Welsh Ambulance Services NHS Trust Integrated Medium Term Plan Summary 2017-2018 Published: MARCH 2017 www.ambulance.wales.nhs.uk www.facebook.com/welshambulanceservice @WelshAmbulance 0 1- INTRODUCTION Welcome to the summary document of our Integrated Medium Term Plan (IMTP). We are conscious that our IMTP is a lengthy, technical document that many may not have the time to read. This summary is our way of trying to make such an important document more reader friendly. The IMTP document is a requirement of Welsh Government for all Health Boards and Trusts in NHS Wales and it sets out our direction for the next three years stating our priorities, challenges and main risks. Throughout the main plan we commit ourselves to 48 actions which can be viewed in more detail in the main IMTP. We believe our IMTP is vital for us in WAST, regardless of it being a necessity for Welsh Government, to ensure there is a clear plan in place for the organisation. In a message from the Chair and Chief Executive they have stated how reshaping an ambulance service is a long term process and therefore a need to focus on our services and how we deliver them especially as the type of patients we are seeing are changing within our ageing population. This can only be achievable with support from our partners and ensuring our teams have the right skills. We hope you find this summary a useful insight into the Trust and the work we are continuing to do to improve the quality of care we deliver to our patients. 1 2 - STRATEGIC OVERVIEW We, the Welsh Ambulance Services NHS Trust (WAST), provide ambulance services for people in Wales, delivering high quality and patient-led clinical care – emergency, urgent and scheduled – wherever and whenever needed. We continue to change the focus of our service to establish ourselves as a clinically- led, quality-driven emergency medical service, non-urgent patient care service and a 24-hour health care and advice service that focuses on delivering the best clinical outcomes for patients. Developing a Long Term Strategy In our 2016/17-18/19 IMTP, we outlined a strategic statement of intent outlining where we want to be in 10 years’ time and giving a commitment to develop a long term strategy for ambulance services in Wales. Through the course of 2016/17 we have refined our thinking further by continuing conversations with our staff and our Board around our long-term strategy and our plan to get us there. Clearly, we cannot conclude our thinking on our longer term vision without exploring further with our key stakeholders. Key partners in this process are: Emergency Ambulance Services Committee (EASC) and the Chief Ambulance Services Commissioner LHBs in their provider role (as opposed to as our Commissioners via EASC), specifically linking in with their vision for unscheduled care and pre-hospital care in particular Primary Care Clusters The Unscheduled Care Programme Blue light partners Local authority and third sector partners We will work with these stakeholders through 2017/18 to explore and further our thinking in this area to inform our longer term strategy and we hope to have ambitions agreed by the end of 2017. 2 Our Refreshed Strategic Aims: A lot has happened in WAST over the last 12 months and so it was appropriate for our Board to review our strategic aims and set our plan against these. The diagram below illustrates our aims. Our Ambition We will place quality at the heart of everything we do, whether that is supporting all our leaders to be vibrant and compassionate, ensuring our services are excellent, in developing strong partnerships or in striving for continued value, excellence and efficiency • To deliver value, innovation and efficiency across the organisation. • To build even stronger partnerships with staff, patients, the wider public and our full range of stakeholders. • To ensure service delivery excellence and further improve the services we provide patients. • Our staff are fantastic. We must ensure they are continually able to be their best. • To ensure all our leaders are vibrant and compassionate and help create a compassionate, caring culture. We have subsequently been able to set our priorities for the coming three years against these strategic aims. Our 10 priorities are: 1. We will progress our quality improvement journey, implementing our Quality Strategy. 2. We will further transform our EMS (Emergency Medical Services) service using the 5 step pathway. 3. We will progress Non Emergency Patient Transport (NEPTS) transformation. 4. We will deliver further improvements to Clinical Contact Centres. 5. We will maintain our focus on workforce engagement. 6. We will continue to develop our workforce. 7. We will deliver a programme of improvement and efficiencies. 8. We will deliver patient and system benefits through our health partnerships. 9. We will realise further benefits from our collaborative stakeholder relationships. 10. We will continue our journey to becoming a highly effective organisation. 3 By bringing together our behaviours, priorities and our strategic aims results in a Strategy Map for the next three years as shown below: 4 Overview of Our Performance We have made good progress in improving key elements of performance during 2016/17. This has been achieved by improving our management processes across all directorates, including a strengthened performance management approach. However, we recognise that we still have areas where performance is fragile and where improvements could be made. The following statements summarise our performance: Enhanced Hear and Treat resulted in 1,700 ambulance dispatches being prevented in December. RED performance levels across all Local Health Boards was at 65% or higher, with the exception, of Powys in May and October. AMBER performance remains an area of concern. Our clinical indicators are not showing the improvement we would wish for. Our complaints and concerns from this patient group confirm the need to refocus our efforts in this area. As at January 2017 our 95th percentile performance was two hours, 11 minutes. The pressures of the winter period have put further pressure on this category of call and reviewing our Amber performance is a priority for 2017/18. WAST’s performance across its support services, which are key enablers for Operations and NEPTS, have generally improved: staff sickness is below 7%, staff turnover below 1%, all in the context of increasing staff numbers. Our Performance Ambitions Last year, we set ourselves 53 performance ambitions to help us measure how we are doing. We ensure that these ambitions are embedded in regular performance reporting and monitoring through our Monthly Integrated Quality and Performance Report and through our Directorate Quarterly Performance Reviews. At the end of Quarter 3 for 2016/17: 16 were either already met or were on track for meeting the ambition in 2016/17. 17 were off track but many with action plans in place to mitigate. 10 are to be measured in Quarter 4 as they are an annual measure or are a 5 year audit measure. 10 measures are to be reviewed to ensure they are the most appropriate measure for monitoring the ambition. Over the last twelve months we have realised some of the ambitions need to be reviewed or alternative metrics need to be set to ensure we capture all data and any issues. We will continue to refine and test our current performance ambitions for 2017/18 and will refresh to take into account our Quarter 3 position for this year 2017/18. Details of both our 2016/17 and our 2017/18 performance ambitions can be found in our full plan. 5 National Policy Context Our full 2017/18 plan outlines the national policy context within which we are operating. New policy guidance which has emerged over the course of the last twelve months and which is relevant to us includes: Taking Wales Forward (2016-2021) NHS Planning Framework (2017/18) where we have noted the importance placed on the following areas within the revised guidance: Primary Care The revised approach to National Delivery Plans Embedding the Wellbeing of Future Generations Act National Wales Strategic Change Agenda In our 2016/17 plan, we recognised that the ambulance service operates as part of a complex health and social care system which is progressing a number of complex service changes and developments, both at internal health board level and at a regional level. It is key that we are engaged appropriately in these change programmes and that we are able to model, and influence, the impact of options or decisions. However, we recognise that there is still work to do in this area as, whilst we can provide an overview of those programmes and projects which we believe will impact on our service, we have not in all cases fully engaged with them. From an ambulance service perspective, we are engaged in the following programmes that have major service change implications: South Central Acute care Alliance (SCACA) Paediatric, Neonatal and Obstetric (PON) Services ENT Services South East Wales Vascular Services Transforming Cancer Services (TCS) Programme All Wales Collaborative Mid Wales Healthcare Collaborative Future Fit A Regional Collaboration for Health (ARCH) Aneurin Bevan – Specialist and Critical Care Centre Clinical Strategies for Hywel Dda and Betsi Cadwalader Health Boards 6 Service Change in Collaboration with Blue Light Partners Over the last twelve months we have carried out new work with our partners including work within the Community Assistance Team (CAT) in North Wales, the Police Joint Response Unit (JRU) and Clinicians in Police Control rooms. Our ambitions are based on effective working with our partners in the NHS, local authorities, the voluntary and private sectors and our blue light partners.