Victoria Healthcare Association

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Presentation transcript:

Victoria Healthcare Association London Ambulance Service NHS Trust Visit

Timetable for the afternoon Introduction to London Ambulance Service NHS Trust (LAS) How we fit within the wider NHS system Areas of focus Our Care Quality Commission (CQC) Inspection Emergency Preparedness Areas of outstanding practice Our recruitment & training of Australian Paramedics The changing picture of the Urgent & Emergency Care Sector

Introduction to LAS Heather Lawrence OBE, Chair

Ambulance Video

Some facts about London Multicultural Capital city 300 languages Seat of Government & Monarchy 620 square miles 5 Sustainability Transformation Partnerships (STPs) 5 Police forces c8.9m Population 3 Airports 32 Clinical Commissioning Groups (CCGs) Tourism Population swells everyday On severe alert

The London Ambulance Service Today More incidents than ever before 1,115,945 Total incidents in 2016/17 An increase of 6.6% compared to last year Call Breakdown 1.8 million calls We handle approx. 5,000 emergency calls every day We are the only pan-London NHS Trust Over 5,000 staff 65% of which are frontline Serving the health needs of c8.9 million Londoners 24/7 Average job cycle time is 86 minutes Average on-scene time is 47 minutes We have a growing aging population with complex health needs Patients with dementia, mental health needs and obesity provide increasing challenges for our service Cat A (life threatening) incidents up 9% compared to last year

How we care for the capital Operating out of over 70 sites 111 Services (rated as Good by CQC) 2 Emergency Operations Centres Cycle response unit 2 Emergency Preparedness Resilience and Response teams Patient Transport Service Motorcycle response unit

Demand for our services keeps increasing Demand has increased year on year, especially for our most critically ill or injured patients (Category A) Category A demand has increased by 60% over the last 7 years We have had to significantly grow our frontline capacity We have also changed how we respond, e.g. Hear & Treat so not all lower acuity calls receive a physical response

How we fit within the wider NHS system Craig Harman, Control Services General Manager

How LAS fits into the wider NHS system LAS is a NHS Trust, ultimately overseen by the Department of Health We are commissioned by the 32 London Clinical Commissioning Groups (CCGs) We now also fit within the five London Sustainability & Transformation Partnerships (STPs) STPs bring together all Health & Care bodies in an area to plan out how to best meet the needs of their populations We also work in partnership with NHS Improvement & NHS England to improve quality & performance outcomes

Performance management & key targets Our key targets are: 999 calls: answer within 5 seconds Cat A: 75% within 8 minutes 95% within 19 minutes 60% minimum in each CCG Cat C1: 50% within 45 minutes Cat C2: 50% within 60 minutes We are also measured by: Clinical Performance Indicators (CPI) Survival from Out of Hospital Cardiac Arrest (OOHCA) Commissioning for Quality & Innovation (CQUIN) However, all of this is changing… Two Ambulance services have been trialling changes to the response model over the last 18 months. The Secretary of State last week agreed for it to be rolled out nationally. These changes include: We will have more time to assess calls that are not immediately life-threatening to make sure the right resources are sent Faster responses for the most seriously ill and injured More lower acuity patients treated over the phone or at home Fewer Category 1 ‘Life Threatening Calls’. These will receive the quickest response (7 minutes) Category 2 ‘Emergency Calls’ will receive an 18 minute response Category 3 ‘Urgent’ and category 4 ‘Less Urgent’ will receive between 120-180 minute responses

Areas of Focus Our CQC Inspection – Adam Levy, Strategy & Planning Manager Emergency Preparedness – Kevin Bate, Deputy Director for Central Operations Areas of Outstanding Practice – Briony Sloper, Deputy Director of Nursing & Quality

How the CQC Operate The CQC are our regulatory body and are responsible for providing assurance that we are delivering ‘safe, effective & high-quality care’ and to encourage improvement The CQC is a non-departmental public body of the Department of Health The CQC conduct inspections and then rate provides as Inadequate, Requires Improvement, Good or Outstanding Where issues are found, the CQC are able to impose different levels of enforcement action from a ‘requirement notice’ through to immediate cancellation of registration

How we have improved 11% Æ75.3% Improved vehicles and equipment Strengthened leadership Significant action taken to address bullying & harassment that was reported in 2015 Increased our frontline capacity through recruitment. Crucially, this includes the recruitment of 543 new paramedics from Australia Restated our vision and Values and built these into our new appraisal system Not experienced harassment, bullying or abuse from managers 2014/15 2015/16 69% 76% New Chairman New Non Executives New Directors Improved committee structure Frontline turnover 16% Æ 8% Frontline vacancies 13% Æ 8% Paramedic vacancies 28% Æ 10% Improved our systems of Medicines Management Improved vehicles and equipment Introduced a new appraisal system designed in partnership with staff 800 new drug packs Invested £10m in Quality improvement programme and £20m in new vehicles Improved tracking and administration of our drugs New make ready service in 5 hubs with full roll out by end July 2017 60 new FRUs 11% Æ75.3%

The LAS has been on a significant journey of improvement since our June 2015 inspection Our June 2015 CQC Inspection Our February 2017 CQC Inspection

Areas of Focus Our CQC Inspection – Adam Levy, Strategy & Planning Manager Emergency Preparedness – Kevin Bate, Deputy Director of Operations – Central Operations Areas of Outstanding Practice – Briony Sloper, Deputy Director of Nursing & Quality

London Ambulance Service NHS Trust

The way we respond to a major incident LAS serious and/or major incident arrangements Pre-determined attendance including Tactical Response Unit, Hazardous Area Response Team (HART), equipment vehicles, command vehicles, mass casualty vehicles, and scene commanders continue to manage the business as usual use surge management and capacity plans be supported by national mutual aid

Marauding Terrorist Firearms Attack (MTFA) Capacity UK ambulance trusts are required to have arrangements in place for these type of scenarios issued with specialist ballistic personal protective equipment (PPE) and major haemorrhage control dressings undergo training with Police/Fire Service staff to operate and provide immediate care and evacuation from the ‘warm zone’ of an incident

Hazardous Area Response Team (HART) 2 HART teams across London with 84 staff each team consists of 6 staff on duty and operates 24/7 HART has a range of capabilities for hazardous areas: chemical, biological, radiological and nuclear defence safe working at height swift water rescue urban search and rescue inland water working extended duration breathing apparatus hot zone working

Equipment Support/Mass Casualty Vehicles 6 equipment support vehicles these provide shelter, lighting and additional lighting at incident scenes Host 3 National Mass Casualty Vehicles mass oxygen delivery system; medical drugs for use by Medical Emergency Response Incident Teams All vehicles are strategically located across London