improved. To implement high performance for our provision of A&E services, we apply the concept of Unit Hour Utilisation (UHU). This is a complex economic model that is used to calculate productivity, resource utilisation and cost, and enables us to accurately manage the resources required to deliver our services efficiently. The UHU provides an efficiency measure, calculated by considering the number of resourced hours, and the amount of activity undertaken within the resourced hours. Based on extensive examination and monitoring of historical activity data, we are able to identify the factors that impact on the UHU, and consider how these can be best controlled and managed in order to maximise efficiency and provide value for money. Demand for emergency services is surprisingly predictable, both temporally and geographically. We can very accurately predict the time and general area of calls, and the challenge is to ensure the right amount of resource is on duty at the right time and in the right place to meet this. UHU informs us, for any given operational area, what the utilisation needs to be to deliver the required response times. The UHU is used to establish the resources required to match the ever changing fluctuations in demand, ensuring neither too many (money wasted) nor too few (response performance compromised) are available to respond to patients when they are required. Unit Hour Utilisation allows us to operate within defined tolerances to deliver operational and financial performance; we have therefore set the UHU levels we plan to deliver over the next five years to ensure that we are a high performing Trust. Implementation of high performance within the organisation will be delivered through a process of continuous improvement. This will include, but is not limited to, using IT enablers; a comprehensive estates review, including identification of appropriate locations for response posts; evaluation of the configuration of single and double-manned vehicles Aim for NHS Foundation Trust status Foundation Trust status is a mechanism that enables us to deliver the system and cultural change required to become a world class provider of emergency and urgent care. This is because the benefits that can only be realised as a Foundation Trust are key enablers to achieving our vision and strategic objectives. These are: Greater autonomy from central control enabling us to fast-track innovations into practice at a more rapid pace; Ability to retain surpluses, allowing increased investment in key service developments to achieve cultural and system transformation; Greater involvement and ownership for local communities, staff and stakeholders a structure designed to be first and foremost responsive to the needs of local patients; We measure efficiency in the system by looking at unit hour utilisation (UHU). By utilising the hours better ie responding or conveying for as many hours in a shift as possible, we are able to save money thus generating savings without sacrificing on quality of service Page 24

25 CHAPTER 3 STRATEGY Long-term financial and business planning future-proofing the organisation and our vision in an austere financial climate; Greater flexibility to respond quickly and competitively to commercial opportunities e.g. geographic expansion or market growth; Development of a representative membership will provide a significantly larger pool of engaged local people wanting to be involved with their local ambulance service thus increasing involvement in the development of future services. A representative membership will also provide us with a greater insight into the varied needs of our local communities; The creation of a Council of Governors that will ensure that the Trust is held to account for meeting the needs of local people through the delivery of our plans that members have helped to shape Consultation process We undertook our consultation from 25 July to 16 October 2009 inclusive. Throughout the 12 weeks we engaged and consulted patients, members of the public, staff, community groups including seldom heard groups, NHS partner organisations, councils, Health Overview & Scrutiny Committees (HOSCs) and local authorities. 809 responses were received in total, 779 using the feedback pro forma (hardcopy, online or electronic voting) and 30 via s / letters. Table 3.1 details the breakdown of respondents by background. Table Background of respondents Background of respondent Number of respondents from this background % of total number of respondents Member of the public / patient % Representative of an NHS organisation 46 6% Employee of SECAmb % Volunteer of SECAmb 29 4% HOSC / Local authority member 45 6% LINk member 45 6% Representative of another organisation 53 7% Overall the response was generally positive, with the majority of respondents in favour of all the proposals put forward. Most questions received a 70-90% positive response rate, however, for the questions about the minimum age for members or governors, the positive response rate dropped to around 60%. See Appendix 4 for a more detailed breakdown of responses. Table 3.2 details the key issues identified during the consultation and the Trust s response. Page 25

26 CHAPTER 3 STRATEGY Table Issues identified during public consultation and Trust response Key issues identified No minimum age for members: The majority of respondents (59%) were in favour of no minimum age for membership; however a considerable proportion (32%) felt there should be a minimum age limit. The arguments centred on the level of contribution that younger children would be able to make, and how children and young people could be engaged. For those who believed that there should be a prescribed age limit, opinion on what the age limit should be varied, with most in favour of age 16 or 18. Minimum age of governor should be 16: The majority of respondents (63%) were in favour of the minimum age for governors being 16, with 31% opposing this view, and suggesting it should be 18 or 21 instead. The rationale for increasing the age limit from 16 was around the experience of individuals to take on the governor role, as well as commitment from young people still in full time education. Representation on Council of Governors: The majority of respondents (70%) were in favour of the proposals for the Council of Governors. Amongst those opposing (16%) the main concern was around the representation of appointed governors and whether one governor could adequately represent all the local authorities in the area or similarly all the PCTs or voluntary sector. There was a strong feeling that the Council needs to ensure accountability, transparency and openness. Trust response There will be no minimum age for membership, but members must be 16 years of age to vote in governor elections. The minimum age for a member to stand as a governor is 16 years of age. There is no increased representation on the Council of Governors from the proposed structure. Membership analysis We have set a target of recruiting 4,500 public members by 31 March This represents 0.13% of the eligible population that we serve. As at 1 March 2010, we had recruited 3,133 members. We currently have a broadly representative membership in terms of ethnicity. However, members of Bangladeshi and Chinese ethnic groups are under-represented. There is an over-representation of women, whilst under 18s are under-represented. The Trust has commissioned a database to mange member information which we use on a regular basis to monitor the representativeness the Trusts membership. There is a robust action plan which details plans to address underrepresented groups. Stakeholder analysis The Trust employs a Stakeholder Relations Manager within the Communications and Engagement department. Figure 3.2 shows an external stakeholder map developed using the influence / interest model (What to do when stakeholders matter: A guide to stakeholder identification and analysis techniques, John M.Bryson, 2003). This analysis informs SECAmb s overarching communications and engagement strategy. Page 26

27 Influence CHAPTER 3 STRATEGY Figure Stakeholder analysis High National media Acute trusts Police force Local Authority CEOs Councillors DH Leadership team NHS South East Coast Specialist Commissioning Group PCTs Unions HOSCs Local media CQC Audit Commission MPs Ambulance Service Network Fire & Rescue Service Social Services Mental health trusts General public Professional bodies Seldom heard groups Patient & public representatives Community responders Voluntary organisations Other ambulance trusts Low Low Interest High Page 27

28 CHAPTER 4 MARKET ASSESSSMENT 4. Market Assessment This section: Describes the market within which the Trust operates Recognises the influencing factors that impact on the environment in which we operate Outlines how our strategy contributes to the overall objectives of the health economy Provides analysis of our key competitors Indicates the market share we hold in the markets in which we operate The key points from this section are: The Trust has a good understanding of the market and competitive influences that will affect it Demand for healthcare services is causing growth in all markets; this is most significant in the unscheduled urgent care market 4.1. Description of local health economy We provide services to the South East Coast (SEC) health economy, incorporating the counties of Kent, Surrey, Sussex and part of north east Hampshire on the Surrey County boundary. Within the region there are eight PCTs,12 acute trusts (four are FTs) and four mental health and specialist trusts (two are FTs). We are coterminous with NHS South East Coast. See section 4.3 for information about local health economy objectives. The region breaks down into 80% rural and 20% urban ( ) This impacts upon where demand is generated. In planning volume and location of unit hours, rurality is considered to ensure consistent compliance with response time targets. Within the region there are some of the busiest stretches of motorway in the country (e.g. M25) as well as major transport links (e.g. Gatwick airport, Channel Tunnel) and as such we are active members of both local and regional resilience forums alliances consisting of category one responders (police, fire and ambulance) as well as other agencies including the Coast Guard, Highways Agency and Health Protection Agency to ensure robust preparedness in the event of a major incident. We serve a resident population of c4.3 million people (Office for National Statistics (ONS) mid 2008 population figures, ) which swells during the summer months due to tourism in coastal areas; this results in an activity increase during these months (see Figure 4.1 and Figure 4.2) which we manage through deploying additional hours as with any busy period. SECAmb values diversity, equal access for patients and equality of opportunity for staff. We aim to create the best possible quality of life for those we serve by delivering a high quality service to all members of our community. Page 28

29 CHAPTER 4 MARKET ASSESSSMENT Figure Emergency calls by month for ,000 58,000 56,000 54,000 52,000 50,000 48,000 46, ,000 42,000 40,000 Source: info.secamb.nhs.uk Figure Emergency responses by month for ,000 53,000 51,000 49,000 47,000 45,000 43,000 41, ,000 37,000 35,000 Source: info.secamb.nhs.uk Page 29

30 CHAPTER 4 MARKET ASSESSSMENT Population in the SEC health economy is increasing and this trend is set to continue as regeneration projects come on stream during the next 20 years including the construction of circa 58,000 new homes in West Sussex by 2026 and the development of the North Thames Gateway in North West Kent and Medway in the next 15 years (Healthier people, excellent care, NHS South East Coast, 2008). Population increase will directly impact upon demand for our services. Table 4.1 sets out the current population breakdown by PCT area. Table Population breakdown by PCT area PCT area All ages (mid 2008) Children (0-15 years) Working age (16 64M/59F) Older people (65M/60F and over) Brighton and Hove City East Sussex Downs and Weald Eastern and Coastal Kent Hastings and Rother Medway Surrey 1, West Kent West Sussex TOTAL 4, , Source: Mid-2008 Primary Care Organisations for England, Office of National Statistics, 1 October 2009 The SEC health economy has an above average population of older people with 21.3% of the overall population being over 65(M)/60(F), the average is 19.36% (Mid-2008 Primary Care Organisations for England, Office of National Statistics (ONS), 1 October 2009). The national trend signifies an ageing population; this will impact upon demand for our services; see Section 4.2 for more detail. The health economy performs comparatively well in terms of key public health issues such as obesity, smoking and healthy eating. However, more than one in five adults in the region are smokers and a similar proportion of adults in some areas are binge drinkers; nearly one in five adults living in the health economy are obese (Healthier People, excellent care, NHS South East Coast, 2008). This has implications for the types of conditions that present to us in particular for life threatening episodes linked to unhealthy lifestyles, long term cardiovascular or pulmonary diseases and for accidents and incidents related to the overconsumption of alcohol. There is inequality across the region in terms of access to GP services. In 2008 GPs had an average patient list of 1,680, however, GPs are not evenly distributed across the region which can result in frustrated access (Healthier People, excellent care, NHS South East Coast, 2008). This presents an opportunity for us; by providing a solution to commissioners in the form of paramedic practitioners who can work alongside GPs and support them by conducting home visits freeing up GPs to conduct surgeries. This is cost effective for the health economy whilst providing a more timely service to local patients thereby improving care and experience. Page 30

31 Calls / Conveyances ('000) CHAPTER 4 MARKET ASSESSSMENT Inequalities also exist in death rates for major killers such as stroke and heart disease. Early deaths from these conditions are higher than the national average in Medway and lower in large parts of the rest of the health economy (Healthier People, excellent care, NHS South East Coast, 2008). This means that the provision of pathways to manage early intervention following vascular compromise will be essential to reduce the death rate and also prevent significant disability following these events, which can be costly to manage and devastating for the patient and their family Key factors driving demand Historically, ambulance services have not been classified as providing urgent and unscheduled care, however, trend analysis shows that this is where the increase in demand has been generated over the last decade. Emergency calls nationally have increased per annum by between 5 and 7% (see Figure 4.3), however, conveyances to hospital have not increased at the same rate signifying that the increase in 999 volume is a result of patients calling with less serious healthcare needs typically falls (22% of SECAmb s overall calls in 2008/09, the largest proportion of emergency calls), exacerbations of long-term conditions (e.g. asthma, diabetes) and minor injuries and illness. Figure Number of emergency ambulance calls / conveyances Calls Conveyances Year Source: NHS Information Centre The following factors inform us that this trend is set to continue in the future: Long-term conditions There are 15.4 million people living with a long-term condition in England ( 2009). Numbers are expected to rise due to an ageing population and unhealthy lifestyle choices. This means more people requiring urgent and unscheduled care services. Page 31