Taking Healthcare to the Patient 2: A review of 6 years’ progress and recommendations for the future June 2011 This document has been produced by and on behalf of the Association of Ambulance Chief Executives June 2011 www.ambulanceleadershipforum.com Taking Healthcare to the Patient 2: A review of 6 years’ progress and recommendations for the future June 2011 Taking Healthcare to the Patient 2: A review of 6 years’ progress IV Taking Healthcare to the Patient 2: A review of 6 years’ progress Introduction 3 National Audit Office report 4 1. Better survival rates for the seriously ill and injured 5 Getting to patients quickly 5 The Future for Targets 11 Providing the best possible care 13 Taking patients to the best place for their care 15 Air Ambulances – common standards and governance 17 Impact on survival rates 18 The future for care for seriously ill and injured patients 21 2. Resolving the needs of patients who do not need the accident and emergency department (A&E) 23 New skills in Delivering Mobile Primary Care 24/7 24 The future skill mix in ambulance services 27 Telephone advice – Hear & Treat 28 The future for telephone advice services 29 Single points of access & directory of service (DOS) 29 The future for the single point of access 30 Alternatives to the Accident and Emergency Department 32 Preventing emergencies 33 The Future in Urgent Care 36 Patient Transport Services 36 3. Even better patient experience 39 How patients rate their experience 39 Patient involvement 44 4. Higher staff satisfaction 45 Staff Survey 45 Improving skills 47 Leadership 51 Equality and diversity 52 Staff support schemes 54 Anti-violence campaign 55 5. Organisational improvement 57 The benefits of merger and close cooperation between ambulance services 57 Communications 61 Joint work on finance and commissioning 63 Being prepared 70 The next six years for ambulance services – Six recommendations 75 References/bibliography 79 Acknowledgements 82 1 Taking Healthcare to the Patient 2: A review of 6 years’ progress Taking Healthcare to the Patient Transforming NHS Ambulance Services 2 Taking Healthcare to the Patient 2: A review of 6 years’ progress Introduction The publication of Taking Healthcare to the Patient in 2005 set an agenda for considerable change and improvement in ambulance services across England. There were more that 31 ambulance services in 2005. They merged to form twelve in total. This has led to improved leadership, greater collaboration, financial savings through joint procurement, much better resilience and most importantly advancements in patient care. The new twelve services have achieved: • Major advances in ambulance clinical education and training and the care provided to seriously ill patients • Greater attention to the many patients who do not have a life-threatening condition • Consistently high patient satisfaction levels • Significant improvement in the speed of answering 999 calls • Significant improvement in technology, infrastructure and emergency preparedness The next five chapters describe the changes that ambulance services have made since 2005 in five key areas: • Better survival rates for the seriously ill and injured • Resolving the needs of patients who do not need the emergency department • Even better patient experience • Higher levels of staff satisfaction • Organisational improvement Not every change described was the direct result of the recommendations in Taking Healthcare to the Patient. Some could not have been predicted at the time, and others are the indirect consequence of the closer working the English ambulance service has achieved after merging into just twelve services. In each chapter we describe some of the recommendations of Taking Healthcare to the Patient to which the achievements relate. While much has been achieved in the last six years, we still have much more to do and some thoughts on where next are outlined at the end of this review. Thanks go to all who have contributed to this report and to those in ambulance services across England who have helped deliver all that is set out in this review. Peter Bradley CBE Chairman, Association of Ambulance Chief Executives June 2011 3 Taking Healthcare to the Patient 2: A review of 6 years’ progress National Audit Office report REPORT BY THE As this review was going to print, the National Audit COMPTROLLER AND AUDITOR GENERAL HC 1086 SESSION 2010–2012 Office published its report – Transforming NHS Ambulance 10 JUNE 2011 Services. The report makes a number of recommendations aimed mainly at further improvements to the efficiency and effectiveness of our services. We welcome the report and its recommendations – many of which are already Department of Health underway across ambulance services in England. Transforming NHS ambulance services Specifically: • We believe we do provide good value for money but recognise there is always more that can be done. • We welcome scrutiny as we believe this can help improve our service which will ultimately benefit our patients. • We are pleased the report recognises the pivotal role ambulance services play within the urgent and emergency care system – and that when we deliver efficiencies it has a significant impact on the rest of the NHS. • We were already working on many of the recommendations in the report, for example we are offering more patients help and advice over the telephone while making sure patients get the right treatment by taking them to places other than hospital accident and emergency departments such as minor injuries units or urgent care centres. • We are pleased that the report recognises the importance of minimising delays during the clinical handover at A&E and the impact delays have on ambulance availability. • We are pleased the NAO report recognises the ‘greatly increased speed’ in which 999 calls are now answered. • We welcome the support the report gives to our cost improvement programmes as we change the way we work while working hard to further improving patient care. Individual Ambulance Trusts will want to discuss the report in their own organisations and with their commissioners. The Association of Ambulance Chief Executives will also work through the reports recommendations and agree any pieces of work that should be followed up nationally. 4 Taking Healthcare to the Patient 2: A review of 6 years’ progress 1. Better survival rates for the seriously ill and injured One in ten 999 patients are at risk of dying; three factors improve their chances of survival: • a fast response; • high quality care from highly skilled ambulance clinicians; and • being taken to a hospital that is appropriately skilled and equipped to deal with their emergency. Over the last six years ambulance services have made good progress in all three areas. Getting to patients quickly In 2005/06 ambulance services in England reached 74.0% of the 1.6 million category A calls (serious and immediately life-threatening calls) they received, within eight minutes of the 999 call. This was already a significant achievement. However, Taking Healthcare to the Patient identified that the 31 ambulance services of the time were not measuring this performance in the same way. The clock for measuring the eight minute period started after the ambulance service call taker had established the “chief complaint” of the patient, this could be as much as two minutes into the 999 call and could also vary by trust. Crucially, the time the caller had had to wait to have their 999 call answered in the ambulance control room after being connected to the ambulance service switchboard was not included in the eight minute target. This situation meant that an ambulance service could succeed in achieving the eight minute target, yet this might not reflect the actual time the patient waited for a response. A true comparison of performance between ambulance services was impossible. Taking Healthcare to the Patient aimed to create a level playing field enabling each Ambulance Trust to be benchmarked against each other. From 1st April 2008, ambulance services had to respond to Category A patients within the eight minutes following the 999 call being connected to the ambulance service control room. To the casual observer, it may not have seemed as if the eight minute target had changed at all. However, the change was significant; for most ambulance services it required reaching patients at least a minute and a half quicker than they had before. It also meant answering the 999 call much faster than ever before, this was important as previously it had not been uncommon for BT to have significant issues with how long operators had to wait for ambulance control rooms to answer 999 calls. 5 Taking Healthcare to the Patient 2: A review of 6 years’ progress The introduction of this new way of measuring the target required ambulance services to speed up three things: • answering the telephone; • dealing with the telephone call; and • sending a vehicle In fact ambulance services have studied every aspect of the call-taking process – from 999 call to the ambulance becoming available for its next call – and made each stage faster and more efficient. Some services needed to change their telephone systems so that they could measure the “call connect” time for every incoming call. Most had to change shift patterns in their control rooms and take on more call taking staff so that there would always be enough people on duty to answer 999 calls within a target of 5 seconds. Likewise, the numbers and shift patterns of dispatch staff were changed. Percentage of 999 ambulance calls answered in 5 seconds, by Ambulance service (AS) Taking Healthcare to the Patient Benefits Measures data collection 100% 90% 80% 70% 60% 50% 40% Percentage (%) London AS 30% North West AS 20% South West AS 10% 0% 2006/2007 2007/2008 2008/2009 2009/2010 Data displayed for trusts who submitted complete data returns Ambulance services answered approximately 90% of calls in 5 seconds in 2009/10, compared to 40% to 70% of calls in 2006/071.