1. Victoria Healthcare Association
London Ambulance Service NHS Trust Visit

2. 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

3. Introduction to LAS Heather Lawrence OBE, Chair

4. Ambulance Video

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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 minute responses

12. 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

13. 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

14. 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%

15. 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

16. 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

17. London Ambulance Service NHS Trust

18. 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

19. 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

20. 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

21. 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