Embed Size (px)
Citation preview
WELSH AMBULANCE SERVICES NHS TRUST
2 0 1 7 -2 0 1 8
ANNUAL QUALITY STATEMENT
C O N T E N T S
04 Foreword06 Your Welsh Ambulance Service at a Glance07 Looking Back10 Helping People to Stay Healthy14 Providing Safe Care17 Delivering Effective Care21 Providing Dignified Care25 Providing Timely Care and Services29 Treating People as Individuals32 Our Staff & Resources36 Looking Forward37 A final word & Invitation38 Endorsements & Feedback40 More Information
In presenting our Annual Quality Statement (AQS) 2017-18 we wish to acknowledge our dedicated staff, volunteers and partners for their continued commitment in ensuring we deliver the best care and experiences for the people of Wales.
This AQS aims to bring together all the work carried out this year to continuously strive to improve the quality of access, communication and care across the Welsh Ambulance Services NHS Trust.
We wish to extend our gratitude to our patients, their families, carers and service users who have taken the time to tell us how it has felt for them using our services and receiving care. It is due to their feedback and honest reflections that we are able to consider, learn and improve our services.
F O R E W O R D
We have pleasure in presenting the Welsh Ambulance Services NHS Trust’s Annual Quality Statement 2017/18. This has been an exciting year in our development, although not without its challenges. The winter of 2017/18 was our busiest on record, with the added issues of poor weather and pressures across the wider NHS Wales system. That said, our staff have pulled out all the stops to rise to the challenge, with many going beyond the call of duty to help patients, demonstrating great resilience, care, compassion and sheer determination to do their best for the people we serve. There remains much work to do to ensure we continue to deliver our very best for patients, working closely with the wider NHS in Wales, partners across the public service, our Ambulance Commissioner and Welsh Government. There have been many patients and staff stories presented to our Quality Patient Experience and Safety Committee (QuESt). These have included people’s experiences of our services and the complexities in accessing our services for those with dementia or sensory loss, as well as the experiences of staff responding to people in mental health crisis. The QuESt committee has been active in overseeing developments and results to improve the quality and safety of our services. The committee has overseen improvements in the way we investigate and respond to complaints and incidents. Earlier in the year, the independent regulator of healthcare in Wales, Health Inspectorate Wales, conducted a review of how effective our governance arrangements were in promoting safe and effective care. It found that the Trust had fostered a ‘more open and supportive culture’ and that there had been improvements in the way we manage complaints and serious adverse incidents, in particular the speed that these are responded to. Our Mental Health Improvement Plan to deliver better experiences for patients in mental health crisis and care for our staff has been fully supported by Welsh Government, with funding made available for us put in place a strong mental health structure and deliver appropriate training for staff over the next three years.Ensuring our compliance with health and safety requirements across the Trust has been another focus of our QuESt Committee. All issues that pose a potential threat to patient and staff safety are being accurately recorded and regularly reviewed. We could not present this Annual Quality Statement without acknowledging the contributions of our former Chief Executive, Tracy Myhill, and Chair, Mick Giannasi. We have said goodbye to both Tracy and Mick who, during their time helped transform the service. They started the journey to develop the Trust into a more clinically-led and patient-focused organisation. We now continue our journey, maintaining the momentum to make positive progress as we strive to deliver our best for the people of Wales. We are proud to have achieved so much but acknowledge that we haven’t always delivered the services we would expect or want to, but remain committed to delivering a caring and responsive ambulance service for the people in Wales.
Patsy Roseblade Chief Executive (Interim)
Martin Woodford Chair (Interim)4 5
We place quality at the heart of everything we do, whether that is supporting all our leaders to be vibrant and compassionate, ensuring our services are excellent, in developing strong partnerships or in striving for continued value, excellence and efficiency.
Y O U R W E L S H A M B U L A N C E S E R V I C E A T A G L A N C E
3 MILLIONNumber of people served by the Welsh Ambulance Service
22,639number of immediately life-threatening incidents resulting in an emergency response
540,891Total number of 999 calls received*
3,871,348Number of visits to the NHS Direct Wales website
685,291Number of non-emergency patients transported to hospital appointments
460,185Number of non-
immediately life-threatening
emergency calls
278,647Total number of calls received by NHS Direct Wales
Our staff across all areas of the Trust answering, triaging and dispatching calls from our Clinical Contact Centres, NHS Direct Wales/111 Centres to our Emergency Medical Service, Unscheduled Care and Non-Emergency Patient Transport Service; all have been doing their utmost to respond to the increasing volume of demand from across Wales. Against this backdrop we have continued our journey in becoming a clinically led out of hospital service, treating people in their own homes and keeping them out of hospital ensuring that our resources are there to respond to the sickest patient first.
This year has presented us with some tough challenges. An increase of calls into our control rooms has meant an increase in demand on our emergency crews; we witnessed our service receiving higher than expected calls into our control rooms over Christmas and New Year. On New Year’s Day we responded to more than 1,800 incidents, around 500 more than on a normal busy day. This winter has been our busiest yet. We have experienced a very challenging winter, with demand at record levels due to high numbers of severely ill, frail and elderly people needing urgent treatment.
L O O K I N G B A C K O N 2 0 1 7 - 1 8
C O N T I N U I N G O U R J O U R N E Y
Along our journey we have achieved several important service developments:-
Computer Aided Dispatch system (CAD) In November we implemented our new Computer Aided Dispatch system (CAD) into our control rooms. The CAD is used by our staff to assess 999 calls and dispatch resources. It is important in the way we manage our emergency service. Funding of £4.48m was secured from Welsh Government to update our CAD system. With the new system our clinical contact centres are now able to automatically assign vehicles, crews and other resources to a call automatically – a task normally completed manually by our allocators. 6 7
*All other calls coming into our contact centres were answered and referred to other appropriate services to meet the caller’s needs
Ambulance Quality Indicators Emergency ambulance services are commissioned on behalf of local Health Boards through the Emergency Ambulance Service Committee and the Chief Ambulance Service Commissioner. We have continued to provide quarterly updates that are published on our Ambulance Quality Indicators (AQIs).
The data looks at specific areas such as clinical care, appropriate interventions and patient flow. They aim to help people understand how we are performing across the 5 Step Ambulance Care Pathway. Mortality Review The Trust has developed a process and platform to carry out mortality reviews. The purpose and intention of a mortality review is to consider patients who were either alive at the time they contacted our service or who are deemed to have potentially survivable illness or injury and have later died whilst in our care. Through this work a secure portal allowing information to be accessed and shared to a multi professional group considers these patients. We are reporting the findings and themes back to staff and our Trust Board to ensure that we improve by learning and implementing lessons.
The system will ensure a location is confirmed and then check for all available appropriate resources. This is vitally important! The CAD is enabling us to reach the sickest patient first with the right resources. Band 6 paramedic We announced in 2017 a new deal for paramedics who would move up the pay scale from a Band 5 to a Band 6 following an agreement between ourselves, Trade Unions, the Emergency Ambulance Services Committee and Welsh Government. This move signaled an acknowledgment of the clinical skills, work and competence needed to be a paramedic. Extra support and development opportunities were offered to ensure that staff gained the required skills and competencies needed as a paramadic. Those who did not wish to undertake the Band 6 role stepped across to a newly created Band 5 Emergency Medical Technician (EMT3) role. Public/staff engagement at Trust BoardWe have invited our staff and local communities, patients and other stakeholders to attend our Trust Board and participate in our engagement sessions. This year we held our Trust Boards in Llanelli, Bridgend, Llandrindod Wells and Wrexham.
We heard from staff who shared their experiences of working in busy control rooms and the challenges they face in meeting patient needs. We listened to the stories of our ambulance colleagues on the challenges of responding to patients during the winter pressures. Our non-emergency transport staff talked about the planning and communication between ourselves and hospitals in arranging for palliative care patients to go home and also of the experiences of patients themselves in particular those in mental health crisis and children/young people.
These sessions have given us a great deal of insight into how it feels for both patients and staff to work and receive care.
Using Social Media to Engage and Share We have used social media extensively this year. It is arguably the most powerful tool at our disposal to engage members of the public in real time, helping them to better understand the services we provide and promoting good health. Leading by example, our senior team are on social media and use it to share, encourage, promote and highlight news that others would find of value. Campaigns like ‘Find your nearest Defibrillator’ and ‘Choking awareness’ campaigns have been driven through our social media channels. Patient and staff stories have been shared through Twitter, Facebook and YouTube, along with seasonal messages and of course communicating to people, in real time, the pressures on the service during levels of high demand. Dementia In September we received the news that the Trust was recognised as a Dementia Friendly Community by the Alzheimer’s Society. This followed a lot of work to improve awareness amongst our staff and to encourage them to be Dementia Friends. We also launched our 3 year Dementia Plan and continue working towards improving the experience for people living with dementia, and their carers who use our services, as well as considering the impact it will have on our workforce. We have continued also to focus on improving inclusion and quality of life for people with dementia across our services.
Integrated Medium-Term Plan IMTP As part of the NHS Wales Planning Framework, we are required to have a three-year integrated plan that is submitted to and approved by Welsh Ministers. Earlier in the year our IMTP received approval from the Cabinet Secretary for Health, Sport and Well Being. A lot of work has been carried out to ensure we deliver on the actions identified in the IMTP with the involvement of staff and partners. Throughout the summer we engaged with people about our long term plans for the ambulance service. We talked to the public, patients and a wide range of partners that generated a lot of debate and great ideas.
We talked about 4 main themes;
• what else can we do?
• staff & leadership,
• how can we make best use of Information Technology?
• working together. In September we also invited people to come and meet staff from different departments to find out about the services we provide as an ambulance trust. We held the event for anyone interested in finding out about current developments across Wales. We also had the opportunity to talk to people about our Long Term Plans for the Ambulance Service.
8 9
SHOCTOBER – developing life-skills and self-confidence in children. We believe investing the time in educating and supporting children to learn new life saving skills, will give them the confidence to make decisions and be more resilient in dealing with problems.
Throughout October we visited primary schools across Wales reaching over 2,000 children. With the help of staff, community responders and partners, children were taught life-saving skills including: CPR, responding to someone choking and a range of other services available to help. Learning and having confidence to use these skills and knowledge may one day save a life.
In total 187 images were submitted resulting in 39 unregistered defib locations being found. These have now been added onto our system.
When someone goes into cardiac arrest, early defibrillation is a crucial part of the chain of survival. People can help their communities so much by familiarising themselves with where they can find the closest piece of lifesaving equipment available to them. Hopefully people will never need to use it, but it really can make all the difference.
H E L P I N G P E O P L E T O S T A Y H E A L T H Y
It is in everybody’s best interests for people to live healthily and be responsible for their own health and wellbeing. Whether it is managing minor illnesses, like a bad cold or infections, or knowing what to do in an emergency and dealing with incidents and accidents, it is so important for people to have the knowledge and skills so that they can be more resilient when the need calls for it. This is why throughout the year we have been busy educating people about the things that they can do to help themselves and others in managing their health and being responsive in an emergency.
Defibuary 2018 For the third year running we held our Defibuary campaign, raising awareness of what a defibrillator is, where to find the nearest in a life-threatening emergency and how to raise funds to purchase one for your community.
9,800
10%
Number of hospital visits in Wales attributed to a heart attack or cardiac arrest
Percentage reduction in survival rate for every minute without CPR and defibrillation
Restart A Heart Day 16 October
There was a fantastic response with our staff and volunteers helping us deliver CPR training to 53 out of 200 secondary schools across Wales for ‘Restart a Heart Day’. Around 9,000 schoolchildren were given a lesson in life-saving CPR. Across the UK as a whole, it was anticipated that 150,000 young people would learn the skill as part of a national CPR training day. In the UK, less than one in ten (8.6 per cent) people survive a cardiac arrest. The British Heart Foundation predicts that if the UK achieved the same survival rates in countries like Norway (25 per cent), where CPR is more widely taught in schools, an additional 100 lives could be saved each week – that’s the equivalent of approximately 5,000 every year.
DEFIBUARYSaving lives in your communityRaising public awareness of the location of life-saving equipment
Loved the practical, hands on approach. We were treated like grown-ups.- Pupil
It was an excellent session to improve pupil knowledge on life saving treatment. - Teacher
10 11
3,871,348 Total number of visits to the NHS
Direct Wales website
2017-2018
NHS Direct Wales website The website has continued to be a popular resource for people accessing information on illnesses and local NHS services, especially the online self-assessment symptom checkers. These have proven very popular with stomach pain being the most commonly accessed symptom checker. Increased use of the symptom checkers are usually a direct result of seasonal illnesses like the ‘winter vomiting bug’ Norovirus or flu.
Choking First Aid In November we launched an online/social media campaign aimed at educating the public about what to do when someone is choking. Choking happens when the airway suddenly gets blocked, either fully or partly, making it difficult to breathe. During our engagement work with different groups and service users we recognised that the risk of choking was a particular theme especially in children, older people, people living with dementia and those with a learning disability. Between November 2017 and March 2018, we reached over 55,000 people via Twitter, over 6,000 via Facebook. Simon’s story available via YouTube, has been viewed over 130 times.
We shared a story of one of our off duty paramedics, Jason who was called upon to give help whilst jetting off on holiday.
12 13
Jason’s Story Jason was on a plane to Cuba with his family when a fellow passenger began to choke. His quick-thinking actions meant the woman regained consciousness just minutes before the pilot was to divert the plane to make an emergency landing. Jason recalls: “We were a couple of hours into the flight when one of the flight attendants went past our row with a first aid kit, and that’s when I noticed a commotion a couple of rows down.
I went and introduced myself, explained that I was a paramedic and then took my seat again. A few moments later, I was asked to help. Straight away I identified that the woman was not breathing, and with the help of her husband and the cabin crew, laid her down in the aisle where I managed to clear her airway.
I gave her some oxygen and monitored her vitals using the kit we had available. Eventually, she regained consciousness.
He said: “Thankfully the patient, who had a history of faints, made a full recovery and continued her journey to her holiday, albeit she was very embarrassed about what had just unfolded. Prior to me stepping in, the pilot had started to plan an emergency landing at the nearest airport which would have been John F Kennedy in New York.“I’m just glad I could be of help.”
It’s not just our staff who respond to the needs of others; the public play an important part in supporting us within their local communities. We often hear stories about members of the public and their spirited actions in coming to the aide of another in an emergency.
Earlier this year, we recorded and promoted Simon’s story. Simon’s quick-thinking saved a young child from choking, the paramedics who responded to the call praised him for his swift actions. Simon’s actions had a positive outcome demonstrating how vital it is to have the knowledge, and the confidence, to use basic life-saving skills.
P R O V I D I N G S A F E C A R E The Trust has a responsibility to keep people safe from harm and to protect them from infections including the protection of our staff . We are working to improve safety, reduce infections and protect people through close monitoring as well as encouraging all our staff to be vaccinated against flu.
Benefits of having flu vaccinations are:• Protects our staff, their families and patients• Reduces sickness absence of staff so
patients get the best level of care during the busy winter period
• Reduces the risk to patients whose age or poor health means flu could have a serious impact on them
It’s not just our staff and volunteers who we have encouraged to be vaccinated.We have been promoting the free NHS flu vaccine to people 65 years of age and over, encouraging them to protect themselves. Parents of children aged two to eight have also been advised to protect their children with the free NHS nasal spray vaccine.Uptake amongst staff has increased but is still not near to where we would expect it to be. The target set for to NHS staff was 60%. We still have some way to go but will continue to encourage our frontline staff to recognise their professional responsibility in protecting vulnerable patients from flu infection.
Preventing Infection
We have continued to work hard to improve infection prevention and control (IPC) standards across all our services. Having good IPC standards benefits everyone. It reduces the spread of infections, improves the care and experiences for patients and avoids potential impact on other services. Our IPC standards are focused on delivering safe patient-centered care. Our focus is mainly on our staff but it is everybody’s business to understand the importance of preventing infections.
The Impact of Poor Communication Earlier this year we took an elderly patient from a care home into the local district general hospital for tests. The patient was taken in one of our emergency ambulances. When the ambulance crew arrived they carried out some basic observations and there was some discussions with the care home staff before taking the elderly patient to hospital. When the crew reached the hospital there was a wait before handing the patient over to the care of the hospital. Unfortunately it was only during this handover that it was identified that the patient was known to the hospital staff as having an existing serious infection. However the patient had by then been settled into the assessment unit. This could have been avoided if better communication had taken place with medical notes, alert cards or correspondence being shared. With that knowledge the hospital could have be alerted before the ambulance crew arrived. In doing things better we have drafted an A-Z of common diseases for staff. Once approved it will inform staff of the different types of infection and appropriate personal, protective equipment they need to wear. Staff have also been encouraged to ask ‘Is my patient infectious?’ ‘Do they have an alert card?’ and ‘Do their medical records show a chronic infection?’ Patients, families, carers and other colleagues have been encouraged to let us know as much as they can about a patient’s condition when we are providing care.
1295members of staff vaccinated out of a total of 3306 employees
= 39%of staff vaccinated
We have signposted people to visit the NHS Direct Wales website and access the online self-assessment Cold & Flu symptom checker (www.nhsdirect.wales.nhs.uk). Information on managing symptoms is available and easy to follow using the symptoms checker. People are able to access advice on treating the symptoms of a cold at home using a number of self-care measures and in some cases people may be directed to another health service depending on their answers.
All views to self-Assessments
= 4,424,597
Top 5 symptom checkers –
1. Stomach pain – 958,444
2. Generally unwell – 678,736
3. Cold & Flu – 570,380
4. Rash – 184,884 5. Back pain – 160,092
14 15
Protecting against Flu
We have worked proactively to reduce the spread of flu by vaccinating as many of our staff and volunteers as possible. Flu is a highly infectious viral illness that is spread by coughs and sneezes, and symptoms include fever, chills, headache, cough, muscle aches and fatigue. For the majority of people who catch it flu is unpleasant, but for some it can lead to chest infections, severe complications and even death.This year, we enlisted the support of our own trained paramedics and nurses, to deliver vaccinations in their area of work at a time to suit colleagues. The message to staff has been that flu affects people differently; some will have the virus and have no symptoms but can still pass the virus on. For some patients this can result in very serious conditions even causing life-threatening complications.
Mental Health Care is provided for more than 25,000 service users across NHS Wales, who either have a mental health condition or are experiencing a mental health crisis. In an emergency or mental health crisis situation, our frontline staff have to be skilled and equipped to deal with, and assess what is the best help for people. Unfortunately, patients, carers and lots of services like primary care, police and voluntary services do not widely know the best routes to access emergency assessments. This may cause confusion leading patients to potentially experience delays in accessing care, treatment and support. We have embraced our responsibility to deliver improvements in the way we care for patients experiencing a mental health crisis. The development of our Mental Health Improvement Plan has been central to this. Examples of feedback:
In response to this feedback we developed, in partnership, a Mental Health Improvement Plan. The success of the plan requires the right expert staff to lead, train and deliver it. The Welsh Government has identified initial recurring funding to help start achieving this. As part of our commitment we are fostering a culture where the mental health and wellbeing of our staff is supported and protected throughout their employment. We will be regularly reviewing the impact of the plan through a Mental Health Steering Group as we recognise there is still much more that needs to be done.
Responding to demand
All emergency calls received by the Trust are prioritised using a system called the Medical Priority Dispatch System (MPDS). This is operated by a call taker who answers the emergency call.
The call taker asks the caller a series of scripted questions to determine the clinical condition of the patient. The answers given to these questions will lead to a call prioritisation.
Anyone calling 999 where someone is facing imminent death and needs help quickly, are categorised as ‘RED’ calls. These calls have an 8 minute response time to reflect the level of urgency needed to get to someone. These calls include cardiac arrest, severe choking or bleeding and not breathing & unconscious.
All other calls are emergency calls, these are categorised as amber. ‘AMBER 1’ calls will receive an emergency response with flashing blue lights. ‘AMBER 2’ calls are those that are serious but life is not in immediate danger.
The Trust aims to attend as soon as possible, with an appropriate vehicle that can be an Emergency Ambulance, a solo paramedic in a Rapid Response Vehicle or a volunteer Community First Responder.
Patients felt staff generalised mental illness and that they are not being seen as individuals.
Staff wanted more up to date education and training and having Mental Health Pathways that are consistent across Health Boards.
Keeping People Safe from abuse and harm
This past year the Trusts Safeguarding Team and staff made a significant contribution to ensuring that people were protected from harm, such as gender based violence and domestic abuse. Our commitment to working with other organisations in safeguarding related activities has been maintained. There has been particular progress noted in relation to our own safeguarding initiatives within the organisation as well as externally with our partner agencies. Throughout Safeguarding Awareness Week (November 13-17), the team hosted a series of drop-in clinics giving staff an opportunity to discuss any issues and pick up information and resources relating to safeguarding. During these drop-in clinics staff were shown how the work they do protects and safeguards children, young people, adults and families/carers, as well as raising the profile of the role of safeguarding. This work is ensuring that the Trust and its staff fulfil their safeguarding responsibilities. Through improved knowledge, skills and attitudes and the promotion of our engagement with safeguarding, we have been able to strengthen our working relationships at all levels.These working relationships mean that together our organisations remains committed in fulfilling its requirement under the Social Services & Wellbeing Act to protect the welfare of vulnerable people who have contact with our service.
D E L I V E R I N G E F F E C T I V E C A R EWe want people to receive the right care and treatment in an environment that is best suited to their needs.
Green calls are considered as being serious but not immediately life threatening and the Trust aims to provide either a face-to-face clinical assessment or where appropriate a Clinical Telephone Assessment.
The MPDS is a system that is used worldwide for the prioritisation of emergency medical calls. In determining the correct questions to be asked the MPDS Academy consults doctors and specialists to ensure that the questions asked can be completed quickly and safely by the call taker in order to arrive at an effective prioritisation given the patients’ clinical condition.
Work is being progressed to improve our times to respond to patients categorised as amber 1 and 2; and to improve their experiences and outcomes.
As an emergency ambulance service, we have to reserve our precious resources for those who need them most – that’s patients whose life is in imminent danger and patients who are seriously ill or injured. Richard Lee, Director of Operations
16 17
Trialling Advanced Paramedic Practitioners (APPs) During November, we launched a new trial in North Wales to deliver enhanced care nearer to patients’ homes. The Advanced Paramedic Practitioner (APP) trial involved a 10-strong team of advanced paramedics operating on a rota basis. Two APPs in rapid response vehicles worked across North Wales every day, attending selected calls. APPs have gained additional education, training and skills, and in many cases are able to assess and treat patients in the community, or refer them to alternative care providers. For patients with conditions which are not immediately life-threatening, the aim of the trial is to deliver care at home, where appropriate, and prevent an unnecessary trip to hospital. The team are also available to attend calls coded as ‘red’ – the most serious category – when they are the nearest available resource.
STORY – Advanced Paramedic Berwyn Jones
Berwyn Jones, an Advanced Paramedic, is part of the new APP trial in North Wales.In October, Berwyn was awarded the Chief Executives and People’s choice award at the Trusts Annual Award Ceremony. He was recognised for the care, calm manner and crucial judgement he made to Rhian, a patient from Llanfairfechan.Rhian credited him with saving her life after recognising she was suffering from the potentially life-threatening condition sepsis. In her nomination, Rhian said: “It is with thanks to Berwyn that I survived, and that my three children have a mother”.“He is the one person that deserves recognition and deserves a thank you from me, he is the one person I owe my life to, he is the one person I will always have in my heart, and he is the one person who deserves this award.” Berwyn, who is currently based at Aberconwy ambulance station, was later invited to be a keynote speaker on World Sepsis Day in Cardiff, to speak to bodies from different health boards about how the sepsis was managed, and how information was conveyed between the Trust and the hospital. While admitting it’s nice to be recognised, Berwyn said: “It’s very important to realise that it’s always a team effort, it’s not just one person that helps people.” “In Rhian’s case for example, the call went through the out of hours system and nurse triage, before it was passed to the ambulance service, then it was dealt with by the controllers and the duty manager before even passing to us on the road.“It then went from us in the RRV to another ambulance, so there’s a chain of events that happen to provide that level of care that Rhian was fortunate she had in good time. “Although individuals can be singled out for a job they’ve done well, it’s important to remember I’m just one link in a much bigger chain.”
The trial has been evaluated and will guide the direction of advanced paramedic practice going forward. It has brought many benefits to patients across North Wales, some of these benefits have included:
• Patients’ needs are resolved at first contact
• Reducing need for transporting patients to hospital
• Enhancing patient experience
Quotes:
A caring & practical person who was extremely thorough in his examination & assessment. A highly reassuring man who is a credit to the service.
The APP was very calm, knowledgeable and professional, giving an excellent service.
She was very helpful, very caring and very reassuring. She took my anxiety about the situation away and calmed me down. I cannot praise her enough, she was excellent.
18 19
partners and stakeholders for the prevention, response and management of elderly people who fall. Example of falls work include:ABUHB In partnership with the Aneurin Bevan University Health Board a team comprising a paramedic and a physiotherapist, using a specialist vehicle, are responding to people who have fallen across the Gwent area. The aim of this partnership has been to provide a timely response for patients who have had a fall, and have a minor injury or are uninjured. Full medical and social care assessments are provided, to determine the most appropriate care pathway - and in most cases that enables patients to stay at home, instead of having to go to hospital. Falls prevention week – March 2018 Around 10 per cent of all 999 calls to the Welsh Ambulance Service are for people who have had a fall. We produced a video to help inform the public about what to do if you have fallen at home. The video, available to watch on YouTube, highlights the importance of using your personal alarm, keeping warm and hydrated if you have fallen. The video also features a demonstration on how to get up from a fall.
In July we established a Falls Strategic Group that would be responsible for designing and implementing a Falls Improvement Plan. A number of test service improvement projects have been undertaken to identify alternative ways of working to improve the quality and responses for non-injury falls. These projects have been undertaken across a number of sites across Wales and all include older people who have fallen and required the assistance of the emergency services. The test projects included:
• Falls Response Service with Aneurin Bevan University Health Board (ABUHB)
• Ambulance Volunteer Service (Community First Responder)
• Community Assistance Team (CAT) in North Wales
• Response and Warden Service (Telecare)
Lack of clear evidence and widespread variation has led to an inconsistent approach across Wales and as such the Trust has been challenged to provide a standardised model of care to elderly people who have fallen. The Falls Strategic group has a Short Term Improvement Plan focusing on work it can deliver as well as a longer-term improvement plan, delivered in partnership with various key
250,000number of people over 65 who will have a fall, of which 7,000 will suffer serious injury
11,000number of hospital beds available each day in Wales
Average number of days per year in which hospital beds are occupied by elderly people who have fallen.
ImpROvIng expeRIences Of peOple wHO HAve fAllen. D E L I V E R I N G D I G N I F I E D C A R E Dignity covers all aspects of daily life and this includes respect, privacy and self-worth. We place a lot of weight on feedback, experiences and observations of everyone who access, use and deliver all our Trust services. We want to achieve a truly ‘patient-focused’ service that is designed to meet
the needs and wishes of individuals receiving care and treatment.
In helping to keep patients at the heart of everything we do, our Dignity Plan details how we will improve the quality of care we provide to patients. The plan reflects our values and behaviours and takes into consideration the most vulnerable people in society, who we come into contact with on a daily basis.
We aim to uphold the values of dignity and respect for patients, challenge poor care and work to improve those areas that patients feel are important. To help us remain focused on dignity we continuously engage with people and ask them the question What does dignity
It means to me to have your privacy and appreciate what my needs are and can they be kept so my dignity is not affected.
Addressing people in the manner you would be expected to be treated yourself. Ensuring people are spoken to politely.
Prompt and fast service, calming voice on the phone, professional staff.
Achieving Dementia Friendly Community Status
In September, we celebrated becoming a Dementia Friendly Community, which is an Alzheimer’s Society’s programme that focuses on improving inclusion and quality of life for people with dementia. See the Dementia Friends website for more information www.dementiafriends.org.uk.
mean to you? Responses have included:
20 21
We consulted and launched our Dementia Plan which outlines our ambition to improve our service for people with dementia, as well as consider the impact it will have on our workforce.
Dementia is set to be the 21st century’s biggest healthcare challenge, so in our plan we highlight the role the Welsh Ambulance Service has to play and the work we will deliver over the next three years to improve the service we provide for people living with dementia.
Throughout the year a lot of regional ‘Dementia Friends’ awareness sessions have been delivered to staff across Wales. The development of a national plan will help us to become an organisation that responds to the clinical and emotional needs of people living with dementia, their carers and families.
The following patient and family experience demonstrates how important this service is in providing comfort and care whilst ensuring the needs of patients are always at the heart of our services.
On the 15th August a transfer took place for a 19 year old patient. The patient, (we will call M), was ventilated in ITU and sadly the decision was made that the ventilator would be withdrawn and M allowed to die. A request was made by M’s parents to the hospital for M to be transferred home on a portable ventilator so she could die in the family home. The hospital contacted us to see if this could be facilitated. A lot of coordination was necessary for this request to be able to take place. NEPTS controller coordinated the transfer perfectly ensuring a prompt response was given (even ensuring the ambulance got to the hospital ahead of the agreed time). NEPTS crew along with Operational Team Leader carried out this difficult transfer conveying M and her mother home along with a clinical escort. M’s ventilator was then withdrawn. M died peacefully in her own bed surrounded by her family one hour later.
Two separate thank-you phone calls then came in from Health Board colleagues for both the NEPTS service and coordination and the professionalism of the crew. In a separate project we had been collecting feedback via a survey sent to all palliative care Health Care Professionals. Written in the comments section was the following:
“We had a particular case this week and the end of life care ambulance service were wonderfully obliging and even contacted the road work team on the heads of the valleys to stop the traffic light system at 11am for the ambulance not to experience any delays as the patient was ventilated.” Having read this we had to find out more, we wanted to know if this really did happen.
Visiting Dementia groupsWe have continued to visit dementia groups to talk to people living with dementia and their carers. People living with dementia told us that they want our staff to be more dementia aware, it’s important that staff understand how to communicate with someone who has dementia and that we include the carer in any decisions that are being made.
At a Dementia Carers group one carer shared their experience with us:
I’m a carer for my Mum who has dementia. We had to call for an ambulance for her recently when she became unwell. The staff who came and treated her were great but we had a long wait outside the hospital for a bed to become available. For Mum and me this was the worst part of our experience.
The lights in the back of the ambulance are very bright and the doors slam loudly when closed. It was a distressing and scary experience for her. I think more time needs to go into the design of ambulance vehicles so they can have quiet closing doors and different lighting options to make them calmer places if you have a long wait.
Staff dementia awareness training compliance
69%
End of Life – Rapid Transport Scheme
Our Non-Emergency Patient Transport Service (NEPTS), has been operating a rapid transport scheme and has made a real difference to end-of-life patients being transported. Initially the service was tested in South East Wales, and delivered professional, caring, responsive and flexible transport for patients who needed transport home or to a hospice in the last days of their life. The dedicated End of Life Care (EoLC) Rapid Transport Vehicle has provided the dignity, comfort and support needed from staff with additional skills to operate the service to EoLC patients. We have worked in close partnership with NHS palliative care teams, local hospices and cancer related charities within South Wales in providing this service. It is challenging emotionally, as staff have supported patients and their families through a very difficult time. It has given patients, and their families, much needed comfort. The comfort to go home and be in their preferred surrounding, if that is what they want, or to be in a hospice where they can be cared for and supported by professional staff.
22 23
I have dementia, I have different disabilities, and a speech impediment. I get flustered when I have to use the phone, especially when there is pressure on me. I forget things. Please speak slowly. If someone has had some training and can understand what I’m going through, it takes huge pressure off me.
We have to feel safe in our environments. Dementia Friendly Communities are so important. This is more important to me than anything else.
I can’t always say what I want to
The NEPTS crew had indeed approached the roadwork’s team the day before and arranged for it to be possible for them to take M straight through the road works without any hold ups. To use the phrase “over and above” almost seems an understatement in this case.Everybody involved in M’s transfer did an amazing job and deserved recognition. All our front line clinicians have received training in EoLC, and all our paramedics are able to administer – anticipatory or just in case medicines – to EoLC patients if those medications are present. Our staff have access 24/7 to an on call Specialist Palliative Care Doctor, this provides increased patient care, greater referral options and increased advance care planning. Our staff also have access to CaNISC, an all Wales Palliative Care Patient Record System that holds information including medical history, recent interactions with palliative care and advance care planning. This allows staff to enhance the care needed to support patients in their time of need.
Responding to people’s concerns We made a commitment last year to improve and simplify our complaints process. There has been significant progress in ensuring that people who raise a complaint receive a timely response to their concerns. Our Concerns Improvement Plan has been completed and has improved the time taken to respond to peoples complaints. However, throughout the months of December (2017), January, February and March (2018), we experienced an increase in the number of concerns being raised. This was largely due to the pressures experienced across the NHS. Despite this during these three months we achieved a 97% rate on our 2 day acknowledgement and 62% rate on our 30 day response rate to complaints. The increase in the number of complaints received continued throughout the early part of 2018. The ‘winter pressures’ impacted heavily on our ability to be able to respond to patients quickly. This was evident in the increase in complaints regarding the length of time taken to respond to an emergency call. The most common reason for complaining was the failure of staff to respond to incidents
in a timely fashion. Timeliness has been a common theme running through incidents, complaints, claims, coroners’ reports and patient experience feedback. However, we continued to exceed our target of responding to over 65% of Red calls within 8 minutes.
Clinical Response Model (CRM)
“Our Clinical Response Model was first introduced to turn us into an ambulance service focused on improving the clinical outcomes for our patients.” Dr. Brendan Lloyd, Medical Director Introduced in October 2015 the CRM signaled a move away from time-based targets, placing a greater focus on patient experience and clinical outcomes. Since the introduction of the CRM our performance for RED calls has become much more consistent across Wales, including previously challenging areas such as Powys and Ceredigion.We have provided regular opportunities for staff to provide honest feedback about how the model is working in practice, and gauge their opinions and ideas about how the model could improve in the future. However we know that we need to do more to improve our response to those patients classed as Amber.
We are proud of the improvements we have delivered for patients in life-threatening emergencies thanks to the hard work of our staff and volunteers.Over the coming year we will continue to work on improving our responses to our patients.
254
547
number of formal
complaints2017
number of formal
complaints2018
115%increase in formal
complaints this year
ToTAl coMplAINTS=1817
including
1211 “on the spot” concerns resolved informally by phone.
547 formal complaints
59 joint investigations with Health Boards
P R O V I D I N G T I M E L Y C A R EPeople should experience timely access to our services that is based on their clinical need and for them (and
Carers) to be involved in discussions and decisions about their treatment.
A RED call is where a patient’s life is in
immediate danger, this could be:
Cardiac arrest and receiving CPR
ChokingIneffective breathing
AMBERcalls refer to those
patients with conditions that may need treatment and care at the scene or fast transport to a healthcare
facility, if needed. Patients are prioritised on the basis
of clinical need and if necessary will receive a
blue light response.
GREEN calls are non-serious calls, which can often be managed by other health services, including healthcare
advice or through self-care
At the NHS
Wales Awards
2017, the Trust
won two awards. The
first for ‘Improving
clinical outcomes for
patients’. The other
was for ‘Outstanding
Contribution to Prudent
Healthcare’ for the
implementation of the
new CRM.
24 25
INcIDENT INvESTIgATIoNS
2041 patient safety incidents,
near-misses and hazards
62 serious adverse incidents reportable to Welsh
Government*
*Figure accurate at time of reporting
Cycle Response Unit The Trust’s Cycle Response Unit (CRU) has helped more than 600 patients in a year by attending 623 calls on the streets of Cardiff during 2017, which was its first full year of operation.The CRU uses pedal power to reach patients quickly in busy parts of the city centre, especially in pedestrianised areas and shopping centres, and on key dates when the city hosts major sporting and entertainment events.The team includes paramedics, emergency medical technicians and community first responders, who attend calls on bikes, which are specially fitted with a siren and blue flashing lights.They carry a range of medical equipment, including defibrillators, and can give life-saving treatment while an ambulance is on the way.
They can also treat patients with less serious illnesses and injuries at the scene, preventing an unnecessary journey to hospital and freeing up ambulance crews to respond to other calls.
The CRU is able to move quickly to patients and provide immediate assessment and treatment before an ambulance crew arrives. In cases where a patient has a less serious condition the CRU can treat them, keeping emergency ambulance crews free to attend emergency calls elsewhere.
Average time from call to response is between three to four minutes - so we’re giving patients the best care they can get within the shortest time possible.
26 27
Non Emergency Patient Transport Service (NEPTS)
NEPTS has launched a staff led improvement programme within the Cardiff area called “Cardiff - Good to Great”. It is made up of fortnightly informal meetings open to all staff both, operational and non-operational.The idea behind the programme is to listen to NEPTS staff to find out what really matters to them and how together, we can make changes to improve the experience of patients. In a new approach to improving the service provided to patients, the team are testing ideas in a small area first so that they can refine them and if they are successful roll them out across the rest of Wales. Due to the high concentration of staff in one location it was determined that Cardiff would be the best place to start. The first meeting, held in mid-October, was used by the Cardiff NEPTS team to generate ideas with a second meeting to prioritise them by assessing their benefit and the ease of implementation.
Some of the prioritised ideas include:
• Provision of umbrellas • Personal issue work mobile phones• Staff taking responsibility for ‘their’
ambulance• Hands-free torches• Provision of linen bags• Sealed ‘consumable’ bags to reduce waste• Managing ambulance parking at hospitals.
Ideas are being progressed and evaluated to see which have made a difference to staff and patients and which need further refinement The NEPTs service across Wales is available between 6am and 8pm Monday to Saturday across Wales. Patients can make a booking through a single national number and can cancel or make enquiries about transport by using enhanced on-line services available 24/7. The changes have significantly improved access for patients, carers and health care professionals to the service. We have improved the responsiveness of our telephone service from 11% to 5%.
T R E A T I N G P E O P L E A S I N D I V I D U A L SPeople using our services have different needs, wants and expectations. We want people to feel valued and
ensure that they are communicated with, engaged and experience care that meets their individual needs.
Promises to children
Colleagues across the Trust have been working to apply a ‘Children’s Rights Approach’ across our services. This is supporting the UN Convention on the ‘Rights of the Child’. Through our engagement, in particular, we have focused on the ‘right to be heard’. Across our services applying a ‘children’s rights approach’ means providing children with meaningful opportunities to influence decisions about their lives.
28 29
It also means making ourselves accountable to children for these decision and outcomes that affect them. Delivering a ‘children’s rights approach’ is contributing to them being better involved in our services however, there is much still to do.
We want children to be central to the decision making with our services, plans and care developed around them. With that in mind we engaged with children between the ages of 8-18 across Wales and online, to find out from them what ‘promises’ they felt we should keep. The result was a set of promises that we are using to measure their experiences against and identify areas where we can improve the experiences of children accessing and using our services. Our ‘Promises to children’ were launched on 20 November 2017 in partnership with Cardiff & Vale University Health Board from the Noah’s Ark Children’s Hospital, Cardiff. Since then we have continued to engage with children (including young carers) on ways to improve their experiences. We have The Future Generations (Wales) Act 2015 focused within our engagement work with children and young people. We have been considering how, through our work with people and communities, we can prevent problems in the future. This can be seen in our education campaigns like Shoctober and Defibuary as well in our continuous engagement model to go out to talk, share and learn from communities.
In May we had Deaf Awareness Week. During the week we held Deaf Awareness sessions in partnership with Wales Council for the Deaf where staff were able to learn more about what it means to be Deaf and had the opportunity to learn some basic BSL skills. Feedback from the Deaf and Hard of Hearing community tells us that people experience communication difficulties when accessing and using our services. We placed hearing loops at all our Ambulance Liaison sites at Hospitals supporting non-emergency transport patients with their communication needs.
We are also in the process of reviewing guidance on how we support people who have guide dogs. We know from patient feedback that some guide dog users still experience
Our Promises to Older People - one year on
During the year we have seen an increase in the number of ‘older people’ calling the ambulance service:
Just under 4% of patients aged 50+ using our services. The biggest age group that needs our help are people aged 76-85.
Launched in October 2016 our ‘Promises to Older People’ set out how we wanted to deliver quality services to older people across Wales. We have been committed to meeting the specific needs of older people and have continued to engage with and listen to them, their families and carers.
The key aims of the Promises are to:
• Provide a better patient experience so that people feel they receive good care.
• Give older people a voice and be heard so that they influence and shape our services
• Maintain and continue to improve provision of dignified care and treat people as individuals.
We have looked at people’s feedback and experiences over the last year to review our progress against the Promises. We found that overall we are keeping them but there are still areas for improvement. The majority of people we heard from were happy with the response from our service and feel that our staff are helpful, professional and treat people with dignity and respect. People also told us that our staff are calm, compassionate and caring. From feedback we could also see there were areas for improvement around our response to people who had fallen and in providing a timely non-emergency transport service to our patients. It was clear that we needed to do more work in providing support for people with specific needs, such as those living with sensory loss and dementia.
problems when using our services, we hope this updated guidance will clarify for staff what the rights of a guide dog user are, and will help provide information about how to support service users and their guide dogs.
Compliments
This year we formally recorded 705 compliments from members of the public and patients. People have reported the positive impact staff have made during often stressful and difficult situations. The top five reported compliments have been:
• Professional attitude of staff• Good advice received• Reassurance to patient/family• Involving patients in decisions • Quality of the clinical care and treatment
Welsh Language
To improve the Welsh language skills of staff, the Trust registered with the ‘National Centre for Learning Welsh’. This provides opportunities for staff to receive a free 10 hour online course teaching basic Welsh suitable for use in the workplace. Staff are able to meet and greet colleagues, patients and stakeholders using Welsh phrases. Over 70 Trust staff have registered onto the course with one member of staff taking the opportunity to attend intensive Welsh language residential course at the Welsh Language Centre, Nant Gwrtheyrn.
Welsh Speaking/Listening Levels 3 - 5 (intermediate to fluent) - as of 31.03.2018.
Out of 3306 staff:Assignment Count = 3098 Achieved = 456 % Level 3-5 = 15%
We are continuing to engage with people across Wales; the Promises are helping us to focus on people’s individual care needs, as well as their carers. In reviewing our promises regularly we can ensure we deliver services in a way that people want and are inclusive of the United Nations Principles for Older Persons. Sensory loss
We have visited a range of sensory loss groups to promote our Pre Hospital Communication App, Medical Information Cards and the 999 SMS Texting service. People were overwhelmingly positive about the new App and especially like the text SMS Service. People have suggested that we consider the use of Skype or Video relay to use a BSL interpreter for Deaf people in an emergency. Many people described how they had used family members to interpret in emergencies, and that this had caused delays as these people often had to travel to make themselves available to interpret. From feedback, we also know that using a friend or family member to interpret can often be uncomfortable from a dignity perspective. The App was nominated in the ‘Excellence in Health’ category in Action on Hearing Loss Cymru Excellence Wales Awards 2017. We were happy to receive the runner up award in this category but were delighted to be awarded winner of the ‘People’s Choice’ award. This award was appreciatively received and is a great recognition of the work done to help improve communication between our staff and people who are Deaf or hard of hearing.
30 31
O U R S T A F F A N D R E S O U R C E SThe demands on our ambulance service staff are well known and with the need for them to increase their
skills, knowledge and specialities in delivering care the demand and pressure on them will continue to grow. We need to ensure we respond with the right person to ensure people receive the best response possible.
Education & Training
There has been significant progress in relation to Statutory and Mandatory training compliance rates during 2017/18, increasing from 65% in April to 88.77% in March against a Welsh Government target of 85%. This improvement can be attributed in part to the Trust’s targeted Statutory and Mandatory campaign, as well as close and effective management by Education and Training Team colleagues, local managers and meaningful messages shared from and amongst Executive colleagues and senior managers.
Training – Control room staff
When people call for an emergency 999 ambulance they need to hear a calm, caring voice on the end of the phone. For the staff working within the emergency control rooms they have to be able to respond to emergencies, traumas and urgent calls. Not knowing what they will be faced with, responding to increasing call volume and having the composure to talk to someone in crisis takes a lot of skill. To ensure that our staff are able to deal with the demands placed on them they have received specific training. For the first time this year training has been delivered in the evening. The theme of the first training event held in January focused on mental health and suicide awareness. Training events are being held each month with a different focus on a particular subject. Through these events we can ensure that our staff can deliver the best patient experience possible.
Providing Online Learning – British Sign Language
Towards the end of 2017, the Welsh Ambulance Services NHS Trust secured 100 licenses for a unique Online learning course for Level 1 British Sign Language (BSL). The course provides video tutorials for the 60 hours of study required to cover the whole Level 1 syllabus.This resource is focused on learning outcomes. Through this training, staff are given the opportunity to sit and pass their Level 1 exams.
All 100 licenses have been assigned to staff from across the Trust – predominately front line staff. There has been a positive response from staff who have been keen to learn a new language that will benefit their own roles when engaging with individuals who are Deaf. Throughout January to March staff completed their BSL training and we look forward to hearing about the positive impact it makes for staff, patients and other service users.
New Vehicles
There are 700 vehicles in our fleet, covering an area of more than 8,000 square miles across Wales. We have some of the most up-to-date and best equipped ambulances to benefit our patients and staff. To help us continue to upgrade our fleet and deliver the best care for the people in Wales, we received £8.2 million investment from the Welsh Government. The money was allocated so that we could buy 90 new vehicles. These vehicles included:
• 18 Emergency Ambulances.• 67 Non-Emergency Patient Transport
Service vehicles (NEPTS);• Five specialist Hazardous Area Response
Team (HART) vehicles, to replace the existing fleet.
It is important that we maintain a modern fleet that is capable of responding to the increasing demands and needs of our patients in Wales.
Keeping staff well and motivated
We have positively focused on the engagement and wellbeing of our staff to help us increase our staff engagement index from the current 59% to 63% by 2019.
Staff engagement and wellbeing We know how people feel determines how good the care we provide is. Our aim throughout 2017/18 has been to focus on staff engagement and wellbeing. This has included ensuring that we provide great support to help people stay healthy, well and engaged but also being able to help colleagues when they need it. We have particularly focused on mental wellness with the introduction of a Trauma Risk Management (TRiM) Programme. This is a peer support system designed to identify those at risk of developing psychological illness as a result of a traumatic event in order to facilitate early intervention and signpost to specialist support. We are delighted that our efforts were recognised with the Trust achieving the Gold Corporate Health Standard. 32 33
Increasing the diversity of our workforce
This year has seen us continue to find ways to help people to be themselves and for us to create a more diverse workforce. We have focused on tackling the mindsets and results of bullying and focusing on increasing our ethnic diversity. To help this, we have been part of an NHS UK support network where we have learnt from others and shared our experiences. Living our values and behaviours We take every opportunity to support colleagues to live our shared behaviours and to help colleagues understand why this is so important. This includes through our recruitment, welcoming/induction, 1:1s feedback, training, leadership development, policies, awards and recognition. In particular, 2017/18 saw the launch of our ambitious Team Leader Development Programme. Our approach will support all of our 240+ Team Leaders to improve their confidence and competence by changing their hearts/mindsets. During 2017/18, 6 cohorts (over 80 people) have commenced their learning.
Occupational Health In preparation for the 2017/2018 Seasonal Influenza flu Vaccination programme the Occupational Health Department and Communications Team flu lead engaged with Flu Fighters England and Public Health Wales in a bid to ensure early planning and preparation to work towards achieving the 60% target of vaccination uptake in patient facing roles within WAST. This year’s campaign has demonstrated a strong focus on ownership at a local health board level and within individual directorates One of the key initiatives adopted is an increase in the accessibility to the vaccine by recruiting and training peer vaccinators. These peer vaccinators have greater access to vaccine supplies than in previous years as WAST has invested in more vaccine fridges that have been located in various locations pan Wales. We again have utilised the Occupational Health Screening vehicles attending hospital ED departments and also NEPTS liaison offices. Training events and WAST meetings have also been targeted to provide vaccination on an every contact counts basis.
The focus of this year’s flu campaign has looked at myth busting and promoting to our staff the need to protect themselves, families and patients by receiving the flu vaccination. This message has been reiterated by the Executive Team along with governing bodies such as the Nursing & Midwifery Council and Health and Care Professions Council. As the uptake in some areas remains poor the Deputy Director of Workforce and OD convened an emergency flu planning meeting in early January engaging with managers from across the organisation to reiterate that uptake needed to improve in the final few months of the flu campaign.
Wales for Africa - sharing expertise overseas The Welsh Ambulance Service has been supporting the charity Partnerships Overseas Networking Trust (PONT) since 2009, working in the Mbale region of Uganda to tackle poverty and improve access to basic health care. We have continued to support the scheme throughout 2017/18 and it continues to go from strength to strength providing a lifesaving resource to the rural communities. Sharing passion, expertise and knowledge, our staff have been instrumental in the development of a motorbike ambulance service in Mbale.
The region has poor roads and infrastructure and motorbikes are more suited to the terrain than four-wheeled vehicles. The scheme also provides bicycle stretchers and mountain
rescue stretchers to help reach the more remote communities. The service, which mostly operates on a 24/7 basis, has now completed more than 25,500 journeys since its launch in December 2010. It operates through a network of volunteer Village Health Teams, whose workers make an initial triage of patients and call for ambulance transport if they feel it is appropriate. Approximately 65% of patients transported continue to be maternity or obstetric related, the remaining 35% of journeys convey children and adults with various other illnesses and injuries.
Staff are planning their next visit in early 2019 to carry out further training with the Village Health Teams and also to carry out monitoring and evaluation work.
With the support of the Trust, the ‘Pennies from Heaven’ scheme is now in place. This is a simple fundraising scheme to support the work of the charity; it allows the contributor to donate the odd pennies from their pay to the charity each month. The charity is also currently seeking support from any individual who would be happy to donate a fixed amount each month.
More details are available on the PONT website http://pont-mbale.org.uk/main/ and on the Welsh Ambulance Service website https://www.ambulance.wales.nhs.uk/Default.aspx?pageId=200&lan=en The scheme is organised by Julian Newton and Tony Rossetti who can be contacted by email: [email protected] [email protected] 35
2017/18 FIgURES:1295 of 3306 all staff = 39%
Staying Healthy What we will do We will develop more online Self Help Symptom Checkers for those using the NHS Direct Wales website. How we will measure it We will report monthly on the number of visitors to the site using the symptom checkers including length of time on the site, pages viewed and search terms used to find specific condition information. Safe Care What we will do Over the coming year we will focus attention on the top 5 conditions/calls that impact on our services. The ‘big 5’ conditions are: mental health; falls; breathing difficulties; chest pain and health care professional calls to emergency ambulance services. We will introduce the Aseptic Non Touch Technique (ANTT) delivery plan from April 2018 as well as a Continuous Professional Development (CPD) Programme available from 2018-2019. How we will measure it We will engage with patients and the public by holding a number of ‘Big Conversations’ across Wales in partnership with local Health Boards exploring patient expectations and measuring their experiences across the big 5 conditions. We will closely monitor ANTT training through training records, reported incidents, complaints and partnership working with Health Boards Infection Prevention & Control colleagues. Effective Care What we will do We will work with the ambulance commissioner and partners to identify opportunities for improvement for patients categorised as an amber call, How we will measure it Working with NHS partners we will review the data being captured, patient experience feedback and concerns reported.
L O O K I N G F O R W A R D P R I O R I T I E S F O R T H E Y E A R A H E A D 2 0 1 8 - 1 9
A F I N A L W O R D A N D A N I N V I T A T I O N This Annual Quality Statement (AQS) has been written specifically for the general public, patients using our services, their families and carers. Within this AQS we have included a combination of data and stories to demonstrate how we are performing as a service and how it feels to be a patient and service user of the Welsh Ambulance Services NHS Trust. We hope that this AQS provides you with a good insight into how we are working hard to deliver quality services to you and the people of Wales. As the only ambulance service in Wales we know how important it is that we are there for you when you really need us. We are continuously reviewing and improving services based on patient, carers and staff feedback. Over the coming year we will be talking with members of the public, patients, their families and carers and wider communities to better understand people’s expectations and what matters most to you. We want to know what influences your decisions when you feel you need our help. We will engage and support people to build confidence with a focus to self -manage by developing knowledge about the different community services available. We will also be working with our NHS and Social Care partners, Ambulance Commissioner and other community services to continually improve our services to ensure that patients receive the most appropriate response when accessing our services. We are taking every opportunity to work in collaboration with partners to focus on developing alternative care pathways for patients with specific conditions, to ensure that patients are able to access the right care for their health needs. This is our invitation for you to get involved and share with us your views, suggestions and experiences. This is your Welsh Ambulance Service and we feel passionately that with your involvement we can together, ensure that we have a service that is designed for and delivers the most appropriate response and care that you need. Please consider getting involved in any of the following ways:• Share your experiences/stories, feedback, suggestions by visiting our website at www.
ambulance.wales.nhs.uk and go to the ‘Have your Say’ section. • Consider becoming a volunteer and joining one of the many Community First Responder
schemes we have around Wales. You could also consider becoming an ambulance car driver and help get patients to their hospital appointments.
• Consider having a career with us• Attend our open Trust Board Meetings to hear first-hand the discussions and decisions about
our services• Join our Network and influence new documents, strategies and service developments. There
are details on how to join our Network at the back of this document.
Claire Bevan Director of Quality, Safety and Patient Experience
Dignified care What we will do We will develop a high quality awareness and training structure for staff that is mapped against Good Work: A Dementia Learning and Development Framework for Wales. How we will measure it We will identify appropriate and relevant learning resources for the different levels of staff working across the Trust and that resources are inclusive of the life course of dementia. Timely Care What we will do The 111 telephone service will see the next phase of roll-out enabling people to access health information, advice and urgent care free 24/7. How we will measure it We will carry out a formal evaluation of the roll out of the service including patient outcomes and experiences. Individual Care What we will do We will measure our ‘Promises to Children’ and create ways for them to give feedback/make a complaint How we will measure it We will capture and review feedback from children and their representatives through a number of patient experience surveys, face to face events and online facilities to see how their experiences measure against the promises. Staff & Resources What we will do We will progress with our estates strategy, relocating a number of older trust site buildings into more modern ones. How we will measure it These moves will be planned through the Trusts committee structures.
We welcome your views and feedback on this Annual Quality Statement and ask that you let us know what you think would be of interest or value to include in our 2018/19 edition.
36 37
E N D O R S E M E N T A N D F E E D B A C KI would like to acknowledge my sincere appreciation for all your
support in Trialling my initiative of Trauma Teddies on Welsh
Ambulances. Within 10 months of presenting the idea, and up to
the present, I can confirm your encouragement and dedication to
getting this project “well under way” following quite a few
teething problems which you managed to resolve. There has been 2 incidents where feedback has been received to
date i.e. at the knitting group (Yarnmongers) Christmas Fayre in
Pontyclun when I spoke to a volunteer First Responder from Talbot
Green who had heard of our scheme and showed great interest
in the project. He went on to make a generous donation, to our
event, which incidentally was fundraising for Pontyclun and
District Macmillan fundraisers of which I am linked, as he wanted
a little teddy to display on his own vehicle to help promote the
benefits.
The second example was a lady knitter Ruth from one of the groups
experienced a local paramedic comforting a very distressed baby
by giving it a little Teddy and actually had a great result
with the baby settling and stopping crying (probably helping the
parents also) - so all looking hopeful. The eager teams of knitters @ Cafe 50, are all well under
way making more for the proposed expansion of the scheme and
distribution to all stations in Wales, hopefully in the near
future. We all thank you for your eager support, media coverage
and even your former Chief Executives mention prior to the end
of the year. Think we may have put the Knitters of Pontyclun into
the forefront of what’s to come in the future of Welsh Ambulances
and even Air Ambulances who knows “the sky’s the limit” excuse
the pun!
Regards Sheila xYarnmongers knitting groupPontyclun
“I was very impressed with how well WAST respectfully engaged with local people on its mental health plans, it is so important to take time to do engagement properly as it can lead to much better service outcomes and is a fundamental part of any community and business development. It was evident how passionate WAST staff are about getting the services right for people and delivering what matters”
Maria Mental Health Development Officer - Interlink
We are very grateful for all your assistance and we trust that you had a good experience with us as well. Both sessions you had with our clients (September and November 2017) were very informative, interesting and engaging. You were excellent. I do hope you will be able to come again and engage with the most vulnerable of our communities.
Many thanks again,
Kind regards,CleideMerthyr Cynon Foodbank
The response from your visits to my CISWO Social Groups in the east of Wales has been very positive. To a group, they have found your talks very interesting and informative and our members realise, through your use of the “Traffic Light” explanation, the need for priority cases to be treated more urgently and how
the ambulance service should be used to maximise its efficiency. They, including myself, did not realise how few ambulances were available. It has been a wakeup call to all of us. I know you collate a great deal of our members concerns during your visits via post it notes and the groups enjoy your quiz. I have also gone through the Welsh Ambulance Service’s Promise to you questionnaire with the groups and nothing has been flagged up and they feel the promises are being kept.We look forward to your follow up visits.
Kind regards
Phil
Your help in the negotiations with various agencies, schools and the overall running of the project has been invaluable to myself.
Without your input into the school the whole project would have been very hard for myself to contain and keep track of everything that has been going on. Especially your facilities you provide to the School environment, which has helped enormously with the whole event, your planning and timelines to make sure everything is on track for future events.The feedback along with parents and pupils has been very positive. Also the inclusion of another primary school “Padre Pio” which will benefit from the whole encounter has been beneficial to all involved, including their pupils.
The whole community will benefit from this project which has highlighted road management, where not to park, to give way to emergency services, how to ring 101/999 what service to ask for and how to save a life.
Kind Regards
MarkCO250Pontypool Station
It’s great to have the opportunity to work in partnership with the Welsh Ambulance service. Most of our Young Adult Carers will need to support someone in future who will need the service, so building that trust and knowing what to expect of the service is really important. We are very excited to be working together on your wellbeing and mental toughness activity day on Friday 23rd February. It will an amazing day for our young people as they will be able to build resilience from the activities they do but also gain knowledge of the ambulance service, and know what to do in an emergency.
Swansea Young Adult Carers Project
I would like to echo Phil’s
sentiments.
There were a lot of preconc
eptions
amongst group members rega
rding
ambulance response times. T
hey
benefited greatly from your
visit
and the clear explanation yo
u gave
regarding the prioritisation o
f calls
and response times. I also fe
el
that the speech bubbles ask
ing
for comments and experience
s were
effective especially when dis
tributed
in advance of your talk.
I have gone through the Pr
omises to
Older People and there have
been no
issues raised with me. It ha
s been
good working with you and
I look
forward to your next series
of talks.
Kind regards
Claire
38 39
M O R E I N F O R M AT I O N A B O U T T H E W E L S H A M B U L A N C E S E R V I C E S A N D I T S D E V E L O P M E N T S
follow the links below to find out more about the work of the welsh Ambulance service, see people’s feedback and hear patient stories.
Welsh Ambulance Services NHS Trust http://www.ambulance.wales.nhs.uk/ For committee papers and reports http://www.ambulance.wales.nhs.uk/Default.aspx?pageId=11&lan=en To hear patient stories http://www.ambulance.wales.nhs.uk/Default.aspx?pageId=183&lan=en NHS Direct Wales – for self-care, information and advice http://www.nhsdirect.wales.nhs.uk/
Social Media Channels: https://www.youtube.com/channel/UC_Jp9nVObDsiYncNVEBVkIQ www.facebook.com/welshambulanceservice www.facebook.com/nhsdirectwales @WelshAmbulance https://twitter.com/WelshAmbulance @WelshAmbPIH https://twitter.com/WelshAmbPIH @NHSDirectWales https://twitter.com/NHSDirectWales
How was your experience with us?
If you would like to give feedback on this document or any aspect of your experience of using the Welsh Ambulance Service, contact the Patient Experience and Community Involvement (PECI) team at [email protected] or visit the Have Your Say section on the website.
To become a member of our PECI Network and have a say in the development of our services, email us at [email protected] or visit our Get Involved page on the website.
If you are interested in learning more about the Welsh Ambulance Services NHS Trust you can read our Annual Trust Report 2017/18 or visit our website.
If you need the document in a different format or language, copies of this Annual Quality Statement and any companion documents are available from the PECI team, tel: 01792 311773 or email [email protected].
40
