1. Performance Position July 2014

2. Delivering the right care, at the right time, in the right place CONTEXT Ambulance service significant activity increase nationally Increase in complaints and untoward incidents A&E attendances significantly up across the system Rising GP referrals for attendance/admission at hospital Hospital admissions of elderly frail biggest rise Clinical capacity within system under pressure Hospitals frequently asking for diverts/deflections

3. Delivering the right care, at the right time, in the right place 1. In the past year, NWAS have delivered reductions in vacancies, improvements in abstraction rates and improved performance delivery, but do not have the capacity currently to consistently achieve performance. 2. Funding increased levels of NWAS capacity may achieve short term improvements in performance, but is not a sustainable solution, and does not address the significant budget cuts that are coming to the North West. 3. Cost reduction opportunities (slide 24) do exist within NWAS, but some identified savings have already been allocated to the required CIP programme. 4. The efficiency gains that NWAS have direct and sole control over (resource availability) are not enough to deliver performance for Cat A & B targets. Health economy collaboration will be required to act on the remainder of the opportunities. 5. Sustainable improvement requires changing the way the urgent care system operates. 6. Scenarios 1-4, and cost reduction opportunities can be used to “buy” the short term headroom in time and resources required to deliver the larger, strategic changes. Cap Gemini Capacity Review conclusions 2010

4. Delivering the right care, at the right time, in the right place This year MonthCall Pick UpR1R2A19 April90.2%75.7%75.8%96.2% May86.9%73.5%74.7%95.6% June81.2%71.5%73.2%95.4% July to date78.5%67.9%68.7%94.0% Year to date83.7%72.2%73.2%95.3% Average 999 daily volume risen from 3199 to 3644 Average hospital turnaround risen from 27.5 to 29.0 minutes (30 x12hr p/w) Increase in patients waiting for both calls and incidents Increase in multiple staff pressures (pensions/pay award/USH/workload) Known financial and system pressures (CIP’s/reconfigurations/resources)

5. Delivering the right care, at the right time, in the right place 2013/14 – 3055 April 14 – 3199 May 14 – 3233 June 14 – 3264 July 14 – 3643 Last week – 3790 Friday - 4053 Red 1 – last week more than NYE week Red 2 – 2 of last 4 weeks higher than both last xmas and NYE weeks Cat A – 3 of last 4 weeks higher than NYE week, last week higher than Xmas week 999 Calls Incidents

6. Delivering the right care, at the right time, in the right place What’s it mean? Red 1 and Red 2 75% – April both < 8 mins – May < 8m 15sec/ < 8m 5sec – June < 8m 25sec/ < 8m 20sec Green 1 in 20 minutes – 80.8% to 79.8% A19 95% – April/May < 18 mins – June < 18m 30s3c Green 2 in 30 minutes – 80.8% to 69.4%

7. Delivering the right care, at the right time, in the right place http://longerlives.phe.org.uk/ Worst Worse than average Better than average Best Overall premature deaths in England by Ambulance Service 2009-11

8. Delivering the right care, at the right time, in the right place Doing Now Utilising additional external monies for deferring planned CIP’s and additional operational resources Operating at REAP 3 and deferring training Additional productivity within the Urgent Care Desk with an increase in hear & treat outcomes Changes to processes and procedures allowing for non-deployment of resources and utilising ‘green cars’ with an increase in see & treat outcomes Local collaborative initiatives e.g. AVS/CRIT

9. Delivering the right care, at the right time, in the right place CCG presentation to AGMA on key characteristics of Integrated Care models Ambition, Preparation & Planning Whole System engagement Governance & Accountability Agreed Strategy & Implementation Plan including BCF Aligned Acute, Primary, Social Care and public health model of care Delivery Model – Integrated Teams etc Enablers Risk Stratification OD - Workforce Plan & Process Funding Agreement Performance Metrics & reporting Assistive Technology Information linking & exchange Implementation Population covered Community Teams in place GP Practices/other Primary care participation Risk Stratified Population Proactive Care Plans in Place Evaluation & Evidence of impact Plans for full roll out Risk Management

10. Delivering the right care, at the right time, in the right place NWAS – Going from Good to Great We are about people. We are here to serve the community of the North West and provide care to those patients that need us by delivering the Right Care, at the Right Time, in the Right Place. We are already a good organisation, with good staff and a good reputation… and we want to be even better. This is our five year plan to be great. We want to ensure the NHS culture of caring underpins everything we do by:  Delivering safe care closer to home  A great place to work  Cause no harm NHS Culture of Caring Working together for patients Respect and dignity Commitment to quality of care Compassion Improving lives Everyone counts

11. Delivering the right care, at the right time, in the right place Options Themes – Safe Quality Utilise NWAS resources differently – Different LHE models/HART/PTS Expansion of no-send and referral parameters – Omega codes/111/Green calls Utilisation of other agencies for workload – Community services/AVS/VAS/Fire Request new Capacity Review with commissioners