Information & Performance Cells

A MODERN AMBULANCE SERVICE

6TH FEBRUARY 2013

Performance Cell

Who are we? West Midlands Ambulance Service NHS Foundation Trust 5.4 million population Over 5000 square miles – 80% rural

2,200 incidents per day 1,400 patient journeys per day PTS operations

Fleet of 850+ vehicles 4 Air Ambulances 4,000+ staff, 1,500 volunteers

Performance Cell

Trust Vision, Values and Objectives

VisionDelivering the right patient care, in the right place, at the right time,

through a skilled and committed workforce, in partnership with local health economies

Achieve Quality and Excellence

Accurately assess patient

need and direct resources

appropriately

Establish market position

as an Emergency Healthcare Provider

Work inPartnership

Service Delivery Objectives

Deliver Service Improvement Increase Efficiency Develop our

Workforce

Transform our Technology

Infrastructure

Values

•World Class Service

•Patient Centred

•Dignity and Respect for All

•Skilled Workforce

•Teamwork

•Effective Communication

Strategic Objectives

Performance Cell

Position before Pathways introduction

Triage Process CSD NHSD

4%

96% Response

R1,R2 G2 G4

68% To Hospital

Performance Cell

Red 1 = Life Threatening Calls

Red 2 = Potentially Life Threatening

Green 2 = Not Life Threatening

Green 4 = Potentially suitable for treatment within the wider health community

Performance Cell

Clinical Triage System

NHS Pathways introduced in 2011

Improved clinical assessment during call

Increased volumes signposted to alternative care pathways

‘Hear and Treat’ increases via Paramedic Triage

Directory of Services (DoS) to link in with wider health community

Allows for more appropriate use of other resources

Performance Cell

Process since Pathways Introduction

Performance TargetsCall Colour Response Target

Red 1 75% in 8 mins

Red 2 75% in 8 mins

Green 2 90% in 30 mins

Green 4 90% triage in 60 mins

Performance Cell

Alternative PathwaysDirectory of Services Patients go to the ‘Right Place, First Time, All of the Time’

Improved patient journey and experience

Better use of available services

Cost base for assessment and referral to care much reduced

Inappropriate ambulance journeys avoided

Reduction in 999 conveyances and A&E attendances

Gives commissioners world class data on what services are needed

GAP analysis aims to improve the quality of the services available by supporting intelligent commissioning and decision making for services redesign.

Performance Cell

Operating Model

Historically: ‘Traditional’ ambulance stations Inappropriate for increasing activity levels Expensive In need of modernisation

Transformation to: Hub and Spoke model Benefits

More efficient use of resource Fleet maintenance Better facilities for staff

Performance Cell

Current Operating Model

HUB and SPOKE model Pioneered in Staffordshire Centralisation of Operations

Hubs: ‘Make Ready’ system used AFAs prepare vehicles Reduced costs/downtime

Spokes: Community Paramedics Advanced skillset Improve response efficiency

Projected completion: 2014

Performance Cell

Patient Treatment

Aim: Deliver the right patient care, in the right place, at the right time

Where were we…

98% of patients received an ambulance response

68% transported to hospital

Skill mix: 52% paramedic

Resource mix:

Ambulance: 80%; RRV: 10%; Other: 10%

Performance Cell

Where are we now - Treatment Types

63% - Transported to hospital

31% - Treated on scene

6% - Treated in the wider health community or over the phone

‘Falls’ account for the greatest proportion of emergency activity but 44% of ‘Falls’ are treated on scene. Could this group of patients be treated elsewhere in the community?

Only 49% of ‘Assaults’ are taken to hospital. Could we improve the efficiency of our response?

Performance Cell

Working with Hospitals Key relationship within health economy

Ensure only appropriate patients are taken to hospital

Quick patient handover essential to keep system moving

Improving handover completion:

Hospitals aren’t penalised for any delays in the crews booking clear from hospital and vice versa

Performance Cell

Hospital Turnaround

Target: 30 minutes Handover: 15 minutes; Crew clear: 15 minutes Continuing improvements in use of handover button

SOC service within the EOC acts as a central intelligence hub between Acutes and WMAS operations.

Delays at hospital deplete resource availability and hinder the ability of the Trust to provide a safe service.

Use of 14 HALOs at the Region’s hospital aims to improve turnaround efficiency.

Publication of daily reports to WMAS extranet increases visibility of turnaround issues.

Performance Cell

Looking Ahead: 111

Improves access to local NHS healthcare services

Targets patients in non-emergency situations, signposting them to urgent care

Safety route built in to direct emergency patients to 999 services

Continuing work to improve safety and reliability of this link

Performance Cell

Looking Ahead: 111

111 and 999: System allows for direct transfer of patients

requiring an ambulance response onto 999 dispatch stack without the need to speak to a 999 call handler

Modelling estimates that 10% of all 111 calls will require an ambulance response, increasing typical 999 activity by 18-20% (300-500 extra incidents) per day

Performance Cell

Looking Ahead: Working with CCGs Ensure the CCG understands the new operating model and strategic direction of WMAS

Ensure the future direction is integrated into the future planning of Commissioning group modelling

Working to enhance local partnership, working to enable shared locations and/or services to reduce costs

Develop alternative and appropriate services for patients, utilising NHS Pathways

WMAS to share knowledge and experience to enhance local service delivery to patients and healthcare professionals, evidence based through available data

Performance Cell

Any Questions

?