Leadership and Safety Culture Across a Complex System

Slides:



Advertisements
Similar presentations
Information & Performance Cells. Performance Cell Who are we? West Midlands Ambulance Service NHS Foundation Trust 5.4 million population Over 5000 square.
Advertisements

Integrated Impact Assessment: Engagement Forum Healthier Together.
NAME – Council of Governors. What is swasft? We provide emergency, urgent and unscheduled care We are a Foundation Trust (March 2011) – aliened Acquired.
The journey towards integrated 24/7 urgent care Rick Stern Urgent care lead, NHS Alliance & Director, Primary Care Foundation NHS Alliance National Conference,
What’s wrong with emergency care in Aneurin Bevan Health Board? Dr Danny Antebi & Dr Julie Vile.
The London Ambulance Service NHS Trust NWL JOINT HEALTH OVERVIEW & SCRUTINY COMMITTEE 14th October 2015.
Unscheduled Care Learning Event Issues Identified from Winter Planning Review Michael Bloomfield 19 March 2015.
St John Project Transport to the Medical Home 20,000 Days Campaign Learning Session March 2013 Project Manager: Jo Goodfellow.
Performance Position July Delivering the right care, at the right time, in the right place CONTEXT Ambulance service significant activity increase.
Remote Practitioners Association Inverness 11 th November 2010 Shirley Rogers Stephanie Phillips Paul Gowens.
NHS West Kent Clinical Commissioning Group The future of urgent care services in West Kent Out of hours and hospital at home service.
Paul Sutton, Chief Executive Reviewing 2014/15 and looking forwards.
Impact On Ambulance Service Mental Health Milestones David Ashford Head of Clinical Practice MH.
Urgent Care Birmingham Health Overview and Scrutiny Committee
The how, why and what of telemedicine in care homes
Hospital Discharge Day Thursday 7th July 2016, 9am – 2pm
East Midlands Ambulance Service
Governing Body 24 January 2017
Presented by Peter Lewis, Head of Contracts
Clinical Director – Emergency & Acute Care Group
Operational Plan 2017/18 and 2018/19
Who we are: Hackney and Homerton
It’s the best known brand in the world for urgent healthcare….…
Financial Performance Report Month 8
Dr Chris Schofield Clinical Lead Liaison and CRHT
Reducing Mortality & Harm in Welsh Ambulance Services NHS Trust
Manchester Locality Plan
…Achieving Continuous Improvement
Central Surgery – Journey to Demand-led Access
Ambulance Response Programme
St. Mary’s General Hospital Orientation
Future Health Sector Vision / Direction of Travel
Emergency Operations Centre
Presentation for patients and the public
National Early Warning Scores: National Ambulance Survey Headline Findings Health Innovation Manchester April 2018.
National Early Warning Scores: National Ambulance Survey Headline Findings North East North Cumbria April 2018.
National Early Warning Scores: National Ambulance Survey Headline Findings Yorkshire & Humber April 2018.
CQC review.
Hospital Transfer Pathway Also Known As
Red2Green Why is this improvement work important?
National Early Warning Scores: National Ambulance Survey Headline Findings Wessex April 2018.
CQC: The new approach to inspection
Patient Forum Pack September 2018
CQC and Performance Update
National Ambulance Service (NAS) Martin Dunne Director NAS
Governing Body Quality Update
National Early Warning Scores: National Survey Headline Findings
Ambulance Response Programme
Presentation for patients and the public
National Early Warning Scores: National Ambulance Survey Headline Findings South West April 2018.
Operational Plan 2017/18 and 2018/19
Author: Beke Tshuma Implementation Lead – Older Person’s Care
National Early Warning Scores: National Ambulance Survey Headline Findings West of England April 2018.
National Early Warning Scores: National Ambulance Survey Headline Findings East Midlands April 2018.
National Early Warning Scores: National Ambulance Survey Headline Findings Imperial Healthcare Partners April 2018.
Patient Flow A Bird’s Eye View
National Early Warning Scores: National Ambulance Survey Headline Findings Health Innovation Network April 2018.
National Early Warning Scores: National Ambulance Survey Headline Findings Kent Surrey & Sussex April 2018.
National Early Warning Scores: National Ambulance Survey Headline Findings Innovation Agency (North West Coast) April 2018.
National Early Warning Scores: National Ambulance Survey Headline Findings UCL Partners April 2018.
Monthly Performance Report
National Early Warning Scores: National Ambulance Survey Headline Findings Eastern April 2018.
999 AND YOU.
NWAS Presentation to Greater Manchester Health Scrutiny Committee
Operational site management principles
Operational site management principles
Integrated Performance Report
Our Team – Emergency Care Intensive Support Team
Patient Forum Pack May 2019 This report refers to May 2019 (M2) data unless otherwise stated All data is based on LONDON Clinical Commissioning Groups.
Safety Hour Discussion Pack
Presentation transcript:

Leadership and Safety Culture Across a Complex System Derek Cartwright Chief Executive

Complex Operating Environment 7m Popn 5.4k Sq. Miles 4 33 76 MPs 46 8 30+ 5 5 29 100’s 100’s 1,420

NHS v Blue Light Service Urgent & Emergency Care Blue Light Collaborative

Regional Service: Local Delivery

Ambulance Turnaround & Delayed Transfer of Care

Hospital A : Manchester Infirmary Hospital B: Salford Royal

805k attendances to hospital. 2015/2016 highlights: Over 1.1M incidents Of Which, 480k REDS (serious and immediately life threatening) Unprecedented growth of around +11% on previous year. 805k attendances to hospital. 358k conveyances avoided (through hear & treat / See & treat)

The System We are all part of the one system NWAS works with partners in the system to improve patient safety and experience in the community and EDs Together we can improve the whole patient experience Ambulance Trusts have lots to offer, BUT The NHS has 999 patients at risk in the community without any support at all this is not safe Hospital A : Manchester Infirmary Hospital B: Salford Royal

This is not safe care Turnaround - Lost Time 1 minute increase = 2 x 24/7 Ambulances each day That’s 336 patient episodes 5 ½ minutes Increase = 10 x 24/7 Ambulances each day That’s 1680 patient episode This is not safe care

Green 4 Response

But you have plenty of Ambulances! Justification But you have plenty of Ambulances!

Transfer of Care Hospital Amb delayed Amb Resource Southport District General 3 5 Aintree University 11 10 Cumberland Infirmary 2 6 Furness General Royal Blackburn 13 Wigan Infirmary 8 Royal Bolton 15 9 Royal Oldham North Manchester General Manchester Royal Infirmary Stepping Hill 4 7 Longest wait for transfer of care on Monday 21st November 2106 at 1600 Resource is Ambulance and UCS at local station

Hospital Turnaround Time

Green 3 Response

Delayed Transfer of Care - Variance between Acute Hospitals

Suggested Mitigation – Get more Ambulances We need eleven people to fully staff an Ambulance (24/7) Paramedics are university educated, the recruitment takes three years An Ambulance vehicle plus equipment can take up to a year to procure, build and get delivered The total cost of a staffed & equipped vehicle = £700K And won’t they just join the queue!

We have very expensive, university educated, corridor assistants. Royal Bolton Monday 21st November 2016

Early hours Fri/Sat/Sun shows sustained pressure through the night Early hours Fri/Sat/Sun shows sustained pressure through the night. Taking much longer to subside Daily mid-morning surge of 999 activity. From ~60 per hour to ~210 per hour mid-day. AE attends subsequently surge from 40 per hour up to around 115 per hour early afternoon.

Why do you convey everyone to ED? Hospitals Say: Why do you convey everyone to ED?

999 Patients

ED Patient Conveyances

528 Nov 2015

12 1714 Nov 16

Quality/Safety Measure SIREN report (safety monitoring) Red 1 and Red 2 incidents with excess attendance time > 60 minutes: December 2016; Red 1 was 13 and Red 2 was 623. January 2017; Red 1 was 20 Red 2 was 605.   Analysis of the 20 Red 1 calls with excess attendance have shown that they were all a result of upgraded calls. We understand we have got a problem with long waits across the board Whilst cardiac arrests are what many think we are here for and every time you hear a siren we are off to a clinical emergency –you know this is not true! Long wait, create long waits but also could be worsening care outcomes for some patients – not all, but our triage system is not good at figuring this out

NWAS and the System Even with an increase in 999s, in 15/16 NWAS took less patients to the Emergency Departments than the previous year NWAS managed more than 33% of patients without transportation anywhere (H&T, S&T) – minimal re-contact rate NWAS transported a further 8% of the patients it attended to destinations other than an ED More than 40% of 999 patients don’t go to the ED Hospital A : Manchester Infirmary Hospital B: Salford Royal

Key Recommendations 1) Whole system approach 6) CAD system visibility 2) Working together 7) Streamline process 3) Financial penalties 8) Modelling capacity & forecast 4) Definitions 9) Escalation 5) Key performance indicators 10) Regional capacity management NHS Confederation (2012) Zero tolerance: Making ambulance handover delays a thing of the past.

What can we do together to improve the situation? Now Our (NHS) Patients are unsafe in the community Our (NHS) Patients think that none of us care Bad in reputational terms for all of us in the NHS Bad for all our People The issue has become normality – for all staff groups – we must change this mind-set What can we do together to improve the situation?

Thank You, Any questions. email: Derek. Cartwright@nwas. nhs Thank You, Any questions? email: Derek.Cartwright@nwas.nhs.uk Tel: 01204 498406