Key service developments

Following analysis of the market in which we operate, we have identified key service

developments which aim to support our strategy to strengthen and extend our core business. These describe what we intend to do, over the next five years, to improve the services we currently provide, in response to the changing environment. These play an important role in improving UHU and contributing to delivery of our Cost Improvement Programmes (CIP):

1. Improving Information Technology systems

Information Management and Technology are regarded as an enabler to achieve the outlined strategic direction. It is crucial that the Trust invests in an infrastructure that is innovative, intuitive and supports more efficient ways of working including:

Single Computer Aided Dispatch System (CAD)

Allows the Trust to record relevant information relating to each 999 call and subsequent activity that occurs. It enables the recording of patient activity, monitors achievement of targets and supports dispatchers in the deployment of the most appropriate care to patients. The key benefits of the CAD is improved operational efficiencies, improving standard working practices,

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and help focus on high performance, allowing more effective and efficient deployment of staff with improvement of performance against response targets and better clinical outcomes; Data quality will be improved due to the consistent approach to recording of information.

Single Mobile Data System (MDT)

MDT terminals are placed in every vehicle which enables them to be tracked and dispatched by staff working in the EDCs. Currently, the Trust operates three separate MDTs which are area specific. Each of the CADs operates with its counterpart MDT resulting in vehicles being restricted by geographical county boundaries. With the introduction of a single CAD the same is required of a single MDT. By doing this vehicles will be used more efficiently.

Ambulance Radio Programme (ARP)

The ARP aims to modernise the radio systems used by UK ambulance services, to ensure interoperability with other emergency services. The new radio system will allow clearer communication between staff and EDCs and, crucially, other agencies.

Single 999 telephony system

The 999 telephony system will be migrated to a new platform that will allow skill sets and

individuals to be used for call answering no matter which call centre they sit in and will therefore improve patient experience and call centre efficiency.

Access to information through a single portal

It is vital that the Trust continues its work to provide performance and routine information to all its users via a simple, intuitive web portal. We will continue to offer more advanced and

integrated reporting tools that further assist operational managers in performing their roles. The CAD, MDT, ARP and the 999 telephony upgrade will give us the ability to virtualise the entire call centre operation. That virtualisation allows the Trust to grow our capacity, both numerically and geographically with minimal investment and hence improve resiliency, efficiency and our effectiveness of managing emergency responses

2. Make Ready

Within the Trust there are 63 ambulance stations that are used as bases for vehicles and crews. Crews have responsibility, at the beginning of each shift, for preparing their vehicle, including an audit of all medical equipment, cleaning the vehicle and checking that all relevant equipment is in working order.

The Make Ready principle differs significantly from this traditional approach. Make Ready is a vehicle and equipment preparation programme designed to minimise cross infection, maximise patient safety and improve efficiency. All of the vehicle preparation is undertaken by specially- trained, non-clinical Make Ready Operatives (MRO) staff, allowing clinicians to focus on the delivery of high-quality patient care.

The introduction of Make Ready brings many benefits, both for patients and staff. As vehicles are cleaned for each shift to a consistently high standard the process significantly reduces the

SECAmb has a nationally recognised

“best of breed” information system that

it uses to integrate data from a myriad of

sources, from the scheduling systems

to optical character recognition

systems. The outcome is a simple portal

that users from any part of the

organisation can see and query

information that is relevant and

meaningful to them. The system, known

locally as “info.secamb”, gets

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risk of cross-infection, benefiting both patients and staff alike. By employing specially-trained teams of MROs to carry out vehicle preparation, this also frees up clinical staff to spend more time treating patients, releasing more resources into the front line and therefore improving both quality and the UHU.

3. Development of Hear & Treat

Hear and Treat refers to additional clinical triage at the point of receiving a 999 call and involves providing clinical advice to patients over the telephone. This ensures that patients receive appropriate healthcare advice quickly, and are directed to the most appropriate service which will best meet their clinical needs.

Hear and Treat aims to increase the clinical desk capacity across the Trusts EDCs and develop a model of care which will reduce the number of front line ambulance resources required, increase the clinical support available to support front line crew and reduce the number of A&E attendances for patients with clinical needs which could be better met by an alternative service. This will give the Trust a number of benefits including the overall reduction in costs to both the Trust and local health economy. The development fits with national, regional and local

strategies to reduce attendances at A&E departments for patients whose needs could be better met with an alternative response, to improve patient s outcome and satisfaction.

4. Implementation of the Front-Loaded Service Model

The clinical concept of operation for the UK Ambulance Service is evolving at an increasing pace with a greater emphasis upon clinical treatment rather than the transport function. This has driven the need to expand the clinical capability of ambulance professionals, leading to a fundamental change in priorities with patient assessment, treatment and, where necessary, appropriate referral, becoming more common, with less demand for transport, these changes are substantial, both operationally and in regard to professional development for paramedics, who have increased responsibility.

The underlying principle of the Front Loaded Service Model is that initial patient assessment is undertaken by an Allied Healthcare Professional, ideally one with advanced qualifications, who is able to determine what the patient needs, and provide treatment or referral to the more appropriate care pathway accordingly.

Through the development of FLSM, it will be possible to more appropriately match staff skills to vehicle provision to ensure a better utilisation of resources and therefore be more cost efficient. This will enable more intelligent dispatch in the future reducing unnecessary duplicate

responses to individual incidents.

In addition to the service developments, we have identified a number of actions that will enable us to improve the UHU, both within 2009/10, and beyond. These will improve efficiencies and contribute to the delivery of CIP:

Rota reviews

By reviewing rotas on an ongoing basis we will be able to establish baseline rotas and

continually align staff to match demand by hour of day and day of week. Overtime will be used to address the variance experienced seasonally. Significant rota review will commence

following the implementation of Make Ready. Deployment plans

These plans set out where we position our vehicles, based on operational demand. By continual review of these plans, in particular, the location of response posts, we are able to

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identify the optimum place for vehicle position to meet demand, thus improving response time reliability. This facilitates more efficient tasking of vehicles.

Performance management Through the full implementation of team-based reporting, we are able to review individual staff performance in relation to key performance indicators that are directly linked to high

performance, identifying and addressing areas of weakness and commending and learning from good performance. This will enable incremental

improvements across the organisation. Community first responder schemes

By introducing further community first responder schemes in identified areas across the organisation,

we will be able to provide a quicker response to patients, in particular in rural areas; this leads to an improvement in performance and clinical effectiveness.

Improved hospital turnaround

By working to meet the target handover time of fifteen minutes, we are able to not only improve the patient experience, but also reduce the number of hours “wasted” within the system, thus driving up UHU efficiency. This work is being addressed as a whole health economy issue and PCTs are considering implementing penalties for acute Trusts in order to ensure their co- operation in achieving this target.

In 2008/09 we increased the

number of SECAmb

community responders to

more than 890 and installed

more public access

defibrillators (PADs) at sites

across the region bringing up

the total to 888 – both of these

initiatives are vital in

improving survival rates for

patients suffering from

cardiac arrest

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