2018/19 – 20/21 Welsh Ambulance Services NHS Trust Integrated Medium Term Plan Contents 1 MESSAGE FROM THE CHAIR AND CHIEF EXECUTIVE ............................................................ 5 2 INTRODUCTION AND HOW TO READ THIS PLAN ...................................................................... 7 2.1 Our Plan at a Glance......................................................................................................................... 7 2.2 How to Read Our Plan ...................................................................................................................... 8 3 A REVIEW OF 2017/18 ...................................................................................................................... 11 3.1 Our Performance in 2017/18 – A Review ...................................................................................... 11 3.1.1 The Demand and Capacity Review ................................................................................ 14 3.2 Our 48 Strategic Actions: A Review ............................................................................................... 15 3.3 Our 2017/18 Performance Ambitions ........................................................................................... 15 3.4 Our Other Significant Achievements ............................................................................................. 15 4 STRATEGIC OVERVIEW .................................................................................................................. 17 4.1 National Policy Context .................................................................................................................. 17 4.2 Emergency Ambulance Services Committee (EASC) and the Commissioning Quality and Delivery Framework ................................................................................................................................... 18 4.2.1 Emergency Ambulance Services .......................................................................................... 18 4.2.2 Non-Emergency Patient Transport Services ........................................................................ 19 4.2.3 EASC Ambulance Commissioning Intentions ....................................................................... 19 4.3 NHS Wales Strategic Change Agenda ............................................................................................ 21 4.3.1 Regional Planning Committee Service Change ............................................................. 21 4.3.2 Health Board Service Change ........................................................................................ 23 4.3.3 Supra-Regional Change ................................................................................................. 23 4.4 NHS Wales Strategic Change Agenda – WAST’s Priorities for 2018/19 ......................................... 24 4.5 Ensuring Integration with Our Health Board Partners’ Three Year Plans ...................................... 25 4.6 External Impacts on Our Services .................................................................................................. 25 4.7 Service Change in Collaboration with Blue Light Partners ............................................................. 26 4.8 Developing a Long Term Strategic Framework .............................................................................. 30 4.9 Our Aims and Priorities .................................................................................................................. 34 5 CHALLENGES AND OPPORTUNITIES IN 2018 - 2021 .............................................................. 37 5.1 Challenges ...................................................................................................................................... 37 5.1.1 Demand and Capacity Review....................................................................................... 37 2 5.1.2 Amber Performance ...................................................................................................... 38 5.1.3 Clinical Risk Assurance Review ...................................................................................... 40 5.2 Opportunities ................................................................................................................................. 41 5.2.1 The New Computer Aided Dispatch (CAD) and Other Technologies ............................ 41 5.2.2 The Clinical Response Model ........................................................................................ 42 5.2.3 Working with Primary Care Clusters and Colleagues .................................................... 43 5.2.4 Workforce Modernisation ............................................................................................ 46 5.2.5 Health Care Professional Calls ...................................................................................... 47 5.2.6 Other Opportunities ...................................................................................................... 48 6 QUALITY, SAFETY AND PRUDENT HEALTHCARE ................................................................... 49 6.1 Strategic Context ............................................................................................................................ 49 6.2 Strengthening Quality Assurance and Improvement Across the Trust ......................................... 52 6.3 Processes to Strengthen Quality Across the Trust ......................................................................... 53 6.4 Outcomes (Assurance, Improvement and Learning) – Strengthening Quality Across the Trust 55 6.5 Prudent Healthcare ........................................................................................................................ 58 6.6 Patient Experience and Community Involvement (PECI) Team ..................................................... 59 6.7 Clinical Structure and Clinical Supervision ..................................................................................... 59 7 OUR SIGNIFICANT SERVICE CHANGES ..................................................................................... 61 7.1 OUR EMS SERVICE DEVELOPMENTS .............................................................................................. 61 7.1.1 STEP 1: Help Me Choose ............................................................................................... 61 7.1.2 STEP 2: Answer My Call ................................................................................................. 65 7.1.3 STEP 3: Come to See Me ............................................................................................... 69 7.1.4 STEP 4: Give Me Treatment .......................................................................................... 71 7.1.5 STEP 5: Take me to….. ................................................................................................... 74 7.2 OUR NON-EMERGENCY PATIENT TRANSPORT SERVICE DEVELOPMENTS ..................................... 76 7.2.1 The NEPTS Business Case .............................................................................................. 76 7.2.2 Commissioning of NEPTS .............................................................................................. 77 7.2.3 The NEPTS Five Step Model .......................................................................................... 78 7.3 SPECIFIC PATIENT GROUP SERVICE DEVELOPMENTS .................................................................... 84 7.3.1 Amber Calls - Responding to the Challenge .................................................................. 84 3 7.3.2 Welsh Government Together for Health National Delivery Plans ................................ 87 7.3.3 Responding to Elderly People Who Have Fallen ........................................................... 88 8 OUR ENABLERS ................................................................................................................................ 91 8.1 Our People ..................................................................................................................................... 91 8.2 Our Finances ................................................................................................................................ 106 8.3 Our Estate .................................................................................................................................... 125 8.4 Our Discretionary Capital ............................................................................................................. 128 8.5 Our Fleet ...................................................................................................................................... 129 8.6 Research and Development ......................................................................................................... 132 8.7 Improvement and Innovation ...................................................................................................... 134 8.8 Health Informatics and Business Intelligence .............................................................................. 135 8.9 Information Communication & Technology (ICT) ........................................................................ 137 8.10 Partnerships and Engagement ..................................................................................................... 143 8.10.1 The Well Being of Future Generations (Wales) Act 2015 (WBFGA) ...........................