1 CONTENTS Acronym Table 5 Message from the Chair and Chief Executive 8 Executive Summary 9 Part 1 Delivery of Our 2015/16 Plan 13 1.1 The New Clinical Response Model……………………………………............. 13 1.2 Quality and Operational Performance Trajectories…………………………... 15 1.3 2015/16 Strategic Change Portfolio …………………………………………… 18 1.4 Maturing Commissioning Arrangements and Increased Focus on Financial Strategy…………………………………………………………………………… 22 Part 2 Organisational and Strategic Context 24 This section, coupled with Part 1, serves as a high level diagnostic of the context within which we operate – it answers the “where are we now?” question. 2.1 Profile of the Trust……………………………………………………………….. 24 2.2 Our Demand & Activity………………………………………………………….. 32 2.3 The Five-Step Ambulance Care Pathway, Commissioning Quality & Delivery Framework, Understanding our Populations and Changes………. 33 2.4 National Policy Context………………………………………………………….. 37 2.5 Major Conditions, Older People and Frailty…………………………………… 42 2.6 Becoming a Listening and Learning Organisation………………………….... 43 2.7 NHS Wales Strategic Change Agenda………………………………………… 44 2.8 Service Change with Blue Light Partners……………………………………... 48 2.9 Ensuring Integration with Our Partners’ Three Year Plans………………….. 49 2.10 The Organisation and Prudent Healthcare……………………………………. 50 2.11 Treating People Fairly – Equality, Diversity & Human Rights………………. 51 2.12 Other Strategic Workforce and OD Drivers…………………………………… 54 Part 3 Creating Our Strategic Framework 57 This section sets the strategic framework for the organisation. It sets out our ambition and answers the “where do we want to go?” question. 3.1 Our Vision, Purpose and Behaviours………………………………………….. 57 3.2 Our Strategic Aims………………………………………………………………. 58 3.3 Our Priorities……………………………………………………………………… 59 3.4 Our Strategy Map………………………………………………………………… 63 3.5 Our Performance Ambitions………………………………………………......... 65 3.6 Developing a Frontline-Led Approach to Planning…………………………… 78 3.7 Becoming a Leading Ambulance Organisation: Where Do We Want to be in 5 – 10 years? ........................................................................................... 84 Part 4 Quality and Prudent Healthcare – the Main Driver of Our Business 86 This section sets out our ambition to put quality at the heart of our plans. It sets out the practical steps we are taking to move towards our vision, any milestones and intended impact of our actions - it answers the “what are we doing and how do we get there?” question. 2 4.1 Moving Forward 2016/19………………………………………………………... 87 4.2 Quality Themes and Improvements for 2016/17 and Beyond………………. 88 4.3 Quality Improvement, Measures and Assurance System………………....... 89 4.4 Quality Improvement and 1000 Lives Improvement…………………………. 90 4.5 Quality Governance……………………………………………………………… 91 Part 5 Our Strategic Change Programmes – Our Service Focused Priorities 94 This section gives an overview of our service change priorities, the practical steps we are taking to move towards our vision, any milestones and intended impact of our actions - it answers the “what are we doing and how will we make it happen?” question. Emergency Medical Services: The Five-Step New Clinical Response 95 Model……………………………………………………………………………… Non-Emergency Patient Transport…………………………………………….. 108 Part 6 Our Enablers – the Building Blocks to Our Success 111 This section gives an overview of the critical deliverables across our enabling functions and sets out how they will develop and strengthen to support service transformation- it answers the “what do we need in place to get there?” question. 6.1 Our People………………………………………………………………………... 111 6.2 Our Finances (Revenue and Capital)………………………………………….. 147 6.3 Our Estate………………………………………………………………………… 163 6.4 Our Fleet…………………………………………………………………............. 166 6.5 Research & Innovation…………………………………………………............. 168 6.6 Service Improvement……………………………………………………………. 169 6.7 Health Informatics and Business Intelligence……………………………........ 170 6.8 Information Communication and Technology……………………………........ 173 6.9 Partnerships and Engagement…………………………………………………. 175 6.10 Corporate Governance and Risk Management………………………………. 179 Part 7 Delivering the Plan 182 This section sets out the delivery framework for our IMTP - it answers the “how do we know what we are delivering?” question. 7.1 Approach to Planning……………………………………………………………. 182 7.2 Plan Delivery……………………………………………………………………… 182 7.3 Risks and Issues to plan delivery………………………………………………. 187 7.4 Engagement and approval arrangements…………………………………….. 190 7.5 Internal Planning model and cycle……………………………………………... 190 APPENDICIES 192 Appendix 1: Emerging Performance Issues Arising from the First Publication of the 193 Ambulance Quality Indicators………………………………………………………. Appendix 2: CAREMORE® Service Change Ideas Currently Agreed with the Emergency Ambulance Services Committee…………………………………...... 195 3 Appendix 3: NHS Wales Strategic Change Agenda Milestones………………………………. 197 Appendix 4: Mid Wales Healthcare Collaborative (MWHC) – Key Actions…………………... 198 Appendix 5: Summary of Health Board and Trust IMTPs’ Integration with WAST………... 204 Appendix 6: Supporting Information Relating to Documented Actions……………………..... 207 Appendix 7: WAST 2016/17 Discretionary Capital Plan……………………………………...... 208 Appendix 8: Strategic Change Programme Structures………………………………………… 211 4 Acronym Description A&E Accident and Emergency Department ABMU Abertawe Bro Morgannwg University Health Board ACPs Alternative Care Pathways AED Automated External Defibrillator AEMTs Advanced Emergency Medical Technicians AFSRC Ambulance and Fire Services Resource Centre ALS Advanced Life Support ABHB Aneurin Bevan University Health Board AP Advanced Practitioner APP Advanced Paramedic Practitioner AQIs Ambulance Quality Indicators ARC Ambulance Resource Centre ARCH A Regional Collaboration for Health AS Ambulance Station AWW Ageing Well in Wales BAF Board Assurance Framework BCUHB Betsi Cadwaladr University Health Board BME Black and Minority Ethnic BJCs Business Justification Cases CAD Computer Aided Dispatch System CVUHB Cardiff and Vale University Health Board CAS Clinical Assessment System CASC Chief Ambulance Services Commissioner CCA Civil Contingencies Act CCC Clinical Contact Centre CCG Clinical Commissioning Group CCIS Community Care Information System CE Chief Executive CFR Community First Responder CPADs Community Public Access Defibs CPAG Clinical Pathways Advisory Group CPAS Clinical Prioritisation Advisory Software Group CPD Continuing Professional Development CPR Cardiopulmonary Resuscitation CQDF Commissioning & Quality Delivery Framework CR Core Requirements CRM New Clinical Response Model CSD Clinical Support Desk CSPT Call Streaming and Prioritisation Software CTA Clinical Telephone Assessment (Hear & Treat) CTL Clinical Team Leader CW Central and West CTUHB Cwm Taf University Health Board DAV Dedicated Ambulance Vehicle EAs Emergency Ambulances EASC Emergency Ambulance Services Committee EBR Established Based Responders ED Emergency Department EDCIMS Emergency Department Clinical Information Management System 5 EFL External Financing Limit EMS Emergency Medical Services EMT Executive Management Team EMTs Emergency Medical Technicians ENT Ear, Nose and Throat EoL End of Life EoLC End of Life Care EPRR Emergency Preparedness, Resilience and Response ESMCP Emergency Services Mobile Communication Programme ESN Emergency Services Network ESR Electronic Staff Record System FC Frequent Callers FRA Fire and Rescue Authorities FRC Trust Board Finance and Resource Committee GA General Anaesthetic GP General Practitioner GPOOH GP Out of Hours HALO Hospital Ambulance Liaison Officers HART Hazardous Area Response Team HB Health Board HCP Health Care Professional HCSW Health Care Support Worker HEI Higher Education Institute HI Health Informatics HQ Head Quarters HR Human Resources HDUHB Hywel Dda University Health Board ICT Information Communications & Technology IG Information Governance IMTP Integrated Medium Term Plan IPC Infection, Prevention & Control IPR Integrated Performance Report JET Joint Executive Team KD Key Deliverable KPI Key Performance Indicator KSF Knowledge and Skills Framework LDP Local Delivery Plan LHB Local Health Board LRF Local Resilience Forum MBTI Myers Briggs Type Inventory MFR Medical First Responders MIU Minor Injury Unit MPDS Medical Priority Dispatch System MRD Make Ready Depot MWFRS Mid Wales Fire and Rescue Service MWHC Mid Wales Health Collaborative NATC National Ambulance Training College NEPTS Non-Emergency Patient Transport Services NEPTSQIs Non-Emergency Patient Transport Services Quality Indicators NHSDW NHS Direct Wales NICU Neonatal Intensive Care Unit 6 NWFRS North Wales Fire and Rescue Service NWSSP NHS Wales Shared Services Partnership OD Organisational Development OOH Out of Hours PA Physicians’ Associates PADR Personal Appraisal and Development Review PCR Patient Care Records PCRM Patient Centred Clinical Response Model PCS Patient Care Services PCT Primary Care Trust PERU Pre-hospital Emergency Research Unit PHEM Pre-hospital Emergency Medicine PHW Public Health Wales PIH Partners in Healthcare POW Princess of Wales Hospital PTHB Powys Teaching Health Board PPF Paramedic Pathfinder PPM Planned Preventative Maintenance PTR Putting Things Right QAIP Quality Assurance and Improvement Panel QuESt Quality, Experience and Safety Committee R&I Research & Innovation RAPID Rapid Analgesia for Pre-hospital Hip Disruption RLSS Royal Life Saving Society RNLI Royal National