It Gives Me Great Pleasure to Be Able to Present Our Annual Delivery Plan for 2012/2013

FOREWORD

It gives me great pleasure to be able to present our Annual Delivery Plan for 2012/2013. The plan represents the culmination of an ongoing conversation we are having with the public, our staff and our partners and provides us with a set of ambitious actions for the forthcoming year. It seeks to build on the progress made during 2011/2012 and is focused on the achievement of the aims we set ourselves within ‘Working Together for Success.

I have no doubt that the challenges we face this year will be great. However, I am certain that the organisation will continue to overcome these by supporting our staff in developing their skills and talents allowing us to further improve the quality of services that we deliver to the people of Wales.

I hope you find the plan useful and look forward to working with you over the coming year.

Elwyn Price-Morris

Chief Executive Officer

Contents Page

Introduction and Context 4

The process for delivering our strategic aims 5

What are the challenges facing the NHS on a National level? 6

What challenges are specific to the ambulance service? 7

What do we need to concentrate on in 2012/2013? 8

So what model of care will we need to deliver over the coming years? 8

Our Approach to Reducing Harm, Waste and Variation 12

Supporting Our Staff to Achieve Transformational Change 13

Review of Performance 2011/2012 16

So how much progress did we make in 2011/2012 with implementing our plan? 16

What does the evidence tells us about our Unscheduled Care Services 18

performance?

What the evidence tells us about our Planned Patient Care Services 19

performance?

Our Business Planning, Performance and Risk Management 20

processes for 2012/2013

Our performance management framework 21

Our Governance arrangements 22

Our Corporate Objectives for 2012/2013 23

Unscheduled Care Services 26

Planned Patient Care Services 33

Support Functions 35

Our Financial Plans for 2012/2013 40

Financial Planning Assumptions 2012/2013 40

Capital Programme 2012/2013 44

INTRODUCTION AND CONTEXT

1.  We published our five-year framework, ‘Working Together for Success’ in December 2010 where we set out a clear goal for the Welsh Ambulance Services Trust in stating that:

‘We wish to move from being perceived as simply a transport service to

a provider of high-quality health care and scheduled transport services’

2. To support us in achieving this we develop an Annual Delivery Plan which sets out our priorities for each financial year and moves us closer to where we want to be as an organisation which provides high quality health care services in Wales. The Annual Delivery Plan plays a vital role in supporting us to implement the aims we have set out in our 5-year strategic framework, ‘Working Together for Success’ as it provides our staff with a clear sense of priority and action. This allows us to focus on the areas of our work that will make a real difference, and deliver real improvement to the people of Wales.

3.  We published our first Annual Delivery Plan in 2011/2012. This Plan therefore represents the second year of our journey towards in achieving our goal. The three Strategic Aims we established in 2011/2012 remain unchanged:

Strategic Aim 1 / To achieve all of the national quality standards of excellence and clinical requirements
Strategic Aim 2 / To provide the right service with the right care, in the right place, at the right time with the right skills
Strategic Aim 3 / To provide high quality planned patient care services which are highly valued by users

4.  Our strategic aims are being used to drive the improvements across the two main services we provide:

Unscheduled Care

Where we want to:

·  Ensure calls to our services are answered promptly;

·  Safely and effectively assess patient’s clinical and non clinical needs;

·  Quickly provide patients with, or direct them to the right service;

·  Respond quickly to patients with immediately life-threatening conditions;

·  Provide advice, guidance and support regarding healthcare to patients over the phone and via the internet;

·  Provide more services for patients in their homes or at scene and support them to live independently in their communities;

·  Develop evidence-based clinical practice and pathways of care in partnership with LHBs;

·  Stop patients being transported to or attending an A&E department unnecessarily;

·  Improve the clinical outcomes for patients and their experience when using our services; and

·  Improve the safety of our services.

Planned Patient Care Services

Where we want to:

·  Provide easy to access and easy to use transport booking for both patients and our healthcare partners;

·  Provide all eligible patients with transport which meets their need and ensure they are picked up and dropped off at the right time for their appointment;

·  Provide patients who are not eligible for our service with advice and support to access alternative transport which meet their need; and

·  Ensure all of our patients have a comfortable journey and a positive experience.

The process for delivering our strategic aims

5.  In order to deliver the vision and goals set out within Working Together for Success we established two main programmes of work in 2011/2012:

Programme 1: Unscheduled Care

Programme 2: Planned Patient Care

6.  We applied the use of care bundles to each programme which define the main elements of a patient’s journey and capture all the improvement actions we intend to take to improve the service they receive. This is illustrated in figure 1 below.

Fig 1 : Work Programme for 2012/2013

Programme 1 / Care Bundle / What are we trying to improve
Unscheduled Care / Access / the access, timeliness and care we provide over the phone for our 999 and 0845 services
Response / the timelines of response we provide to patients
Assess and Treat / the quality of care provided, the outcome of that care and the patients experience of our service
Programme 2 / Care Bundle / What are we trying to improve
Planned Patient Care Services / Access and Booking / the access to our services and the ability to book transport which meets patients individual needs
Providing transport and patient care / the quality of service we provide, ensuring that patients are transported at the right time, all of the time, and that the service meets their individual needs

7.  The Care Bundle structure has been successful, allowing an integrated approach to improvement to develop across the Trust. This approach will therefore continue in 2012/2013.

What are the challenges facing the NHS at a National level?

8.  The past twelve months has seen an increasing amount of clarity regarding the issues facing the NHS and other public services in Wales. It is extremely important that we analyse the key issues and develop a good understanding of them as it will allow us to design and deliver services that meet people’s needs and expectations at an individual, community and population level. We believe the following issues are some of the most important ones facing the NHS in the coming years:

·  Health Better for Everyone: significant improvements are required in improving the health of the population. This includes giving children a good start in life, reducing the inequality of health of the most and least deprived; reducing the levels of obesity, smoking, alcohol consumption and drug abuse, and increasing people’s quality of life.

·  Better Access to Services and Patient Experience: further improvements need to be made to improve people’s access to services within primary, community and secondary care settings. A wider range of services which are designed around need, will improve the quality of care and reduce the pressure on secondary care services. The provision of health services, both advice and treatment, on-line and over the telephone will need to be fully exploited if we are to meet the public’s expectations in a modern 24 hours a day, 7 days a week world.

·  Improving Service Quality, Patient Safety, Outcome and Experience: continued improvement needs to be made in developing and delivering systems which provide care that is evidence based and compares well with the best available. This will significantly improve the safety and outcome for patients, guarantee them the required levels of dignity and respect and make their experience of the service a good one.

·  Greater Transparency: we will need to provide the public with a greater range of user-friendly information about our services, and how good they are.

·  The Health Burden is Growing: the ageing population, high levels of unhealthy living, and the increasing rate and prevalence of chronic conditions in Wales will test the NHS like never before. This will require a concerted effort from all organisations at every point of the system; public health and information, prevention and intervention.

·  Funding is Limited: the financial outlook for Wales is perhaps the most challenging ever, with an expected reduction in resources of approximately 20% over the next four years. This will require services to be designed and delivered in a different way, centred around patients and with quality at their heart.

·  Service Changes within Wales: The need for change is clear as the current system does not achieve the levels of patient safety, experience or outcome that are comparable with the best. The coming years are likely to see a significant change in how services are provided, where they are provided from, and what type of staff provide them.

·  One system for Wales: the reformed health system in Wales will need to fully integrate to ensure that people are able to access and use services seamlessly. A significant emphasis will also be placed on the NHS to work well with other public services and the voluntary sector to ensure that scarce resources are used as efficiently and effectively as possible.

What challenges are specific to the ambulance service?

9.  The following issues have been identified as specific to the Welsh Ambulance Services Trust:

·  The continued introduction of the National Ambulance Performance Standards: good progress has been made to date but the next phase of implementation represents a significant challenge for the Trust.

·  Communicating with the public about using the ambulance service in a more informed way: the ambulance service of the future will not need to send ambulances to every call as there will be a range of other services to support people remaining safely within the community. The cultural and behavioural change required from the population of Wales is very significant.

·  Demonstrating the value we can add to the new system: we need to work with our partners and demonstrate the additional value we can bring to the public through the improvement of services, increased range of clinical skills and by maximising the opportunity that our central co-ordinating role gives us.

·  Developing a clinical culture and supportive environment: by increasing our range of services and clinical skills we will be asking our staff to work in a different way. We will need to fully support them in this journey by developing a clinical culture which learns from each episode of care, successful or otherwise, and fully supports individuals as they develop their clinical skills, experience and knowledge.

·  Gain further understanding of the implications of the Welsh Governments emerging policy framework: The Welsh Government has published a range of new policies recently including:- the 5-Year Service, Workforce and Financial Framework, the Annual Quality Framework, Setting the Direction, Rural Health Strategy, Chronic Conditions Management Framework, the Griffiths Review and 1000 Lives Plus, Safeguarding Children: Working Together Under the Children Act 2004, and the Welsh Healthcare Associated Infection Programme. It is clear that the Government require the NHS to provide a wider range of services within the communities that people live; improve the levels of efficiency; reduce the occurrence of harm; improve the patient’s experience of the care they receive and improve the outcomes of that care. The ambulance service needs to clearly identify the implications, impact and opportunities that the policy direction offers over the coming years.

What do we need to concentrate on in 2012/2013?

10.  Our analysis of the future challenges has told us that the aims and objectives we set out within ‘Working Together for Success’ are the right ones, which we will continue to pursue. In 2012/2013 we will need to:

·  Place the reduction of waste, harm and variation at the centre of everything we do. Our focus will be on delivering evidence based care which is right first time;

·  Strengthen our clinical leadership to allow our clinicians to make the fullest contribution to patient care possible;

·  Develop a wider range of clinical skills and services which better meet the need of people and improved clinical outcomes;

·  Develop our capacity and capability to make a greater contribution to the provision of primary and community care within the pre-hospital setting;

·  Increase the contribution we are making to the health system by reducing unnecessary conveyances to hospital;

·  Integrate our Unscheduled and Planned Patient Care Services to support the whole system in running smoothly;

·  Support the continued clinical and professional development of our workforce to allow it to respond to the changing needs of people and patients who use our services;

·  Design new services around patient need in partnership with patients, Local Health Boards and other partners with the focus away from traditional hospital based delivery;

·  Analyse our capacity and demand to better inform decision making regarding the use of resources;

·  Develop a range of alternative pathways of care with partners;

·  Increase our levels of efficiency and productivity; and

·  Change our mix of clinical skills and vehicles to meet patient need more effectively.

So what model of care will we need to deliver over the coming years?