Performance Position July 2014. Delivering the right care, at the right time, in the right place CONTEXT Ambulance service significant activity increase

Performance Position July 2014

Delivering the right care, at the right time, in the right place

CONTEXT

• Ambulance service significant activity increase nationally• Increase in complaints and untoward incidents• A&E attendances significantly up across the system• Rising GP referrals for attendance/admission at hospital• Hospital admissions of elderly frail biggest rise• Clinical capacity within system under pressure• Hospitals frequently asking for diverts/deflections


1. In the past year, NWAS have delivered reductions in vacancies, improvements in abstraction rates and improved performance delivery, but do not have the capacity currently to consistently achieve performance.

2. Funding increased levels of NWAS capacity may achieve short term improvements in performance, but is not a sustainable solution, and does not address the significant budget cuts that are coming to the North West.

3. Cost reduction opportunities (slide 24) do exist within NWAS, but some identified savings have already been allocated to the required CIP programme.

4. The efficiency gains that NWAS have direct and sole control over (resource availability) are not enough to deliver performance for Cat A & B targets. Health economy collaboration will be required to act on the remainder of the opportunities.

5. Sustainable improvement requires changing the way the urgent care system operates.6. Scenarios 1-4, and cost reduction opportunities can be used to “buy” the short term

headroom in time and resources required to deliver the larger, strategic changes.

Cap Gemini Capacity Review conclusions 2010


This year Month Call Pick Up R1 R2 A19

April 90.2% 75.7% 75.8% 96.2%

May 86.9% 73.5% 74.7% 95.6%

June 81.2% 71.5% 73.2% 95.4%

July to date 78.5% 67.9% 68.7% 94.0%

Year to date 83.7% 72.2% 73.2% 95.3%

• Average 999 daily volume risen from 3199 to 3644• Average hospital turnaround risen from 27.5 to 29.0 minutes (30 x12hr p/w)• Increase in patients waiting for both calls and incidents• Increase in multiple staff pressures (pensions/pay award/USH/workload)• Known financial and system pressures (CIP’s/reconfigurations/resources)


2013/14 – 3055April 14 – 3199May 14 – 3233June 14 – 3264July 14 – 3643Last week – 3790Friday - 4053

Red 1 – last week more than NYE week

Red 2 – 2 of last 4 weeks higher than both last xmas and NYE weeks

Cat A – 3 of last 4 weeks higher than NYE week, last week higher than Xmas week

999Calls

Incidents


What’s it mean?

• Red 1 and Red 2 75%– April both < 8 mins– May < 8m 15sec/ < 8m 5sec – June < 8m 25sec/ < 8m 20sec

• Green 1 in 20 minutes– 80.8% to 79.8%

• A19 95%– April/May < 18 mins– June < 18m 30s3c

• Green 2 in 30 minutes– 80.8% to 69.4%


http://longerlives.phe.org.uk/

Worst

Worse than average

Better than average

Best

Overall premature deaths in Englandby Ambulance Service 2009-11


Doing Now• Utilising additional external monies for deferring

planned CIP’s and additional operational resources• Operating at REAP 3 and deferring training • Additional productivity within the Urgent Care Desk

with an increase in hear & treat outcomes• Changes to processes and procedures allowing for

non-deployment of resources and utilising ‘green cars’ with an increase in see & treat outcomes

• Local collaborative initiatives e.g. AVS/CRIT


CCG presentation to AGMA on key characteristics of Integrated Care

models


NWAS – Going from Good to Great

We are about people. We are here to serve the community of the North West and provide care to those patients that need us by delivering the Right Care, at the Right Time, in the Right Place.

We are already a good organisation, with good staff and a good reputation… and we want to be even better. This is our five year plan to be great.

We want to ensure the NHS culture of caring underpins everything we do by:Delivering safe care closer to homeA great place to workCause no harm

NHS Culture of Caring

•Working together for patients•Respect and dignity•Commitment to quality of care•Compassion•Improving lives•Everyone counts


Options Themes – Safe Quality • Utilise NWAS resources differently

– Different LHE models/HART/PTS

• Expansion of no-send and referral parameters– Omega codes/111/Green calls

• Utilisation of other agencies for workload– Community services/AVS/VAS/Fire

• Request new Capacity Review with commissioners

Documents

Performance Position July 2014. Delivering the right care, at the right time, in the right place CONTEXT Ambulance service significant activity increase