Our Quality Account
2011/12
Contents
Page No
Executive summary
A brief overview of our Trust (what we do)
3
5
Part 1
An introduction to our Quality Account (your definitions of quality)
Board Assurance Statement
Chief Executive’s Quality Statement
9
11
12
Part 2
Priorities for Improvement (where we need to improve)
Quality Management Systems (how we will support improvement)
Our current quality performance (what we did and how we improved)
Our local improvement priorities (what we pledged to do)
14
21
26
34
Part 3
How we developed our Quality Account (what you said)
Review of quality performance (how we did last year)
43
45
Glossary
55
Contact details
57
We asked our Foundation Trust members to describe in one word how they view EMAS. The above shows
what they said - the size of each word is in proportion to the number of times members used it.
2
Executive Summary
This Quality Account reviews our performance in 2011/12 and sets out our key priorities for quality
improvement for 2012/13. Last year’s Quality Account reflected quality developments from a Trust-wide
perspective. It is our intention that next year’s Quality Account will provide County-based information to show
how our improvement activities have benefited local health communities
In 2011/12, EMAS continued to improve the quality of care provided. Last year we identified the following
quality improvement priorities against the 3 ‘domains’ of quality – patient safety, clinical effectiveness and
patient experience.
Priority
Quality measure
Priority 1: Communication and Joint Working
Patient safety
Priority 2: Developing our workforce
Priority 3: Effectiveness of treatment (Clinical Performance Indicators - CPI)
Clinical effectiveness
Priority 4: Response to our patients (Accident and Emergency - A&E)
Patient experience
Priority 5: Treating patients with dignity, respect, care and compassion
Delivering against the above priorities has yielded a number of benefits for patients:
Priority 1: Communication and Joint Working
We introduced a structured communication tool to improve communications between staff and organisations
during patient care handover processes. Improving the quality and comprehensiveness of clinical information
communicated has enhanced our ability to care for patients effectively. We also continued to work with our
staff to develop our mechanisms for sustaining compliance with Safeguarding and Infection Prevention and
Control standards for optimum patient care. Compliance audits for safeguarding and infection prevention and
control have consistently shown excellent results which demonstrates our staff are delivery high quality care
in this respect.
Priority 2: Developing Our Workforce
We increased our paramedic numbers to ensure our patients receive high quality care from skilled and
competent clinicians. We have made significant progress to achieve our desired staffing levels and skill mix
ie a ‘relief rate’ of 27% against a target of 28% and our target skill mix of 60:40 (registered to non-registered).
In addition, 92% of A/E and PTS staff had completed the EMAS Essential Education Programme.
Priority 3: Effectiveness of treatment (Clinical Performance Indicators - CPI)
We improved our performance against a number of national clinical performance indicators and implemented
improvement plans to target areas where further improvement was needed. This has enabled us to
continually improve the quality care we deliver to our patients.
Priority 4: Response to our patients (Accident and Emergency - A&E)
We introduced measures which led to improvements in our response times to patients with life-threatening
conditions. The additional investment in our clinical assessment team has led to more appropriate
management of non life-threatening calls via telephone-assessment and referral to local community services.
3
Where we need to improve our response times to national targets, we have developed plans to improve our
performance.
Priority 5: Treating patients with dignity, respect, care and compassion
We have developed our services for service users with learning disabilities and implemented a Trust wide
‘Dignity in Care’ campaign. We now have over 400 ‘Dignity Champions’ across the Trust with over 80% of
these in patient-facing roles. We also increased the number of staff attending learning disability training. This
gave staff a greater understanding of how to care for patients holistically taking account of their individual
needs and family relationships. Our engagement with service users and carers has enabled us to identify
ways to make our service more accessible to all.
In 2012/13 we will continue to drive forward our quality improvement initiatives to enhance patient safety,
patient experience and clinical outcomes for patients. Our priorities have been developed with our staff,
service users and the public and are shown below:
Patient safety
Priority 1:
Improvements in response to staff survey key questions and
Performance Development Reviews (appraisals)
Priority 2: Continue to improve the processes for call handling, clinical
assessment and the deployment of resources
Clinical effectiveness
Priority 3: Existing clinical performance indicators to be improved and new
indicators to be developed taking into account regional priorities
Priority 4: Continue to engage with stakeholders across local communities to
enable patient experience to influence service improvement and development
Patient experience
Priority 5: Develop a training package linked to a new Domestic Violence Policy
to equip frontline staff with the knowledge to recognise and deal effectively with
victims and perpetrators of Domestic Violence
Progress against priorities identified in the Quality Account for 2012/13 will be regularly monitored by the
Quality and Governance Committee, a sub-committee of the Trust Board. A mid-year Quality Account report
will also be received by the Trust Board to provide additional assurance of delivery.
4
A brief overview of our Trust
(what we do)
Introduction
East Midlands Ambulance Service NHS Trust (EMAS) currently provides
Emergency and Urgent Care and Patient Transport Services for the six
counties of Derbyshire, Leicestershire, Rutland, Lincolnshire (including
North
and
North
East
Lincolnshire),
Northamptonshire
and
Nottinghamshire.
We employ over 3,200 staff at more than 70 locations, including two
Emergency Operation Centres at Nottingham and Lincoln, with the
largest staff group being accident and emergency personnel. Our
overall annual income budget for 2011/12 was £161 million.
Our accident and emergency crews respond to over 586,000 emergency calls every year, that is one call every
54 seconds, while our Patient Transport Service (PTS) and volunteer ambulance car drivers provide care and
transport on over 2,900 journeys to and from routine appointments each day - over 1 million journeys a year.
Following a competitive tendering exercise, from July 2012, EMAS will no longer provide PTS other than in
North and North East Lincolnshire.
We rely on our volunteer staff to help us provide a quality service. These include Community First
Responders, LIVES responders, Voluntary Care Drivers, St John Ambulance, The Red Cross and our own
staff who respond as Medical First Responders in their own communities. We also utilise EMICS (East
Midlands Immediate Care Scheme) doctors who respond to emergencies. All doctors in EMICS are
volunteers who attend emergency incidents at the request of and in support of staff from the EMAS. These
doctors are all very experienced and fully trained in trauma work and are equipped to perform life-saving
interventions at the scene of an incident such as an industrial or road traffic accident or a rail crash. They
carry with them a wide range of specialist equipment to deal with the serious trauma and other emergencies
that might be encountered in their day to day emergency work. The positive partnership EMAS has with
organisations such as LIVES and EMICS is particularly valuable in supporting timely responses to patient in
more rural areas.
We also work closely with three air ambulance charities: Lincolnshire & Nottinghamshire Air Ambulance,
Derbyshire, Leicestershire & Rutland Air Ambulance and Warwickshire & Northamptonshire Air Ambulance.
What can you expect from us when you call 999?
When you call 999 and ask for an ambulance, you will be immediately connected to one of our highly trained
ambulance control centre teams. They will ask you for your location, the telephone number you are calling
from and details of the main problem. While you are talking to our control team, appropriate help has
already started to be arranged.
If the illness or injury is life-threatening, we instantly pass the information we have been given to the nearest
available ambulance vehicle so that they can get to the location as quickly as possible. In many cases we
will send a fast response car or a community first responder, where they can get to the scene more quickly
than a conventional ambulance and start to provide care immediately.
Whilst help is on the way, our control team will offer advice on how to help the patient and they will usually
remain on the phone until the vehicle arrives.
5
On arrival, the patient’s condition is assessed and treatment is given. Where necessary the patient is quickly
transported to a hospital A&E department or, where appropriate, to a centre which specialises in the
treatment of head injuries, heart attacks or stroke.
In non life-threatening cases, a ‘blue light’ emergency response from an
ambulance is not always needed but if we decide to dispatch an
ambulance, crews will often provide treatment at the scene. If we decide
an ambulance response is not needed (based on the information given to
us by the caller) an advisor will call back, carry out a full clinical
assessment of the patient’s condition over the phone and then suggest
the best treatment - such as being cared for at home, being referred to a
GP, pharmacy or community based care service.
On 1 April 2011, the Department of Health introduced new national targets for ambulance
services. The Category A life-threatening call target of responding to 75% of all cases within 8 minutes of the
call being received was unchanged. However, eleven new Clinical Quality Indicators were introduced for
non-life threatening calls. This means we are measured on how we treat patients and the outcomes of the
treatment rather than just on timeliness. By monitoring performance in this way, we are able to identify good
practice and any areas which need improvement. As an organisation keen to develop and improve, EMAS
welcomed this change. Examples of the new quality measures are:
Outcome from cardiac arrest – survival to discharge rates
Outcome following stroke
Proportion of calls dealt with by telephone advice or managed without transport to A&E (where this is
clinically appropriate)
Unplanned re-contact from the patient within 24 hours of discharge of care (i.e. where patient not
transported but has received telephone advice or treatment at the scene)
The following flow chart identifies how the timeliness of our response to 999 calls is measured:
6
Patient Transport Services (PTS)
EMAS provides a non–emergency transport service for eligible patients across the East Midlands. This is for
patients whose medical condition is such that they cannot travel by public or private transport and their
needs are best served by non-emergency ambulance staff. Every year, our PTS staff transport about 1
million patients to hospital, treatment centres and other health related facilities within the area we serve and
to other specialised centres outside of the region.
Earlier this year the service was put out to competitive tender by the commissioners of the East Midlands.
Whilst a quality bid was submitted by EMAS the commissioners chose to award the business to 2 private
operators. The counties of Derbyshire, Northamptonshire and Lincolnshire (excluding North and North East
Lincolnshire) were awarded to NSL and the remaining Leicestershire and Nottinghamshire (including
Bassetlaw) were awarded to Arriva. North and North East Lincolnshire continue to be part of the EMAS
provision having gone through a similar tender exercise 18 months ago.
st
The new contract is due to commence on 1 July 2012 for the East Midlands. Until then, patients will
continue to be transported by EMAS resources. EMAS are working closely with the commissioners to ensure
a smooth transition for patients. All changes to booking arrangements and contact details will be
communicated to existing patients and the revised eligibility criteria will be stringently applied by the new
operators in an effort to reduce the number of patients accessing the service inappropriately.
7
Our Quality Account
2011/12
Part 1
8
An introduction to our Quality Account
(your definitions of quality)
We have compiled this document to provide readers with information about EMAS’ past, present and future
activities in relation to the important subject of quality.
In 2010, the Department of Health (DoH) mandated that all NHS provider Trusts published a Quality Account
on an annual basis. The purpose of the Quality Account is to demonstrate our commitment to quality and for
others to hold us to account. Quality is broken down into three domains:
Patient safety
Clinical effectiveness
Patient experience
This Quality Account reviews our performance for 2011/12 and sets out our key priorities for 2012/13.
To make our Quality Account useful to all readers, we asked a broad range of organisations and people how
we could make the three domains of quality meaningful to them. The table below summarises the responses
we received and these are updated annually:
What does quality mean to you?
Area
Patient
Safety
Clinical
Effectiveness
We asked
What would make you feel safe?
What would you expect from us
when we treat your ailment or
condition?
Respondents said
good and effective communication between
professionals, between care agencies and
others
treatment in a clean environment
being given reassurance, made to feel calm
and less anxious
an appropriate response being provided
Appropriate personal protection
Ability to control wheel chairs safely
prompt response times
prompt and up-to-date care delivered by
knowledgeable, calm, capable staff
well maintained vehicles, with up-to-date
equipment.
Treatment is fast and effective
Personal data is protected
Resources are used effectively
Staff are identifiable
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Patient
Experience
How would you like to be treated
by the Ambulance Service?
with care, compassion and dignity
polite, friendly and professional staff
a service that focused on patients.
Staff who are knowledgeable, polite and
understand the needs of a diverse group of
patients.
Patients are listened to
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Board assurance statement
Every member of the EMAS Trust Board has been involved in identifying the quality indicators, agreeing the
content and endorsing the content of this Quality Account.
We took into consideration the feedback we received on previous quality accounts and in response this year
we have developed our quality priorities and indicators with our stakeholders and our staff.
Non-Executive Directors continue to play a pivotal role in providing challenge and scrutiny, assessing our
performance and contributing to our future strategy.
It is important to endorse our achievements in relation to compliance with the Care Quality Commission. We
welcomed a visit from the CQC in October 2011 and were assessed against 4 outcomes as follows:
Outcome 04 - Care and welfare of people who use services
Outcome 07 - Safeguarding people who use services from abuse
Outcome 12 - Requirements relating to workers
Outcome 16 - Assessing and monitoring the quality of service provision
All outcomes were found to be fully compliant with the exception of Outcome 12 because not all staff
employed before the regulation requirements were introduced (in 2002) had been subject to a criminal
record bureau check.
The organisation’s performance in respect of quality is closely monitored by Board members as an integral
part of their overall responsibilities.
Statement of Directors' responsibilities in respect of the quality account
EMAS Directors are required under the Health Act 2009, National Health Service (Quality Accounts)
Regulations 2010 and National Health Service (Quality Account) Amendment Regulation 2011 to prepare
Quality Accounts for each financial year.
The Department of Health has issued guidance on the form and content of annual Quality Accounts (which
incorporate the above legal requirements).
In preparing our Quality Account, Directors are required to take steps to satisfy themselves that:
the Quality Account presents a balanced picture of the Trust’s performance over the period covered;
the performance information reported in the Quality Account is reliable and accurate;
there are proper internal controls over the collection and reporting of the measures of performance
included in the Quality Account, and these controls are subject to review to confirm that they are
working effectively in practice;
the data underpinning the measures of performance reported in the Quality Account is robust and
reliable, conforms to specified data quality standards and prescribed definitions, is subject to
appropriate scrutiny and review; and the Quality Account has been prepared in accordance with
Department of Health guidance.
EMAS Directors confirm to the best of their knowledge and belief they have complied with the above
requirements in preparing this Quality Account. By order of the Board.
Chief Executive
Chairman
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Chief Executive’s quality statement
Welcome to East Midlands Ambulance Service’s (EMAS) third annual Quality Account which provides:
a summary account of our performance against selected quality metrics (measures) for last year
details of our quality priorities for the forthcoming year.
This report is for the public, it shows what we are doing well, where we need to make improvements and
what our priorities are for the coming year. I am delighted to share with you our annual Quality Account.
Quality Accounts are intended to show how NHS services are truly putting quality at the top of their agenda.
Their introduction in 2010 marked an important step forward in putting quality on an equal footing with
finance. NHS Trust Boards are ultimately responsible for quality of care provided and they must ensure that
Quality Accounts:
demonstrate commitment to continuous, evidence based quality improvement;
set out to patients where improvements are required;
receive challenge and support from local scrutiny;
enable Trusts to be held to account by the public and local stakeholders for delivering quality
improvements.
After joining EMAS as Chief Executive in December 2011, I have spent a great deal of time visiting our
committed and talented staff across the East Midlands and seeing how our many departments work. I
continue to be impressed by the pride, professionalism and friendliness of everyone I meet and their
determination to improve the quality of our services and care.
In EMAS, our number one priority is to maintain and improve the quality and safety of the service. We strive
to deliver the right care, in the right place, at the right time through being clinically-led and patient focused.
Working in partnership with our service users ensures that improvements in care are not only evidencebased but are responsive to need, reflecting the issues that patients tell us are important to them.
In 2011/12, EMAS has continued to make significant improvements in the quality of services we deliver. A
major focus for next year will be the on-going implementation of quality improvement initiatives that enhance
patient safety and improve the experience and clinical outcomes for patients. The priorities for the year
ahead have been drawn from our staff, service users and the public.
To the best of my knowledge, the information contained within this Quality Account is accurate and reflects a
balanced view of EMAS’ current position and future ambitions. I hope you enjoy reading this report and
share in the pride I have in the services we have been able to provide for our patients in the last year, and
will continue to provide in the future.
The Quality Account celebrates our hard work and achievements. I would like to congratulate staff for
providing outstanding care to patients whilst ensuring the Trust remained financially sound. This would not
have been possible without the hard work of everyone who works for and supports the Trust.
Thank you.
Chief Executive
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Our Quality Account
2011/12
Part 2
13
Priorities for improvement in 2012/13
(where we need to improve)
In association with patients, staff and other stakeholders (see Part 3 – How we developed our Quality
Account) we have identified a broad range of key priorities for 2012/13. These cover what are considered to
be the most relevant factors given the role EMAS performs in providing high quality patient care. These
priorities have been developed in line with the views of our stakeholders. Note that the priorities listed below
are of equal importance:
Priority
Quality measure
Patient safety
Priority 1:
Improvements in response to staff survey key questions and PDR
Priority 2: Continue to improve the processes for call handling, Clinical
Assessment and the deployment of resources
Clinical effectiveness
Priority 3: Existing Clinical performance indicators to be improved and new
indicators to be developed taking into account regional priorities
Priority 4: Continue to engage with stakeholders across local communities to
enable patient experience to influence service improvement and development
Patient experience
Priority 5: Develop a training package linked to a new Domestic Violence Policy
to equip frontline staff with the knowledge to recognise and deal effectively with
victims and perpetrators of Domestic Violence
14
Priority 1: Improvements in response to staff survey key questions and PDR
EMAS is committed to ensuring its workforce is competent and confident in practice; and that staff are
appropriately supported to do their job effectively. Compliance with Care Quality Commission (CQC)
Supporting Staff standards will demonstrate the Trust’s commitment to ensuring high quality safe patient
care.
Quality measure
Patient
Safety
Quality indicator measured by
Maintaining CQC Supporting
Staff Standards that ensure safe
recruitment processes;
supportive management
behaviour; and employee
assistance programmes.
Education and Development:
• Attendance on Essential
and Mandatory
Education
• Performance
Development Review
•
•
•
•
Maintaining
compliance
with
CQC
Supporting Staff Standards
Improved Staff Opinion Survey outcomes
and 45% response rate
100% attendance on Essential Education
100% completion of PDRs on a 12 month
rolling basis
Priority 2: Continue to improve the processes for call handling, Clinical Assessment and the
deployment of resources
Every patient counts and needs to be treated appropriately according to their individual needs. It is therefore
necessary that we remain committed to providing a fast, safe and effective service from the moment the call
is connected to the time of treatment, assuring that the patient’s needs are assessed and met in the most
appropriate and timely manner.
Quality measure
Quality indicator measured by
Call pick up 95% within 5
seconds to improve overall
speed of response to patients
with life threatening conditions,
by June 2012.
Patient Safety
Implementation
of
NHS
Pathways to ensure continuity of
clinical assessment across all
types of calls, so the patient
receives the most appropriate
response to meet their individual
needs, by October 2012.
Report of percentage of calls hitting the 5
second call pick up target.
An improvement in the number of calls that are
directed towards the right outcome, first time –
with an emphasis on Hear and Treat, See and
Treat and See and Convey, according to
requirement of patient.
15
New
deployment
plan
developed utilising evidence
based Tactical Deployment
Points to improve speed of
response to patients with life
threatening
conditions,
by
October 2012
Performance in relation to national/local
standards benchmarked against the results
achieved by other UK ambulance services.
Report to compare performance prior to and
following implementation of new Tactical
Deployment Posts.
Priority 3: Existing Clinical performance indicators to be improved and new indicators to be
developed taking into account regional priorities
The National Clinical Performance Indicators (CPI) currently cover the areas of Heart Attack, Stroke, Asthma
and Hypoglycaemia. EMAS has shown continued improvement in these areas and many of these are now
business as usual with consistent performance at high level nationally. Due to the limited number of cases, it
is intended to produce a set of our own indicators on further areas to be measured and performance
managed increasing our scope of clinical effectiveness.
Quality measure
Clinical
Effectiveness
Quality indicator measured by
Improvement to reach or
maintenance of standards for
existing CPIs in line with CQC
Quality Risk Profile standards.
Demonstrable
improvement
from a Quarter 1 baseline in any
newly developed indicators.
Outcome for patients: consistent
high quality care, and improved
clinical outcomes across these
areas
Existing CPI areas measured against National
benchmarks. New Indicators reviewed by a
measure of improvement using an identical
methodology.
Priority 4: Continue to engage with stakeholders across local communities to enable patient
experience to influence service improvement and development
The Equality Delivery System (EDS) is the national performance framework for the NHS to demonstrate
progress on equalities; identify and improve equality performance and objectives that address inequalities
and deliver positive outcomes for patients. Implementation of the EDS and external engagement will enable
stakeholders to grade our current equality performance and influence the development of equality objectives
to support the Trust’s goal to improve equality performance.
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Quality Measure
Clinical
Effectiveness
Quality indicator measured by:
Ensure stakeholder
engagement is representative of
seldom heard groups; and
members from protected
characteristics (identified in the
Equality Act) to ensure
meaningful grading activity is
conducted to measure current
equality performance.
One Annual EDS Grading Event to be held per
county during the year.
Through the above stakeholder
engagement and influence,
develop relevant equality
objectives to support
improvements in the Trust’s
equality performance in line with
the priorities identified by
seldom heard groups and
members from protected
characteristics.
EDS objectives developed in conjunction with
community groups by 6 April 2012 prior to Board
submission
Priority 5: Development of a training package linked to a new Domestic Violence Policy to equip
frontline staff to recognise and deal effectively with victims and perpetrators of Domestic Violence
The 2009 Government strategy “Together we can end violence to women and girls” recommended that the
NHS improves its response to domestic violence (of all forms) against women and children. The
development of a policy and education for all staff will demonstrate EMAS’ commitment to addressing
Domestic Violence and Abuse through partnership working with key statutory, voluntary and private sector
agencies.
Quality Measure
Quality indicator measured by:
Implement a Domestic Violence
and Abuse Policy to ensure the
adoption of a safe, consistent
and quality approach.
Patient
Experience
Domestic Violence and Abuse Policy to be
implemented by 30 April 2012
To increase awareness and
improve staff confidence in
addressing Domestic Violence
and Abuse through a module
within our Essential Education
programme
and
a
Communications campaign
Disseminate education Trust-wide to EMAS staff.
100% staff will receive the education by 31 March
2013.
To ensure that lessons learnt
from
Domestic
Homicide
Reviews (DHR’s) are embedded
into practice
We will monitor action plans from DHR’s within the
clinical governance framework
We will monitor the number of staff who have
provided individuals with appropriate signposting
material for support services.
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EMAS captures patients’ experience in a variety of ways. One way is by inviting patients and carers into our
Trust Board meetings to tell their story. We have included 2 examples below – one where we have done well
and one which shows we need to improve:
Patient Story
We heard from an elderly lady who made a 999 call for an emergency ambulance after suffering what she
thought was a stroke. Mrs W had seen the public announcements on the television for what to do in the
event of having a stroke. She knew time was of the essence. However we failed Mrs W because we got it
wrong. We did not send a response in time and Mrs W called back a total of three times. The care she did
receive was excellent and she was transported directly to hospital. The staff were caring, calm and
compassionate.
When Mrs W wrote to complain, her complaint was acknowledged and an investigation was begun.
However, our complaints handling process was flawed. EMAS had failed Mrs W again. By this time, Mrs W
was anxious, distressed and unable to focus on getting better until the complaint had been resolved. Mrs W
was forced to complain again and this time senior management responded. Mrs W was visited in her home
and an apology was given. A full and open account of the investigation was provided and explanations were
detailed and honest. Mrs W was invited to present her story to the Trust Board. The Trust Board listened and
responded.
Mrs W was able to write again to EMAS, this time to say thank-you for the care and attention she had
received. Mrs W was now able to concentrate on recovering from her recent illness.
What we did:
We admit that we sometimes get things wrong, however, we need to acknowledge when this happens,
apologise and ensure we are open and compassionate at all times. Our staff have received additional
training and support. We offer local resolution meetings to ensure our complainants reach a satisfactory
outcome. We have robust monitoring systems in place and our performance is reported (through the quality
dashboard system) to our Trust Board.
Carer Story
We heard from a lady (Mrs H) who cares for her 40 year old sister, who has profound multiple learning
disabilities. Her sister, who lives in residential accommodation, makes frequent visits to family and friends
and has very limited ability to communicate, achieving this mainly via facial expressions and gestures. She
does however have good cognitive understanding and is aware of everything that is going on around her.
Caring for her sister when she is on a home visit means helping her do everything that most of us take for
granted. As a carer, her real concern is the challenges her sister faces:
•
•
•
•
Many people talk over her sister, often talking to family members instead. This is very demeaning as
her sister is an adult.
Dealing with other people’s embarrassment when they come into contact with her sister.
Managing the pre-conceived ideas, stigma and discrimination about people with learning disabilities.
Protecting her sister’s interests when she has to be admitted to hospital.
Until recently, Mrs H worked in the NHS as a liaison between patients with learning disabilities and hospital
staff, breaking down the communication barriers to ease anxieties. On Christmas Day 2010, Mrs H’s sister
was at home on a family visit when she suffered a significant and prolonged seizure, later diagnosed as
‘status epilepticus’. An ambulance was called to the house, arriving quickly. What impressed Mrs H was that
the first thing the crew asked for after they had introduced themselves was her sister’s ‘Traffic Light
Assessment’ - a colour coded document designed for people with learning disabilities, which gives essential
information about a patient’s medical history, routine, likes and dislikes etc.
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The crew directed their conversation to Mrs H’s sister debating whether or not to admit her on Christmas Day
when she would rather be at home with her family. The crew had a calming effect on the family and put
everyone at ease. After doing their clinical observations, explaining everything to her sister throughout, the
crew sought Mrs H’s opinion as her Carer with extensive experience of learning disabilities to determine the
best way to move and handle her sister. A testament to the way the crew treated Mrs H’s sister was that she
was not anxious when she finally came out of the seizure. She recovered so well she was able to be left at
home in the care of her family. .Mrs H was asked what it was that was so special about the way the crew
approached the situation that day. We asked ‘If you could reach all 3,000 staff across the Trust, what would
you say it was it about this crew that made the difference?’ Without hesitation she responded, ‘They
listened, they genuinely cared about my sister and our family and they understood about learning
disabilities’.
What we did
We shared this carer’s story with our Organisational Learning team for use in Essential Education because a
‘real-life’ story can convey a very powerful message to staff. Key messages from this story were also
included in our Chief Executive’s bulletin (a weekly bulletin sent to all staff). We will continue to act upon the
recommendations of key reports such as ‘Six Lives’ and ‘Dignity in Care’ to build upon the excellent care our
crews are providing for patients with learning disabilities.
EMAS also learns from complaints and compliments to make sure we are continuously improving our
services. The following gives examples of extracts from both complaint and compliment letters:
Extracts from letters of thanks sent to EMAS
Mrs D, Nottinghamshiree:
I was unfortunate to have a horse riding accident in the woods with no direct access to the scene. I would
just like to praise the ambulance personnel who attended to me. Both young men were very professional
and caring. They put me at ease at a frightening time. I can only imagine how difficult it was to transport me
out of the woods on a spinal board and they never once complained. They are a true credit to your service
and I cannot thank them enough.
Mr C, Northamptonshire
My son fell down his stairs last night and we needed to call an ambulance. The ambulance staff could not
have been more considerate, professional, ultra efficient and helpful in trying circumstances for us. I feel I
must give you this feedback. They are a credit to your ambulance service and their profession generally.
Mrs P, Lincolnshire
We made a 999 call for a student presenting with an asthma attack, within a few minutes a paramedic
arrived. Whilst dealing with the asthmatic, another student become non respondent, unaware of her
surroundings etc and went floppy. The paramedic was absolutely fantastic and if he had not been there I
would not have known what to do, he remained calm and professional at all times. Our thanks to him for his
help from the whole school and governors & parents of the student concerned.
Extracts from could do better letters sent to EMAS
Mrs C, Leicestershire:
My mother was discharged from hospital after being there for 11 weeks. I had continually told the hospital
how difficult it would be to get my mother back into the house - the occupational therapist had been out to
see herself and agreed. When the patient transfer ambulance arrived I went out to them and told them direct
of the problem. They didn’t come to see for themselves but brought my mother to the front door in a
wheelchair, lifted it over the threshold and proceeded to assist her out of the chair. Her legs were not strong
19
enough to hold her so she began to slip to the floor. What was to be a simple task of looking after her on her
discharge with only a frame and one carer to come in has turned into needing a hospital bed, a hoist and two
carers four times a day to look after her. Something that wasn’t her fault and was due simply total lack of
assessment and care by the ambulance team that brought her home.
Mrs G, Northamptonshire:
I fully understand that the ambulance service is under pressure at times, but when a call is put through that is
obviously an ‘emergency’ call I feel that it is not too much to expect that at least a correct category be
applied to the information that is being relayed. I am registering this complaint in the sincere hope that this
kind of situation will not arise in future.
Mrs M of Derbyshire
Raised a concern that an ambulance on blue lights pulled out of a junction leading to them having to make
an emergency stop.
20
Quality Management Systems
(how we will support improvement)
Embedding quality within EMAS is crucial to ensuring high quality, safe, patient care and clinical
effectiveness. The support and commitment of our workforce is paramount to achieving this and to driving
continuous improvement across the services and care we provide. Developing our workforce to ensure staff
are appropriately skilled and supported to develop and improve their practice therefore remains a high
priority for the Trust.
Our priorities for improvement are already identified in Part 2, articulating what we intend to do to support the
continuing development of our workforce during 2012/13 to ensure our staff remain up-to-date and fit to
practice.
This section of our Quality Account provides a brief summary of how we intend to improve quality through
workforce and organisational development plans, systems and processes.
Planning and Developing the Workforce
Education and development
Ambulance services have experienced significant change and increasing diversification over recent years.
This has resulted in us moving away from being organisations which merely transfer patients to hospital into
a service which has direct responsibility for patient assessment, clinical treatment, managing patients at
home, and, when relevant, referring patients through alternative healthcare pathways ensuring patient care
is responsive and appropriate to their needs.
This highlights the changing role of ambulance service practitioners who now need a greater range of
competences, skills and underpinning knowledge whilst maintaining the vocational nature of their training.
The move towards a model of higher education and registration with the Health Professions Council (HPC)
provides consistency with the pre-registration programmes of other allied healthcare professionals and
ensures Paramedics are awarded equal status. This provides the foundations upon which we will continue to
further develop professional practice across EMAS.
We have already implemented systems and processes of workforce and education planning, involving staff
and clinicians within the Trust alongside local health community partnerships and regional workforce
planning and education commissioning systems. This has led to improved data quality and more systematic
education and recruitment planning to resolve workforce demand and supply factors.
In the last quarter of 2010/11, we implemented a new Education Planning Framework designed to ensure
the collation of EMAS’ Training Needs Analysis based on robust information systems including compliance
with national quality standards.
National Public Sector Strike 30 November 2011
We started our continuity planning work early with a cross functional workshop in June 2011to explore issues
and develop different responses in the event of a public sector strike . This workshop proved particularly
useful for designing our approach to communications. We also started early discussions with our Union
Leads and established an open and collaborative way of working with them.
21
We had a small team of 3 people (HR, Communications and Continuity Planning) who worked together to
produce an integrated plan . The communications plan focused on personalised ‘neutral’ messages from the
Interim Chief Executive which recognised the strength of feeling that staff have about pensions. In particular,
the communications acknowledged that if staff chose to strike that, for many, this would not be an easy
decision. Letters to home addresses were supplemented with a dedicated site on our Intranet which was
updated regularly with latest Q and A’s. A phone help-line was created should staff have concerns they
wished to raise confidentially. All our communications were shared, in advance, with Union Leads. Our
communications plan, Q&A’s and letters to staff were shared with other Ambulance Trusts and Health
Partners in the East Midlands .These organisations were able to use some of our material, as appropriate for
them, saving them time and resources
We had regular discussion with Union Leads about leave arrangements, when the strike would start and
finish, working with third party providers, picketing etc which enabled early clarification and communication
about matters of payment. Our Operational teams were also able to complete timely, detailed continuity
plans and keep local hospitals and other health providers in touch with developments. Senior Operational
Managers devoted time to plan for the strike and to ensure that all areas had effective continuity plans in
place. There was strong leadership from the Director of Operations.
On the day of action, we had an 82% attendance and achieved a 78.46% performance standard for lifethreatening calls (Red1 and 2 calls requiring an ambulance attend within 8 minutes).. Overall, our
performance was ranked third highest against other UK ambulance services.
Staff support and wellbeing
Occupational Health services
The Occupational Health service will provide or source, in each case referred to it, the appropriate levels of
support within the terms of its contract with EMAS . Managers providing support to staff involved in traumatic
or stressful incidents, complaints and investigations refer cases to Occupational Health through relevant
referral channels.
Employee Assistance Programme
Confidential counselling is offered through our contract with the Employee Assistance Programme Provider,
Care First. Care First counsellors are available to provide support for anything a staff member may wish to
discuss. The services are available online at www.carefirst.co.uk, and via a Freephone number 24hrs a day
365 days of the year.
Staff Support Network
Support is available through a team of volunteers from across our Trust all of whom have extensive
experience within the Ambulance Service. Volunteers in the Staff Support Network are there to help
colleagues working in all sectors of the Trust to come to terms with things they have observed or dealt with
over the phone such as traumatic incidents (cot deaths, serious road accidents, murders and serious
injuries) and problems staff may have at work (training issues, relationships with colleagues).
Specialist Harassment Advisors
To assist EMAS in preventing bullying and harassment, Specialist Harassment Advisors have been trained
to provide guidance, assistance and advice on the prevention and/or remedy of bullying and harassment.
Contact details are available on our staff intranet site and Advisors can be contacted directly by staff
members.
Trade Union support and support through a named contact
This support is of particular importance during the process of disciplinary, grievance, bullying and
harassment and other internal investigations and hearings. Staff that are suspended from work during these
processes are given a named point of contact who is responsible for keeping in touch with the individual and
providing a link with the workplace during their time away. Staff who are trade union members contact their
local trade union representative for details of support mechanisms available through their union.
22
Access to a mentor/coach
In certain circumstances and with agreement from the member of staff, arrangements can be made to link
the person with a mentor or coach. A list of internal non-clinical mentors and coaches is available on the staff
intranet site. . Clinical Mentors can be accessed through Clinical Education Departments and further advice
on this can be sought from that team. . In exceptional circumstances, arrangements can be made for an
independent mentor or coach from outside the organisation. Where such support is arranged, it is on a time
limited basis with clear terms of reference for the provider.
Mediation services
There are a limited number of trained mediators available within the organisation. Mediation is appropriate in
certain circumstances in particular when attempting to resolve grievances or claims of bullying and
harassment. Mediation is only appropriate where all parties agree to this approach. If it is not possible to use
an internal trained mediator, then EMAS may consider the use of a mediation service provider such as
Advisory, Conciliation and Arbitration Service (ACAS). Advice on the use of mediation is provided by our
Human Resources Department.
Chaplaincy support
Chaplains working for the Trust that are available to offer support to staff. Contact details are available on
the staff intranet site and staff can contact chaplains directly for support.
Legal support for staff
If EMAS deems it appropriate, legal support is provided for support staff attending court as a witness.
Further detail on support available for Coroner Court is available in our Coroner’s Policy. Managers should
advise staff that they should get legal support if they are being interviewed under caution for any reason. For
further information on support for staff attending an employment tribunal, is provided by our Human
Resources Department.
Informal support through line manager and colleagues
It is often the case that talking through a problem with a colleague or with a manager will enable the
individual to resolve their issues informally. This is often the most effective way of dealing with problems and
can resolve issues early on before they escalate.
Support for staff involved in a violent incident
EMAS has a dedicated Security Management Specialist who works to protect staff from the threat of
violence, reduce the risk of security breaches and to provide support following an incident. More information
on support available through this role is available on the staff intranet site.
In addition to the above, we have a wide range of policies and procedures to support staff – Sickness
Absence Policy, Raising your Concerns policy, Supporting Staff & Management of Stress policy, Bullying
and Harassment policy, Work-Llife balance policy and the Special Leave policy
Sickness absence
The Trust is committed to the health and wellbeing of our workforce and to increase levels of attendance.
A number of actions continue:
•
•
•
•
•
•
•
•
•
•
Occupational Health provision supporting early intervention and access to physiotherapy and
employee assistance programme
Publishing consistent data within EMAS to highlight costs of sickness and areas of concern
Specific targets set for each division and performance managed through the Performance
Management Framework
Monthly focus meetings with the Director of Workforce and Operations with each Assistant Director
of Operations to scrutinize the management of sickness including unblocking barriers
Increasing the due diligence procedures with Resource Management Centre, Human Resources and
the Operational Directorate
Increased case review and sharing of best practice within Human Resources
Supportive Manager training to include skills for managing attendance
New Attendance Management Policy
Toolkits being developed to support managers
Review of how the ’fit note’ is utilized to enable staff to return to work on alterative duties
Absence management is a key focus with all managers and there has been a downward trend.
23
Statistical information on sickness absence rates
Quarterly Performance
Q1
Q2
Q3
Q4
6.62%
6.99%
7.35%
6.06%
KPI
Target
5.50%
Average
6.82%
Equality Delivery System
The Trust is implementing the NHS Equality Delivery System (EDS) to ensure equality, fairness and
improved access to services and opportunities. The EDS is a national framework designed to improve the
equality performance of the NHS and embed equality into mainstream business. The EDS is a tool for the
NHS to use in partnership with stakeholders, to review equality performance and identify equality objectives.
At the heart of the EDS are a set of 18 outcomes grouped into four goals. These outcomes focus on the
issues of most concern to patients, carers, communities, NHS staff and Boards. It is against these outcomes
that performance is analysed and graded to support development of equality objectives. EDS grading to
determine equality performance is undertaken by stakeholders, including patients and members of our local
communities.
Leadership
We are seeing a move away from a traditional command and control culture to one of localised, empowered
management teams working within the heart of their communities. The need to sustain this cultural shift is
recognised and we have been working hard to understand our current culture so we can develop plans to
ensure change is implemented, embedded and sustained.
Strong leadership is key to defining and driving EMAS’ culture and to
facilitate the on-going empowerment, management, and delivery of our
strategic aims. Differing strategic objectives such as financial
imperatives, service quality objectives or wider social and environmental
issues will require adaptive leadership styles and skills. Strategic
thinking, entrepreneurial leadership, influencing and partnership working
will be key skills in this area and will need to be delivered by
demonstrating a visionary, pacesetting and coaching style. As an
empowering organisation, we need leadership to be prevalent at all
levels, especially amongst those staff who deliver front-line services.
We are also developing our Talent Management Strategy which sets out our aims, objectives, systems and
processes to support an integrated approach to workforce planning, resourcing, education and development,
and succession planning. This will ensure we have the capacity and capability from Board to front-line to
deliver high quality, safe, patient care and services.
Innovation
We believe great ideas come from our staff. These ideas can then be turned into actions and result in
service improvement. The EMAS Staff Suggestion scheme was re-launched in 2010 as a result of staff
feedback gleaned from station visits carried out by our Foundation Trust and Organisational Learning
Teams. The same themes were also evident during a series of staff focus groups which were undertaken to
design a culture survey for all staff to complete which focused upon staff views across areas such as
innovation, quality, and the Trust Values.
24
Since its re-launch in July 2010, we have received 1,663 ideas. The top ten key themes have been:
Educating the public
Equipment
Recognition
Fleet - Vehicles
Internal communications
Operations
Resource Utilisation
Training
Staff engagement
Uniform
Control/EOC
Human Resources
Many of the ideas put forward have been turned into action. Here are some examples of our successes:
Introduction of a staff recognition scheme
Development of a five year Community Engagement Strategy and
five year Membership Strategy with a focus on educating the public
and looking to improve the service in response to the same
Pilot schemes introduced to assess the functional viability of items of
new medical equipment
Review of the Staff Engagement Strategy including a review of the
staff recognition scheme
A continual review of internal communication channels from the
introduction of ‘EMAS Dialogue’ through to a Chief Executive’s
Weekly Bulletin to replace both 'EMAS Dialogue' and EMAS Matters
in response to the needs of the organisation
Review of ‘light duty’ role for staff who cannot fulfil their normal duties
Consideration of resource utilisation ideas leading to the introduction of the Resource Management
Centre
The Trust also has several examples of innovation supported by the Strategic Health Authority and Regional
Innovation Fund (RIF):
Hope Exchange Programme
Innovation Cell at Leicestershire and Northamptonshire Divisions
Fallers Programme within Leicestershire and Northamptonshire Divisions
Future consideration of internal Innovation Fund (linked to Charitable Funds)
Ttwo RIF projects have been awarded to EMAS to improve hospital turnaround times and demand
management tecnhiques
25
Learning
EMAS has an embedded system of sharing learning across the organisation through our established
Divisional and Strategic Learning Review Groups (SLRG). SLRG members review the feedback and take
steps to communicate the learning outcomes across the Trust. In 2011, we were able to identify the
following improvements:
Service Improvements
Following a number of issues involving requests for ambulances from General Practitioners, we
reviewed our booking service and re-designed our internal processes.
Following a number of patient stories, we recognised we needed to improve our complaints service.
We did this by re-structuring our team leading to improved response times and customer service.
We introduced a telephone referral line for front-line crews who had safeguarding concerns to speed
up the referral times.
A new system of managing patients’ property was introduced in response to claims for lost property.
The introduction of a safety-netting leaflet for patients not taken to hospital. This gives patients
information about their condition, who to call should they need help and what symptoms to look for
should they deteriorate.
The introduction of a structured communication tool for clinical information about patients (SBAR).
Staff Survey
In 2011, we conducted our annual NHS Staff Survey questionnaire. Our response rate was 36.6%.
Although we didn’t get our results until spring 2012, we held a Trust wide event in November 2011 to
commence an interactive approach to engagement using results and themes from previous staff survey’s
and the Zeal culture survey. The EMAS Big Conversation was the start of on-going conversations with staff,
which offered them the opportunity to get involved in service development, highlight how they feel, and
identify what matters to them most. This is currently being followed up by Local Conversations in
divisions/areas. The themes we are currently progressing are recognition, how to give staff a greater say in
the workplace, supportive management behaviours, team and interpersonal relations in the workplace and
how we can improve the way we work together as an organisation. We are also developing a Staff
engagement strategy to underpin everything we do.
Our current quality performance
(what we did and how we improved)
We have reviewed all the data available to us on the quality of the care we have provided to our patients.
The following information identifies what we did during 2011/12 to monitor and assess our quality
performance outcomes.
The factors listed overleaf demonstrate that we have made good progress in many areas whilst
acknowledging that we can make further improvements in 2012/13.
26
What Issue we addressed
What we did and how we improved
A Theme emerged from serious untoward events
around the care of patients under the influence of
alcohol with possible spinal injuries.
Specific education on managing patients under
the influence of alcohol has been added to the
essential education programme to support staff
in correctly managing these patients
High numbers of requests for urgent transport to
hospital from Healthcare professionals going out of
time or being delayed due to high volume of 999
calls.
Following a consultation with primary care
clinicians, the 1 hour and 3 hour booking
options were removed. In cases where a patient
was very ill , the 999 system is used. This has
led to fewer calls going out of time and sicker
patients being dealt with more appropriately.
Poor recognition of sepsis and septic shock in the
pre-hospital environment (other than meningitis)
A clinical bulletin was issued to all staff to
improve the recognition of potential sepsis and
a trial is being undertaken using a specific
proforma to improve the recognition and care of
patients with this condition.
Need to ensure that our essential education and
supervision programmes reflected both external
and individual need.
Development and implementation of Clinical
Supervision framework and Essential education
programme including safeguarding and Infection
Prevention and Control, appropriate to the staff
role.
Need to ensure that our staff are developed to give
the highest quality of service across a range of
functions.
A range of learning interventions was provided
to support staff in their personal and
professional development including clinical
updates,
post-registration
continuous
professional development (CPD) opportunities,
management
development,
NVQs
and
apprenticeship programmes.
Need to ensure visibility of senior managers and
opportunity for staff to raise issues directly with
them
A system of Chief Executive’s weekly bulletins
provide staff with direct information from the
senior leadership team along with a programme
of Directors tours and Patient safety visits
allowing opportunity for staff to raise issues of
importance directly with senior managers.
27
Participation in Clinical Research
There is good evidence that health organisations which undertake effective research provide better care for their patients. This is because staff involvement leads to
them being given the opportunity to put into practice (through additional training) the knowledge and skills gained through the process. Research at EMAS involves
strong support from the executive team, managers and, importantly, the many front-line staff who participate in the studies undertaken.
EMAS is involved in a number of research projects some of which were completed in 2011/12. The table below shows the projects, the status and either the intended
or actual outcomes of the studies.
Funding organisations: The Health Foundation (HF), NIHR Programme Grants for Applied Research (NIHR), Research Design Service for the East Midlands (RDS).
NIHR Health Technologies Assessment (HTA), NHS Policy research programme, (NHSPR), Department of Health (DH)
CURRENT STUDIES
PROJECT
Patient reported
Outcomes for Vascular
Emergencies
(PROVE): Interview
study of patients and
practitioners for
developing PROVE
(IS-PROVE)
Developing new ways
of measuring the
impact of ambulance
service care
Pre hospital Pain
Scoring and Linked
EMAS LED
OR
HOST SITE
EMAS Led
EMAS led
TYPE
&
STATUS
NIHR Portfolio
Research
Research
PROJECT SUMMARY
CHIEF
INVESTIGATOR &
FUNDING
ORGANISATION
The study’s main objective is to develop an understanding about what
aspects of care and outcomes are important to patients accessing the
emergency services for stroke and heart attack.
The completed study has shown features of pre-hospital care that
improve outcomes and experience for patients. These include
communication, holistic care, appropriate treatment and smooth
transition from home to hospital. The results are being used to inform
development of PROMS (Patient Reported Outcome Measures) and
PREMS (Patient Reported Experience Measures)for stroke and heart
attack.
Niro Siriwardena
The programme aims to develop new ways of measuring the impact of
care provided by the ambulance service to support quality
improvement through monitoring, audit and service evaluation.
Prof Niro
Siriwardena
Funded by: HF
Funded by: NIHR
The programme is currently in progress.
EMAS Led
Research
The aim of the study is to gain an understanding about pain
assessment and management in the pre-hospital environment which
Funded by: RDS
28
management System
(PSALMS)
would be used to inform the development of a pain management tool.
and EMAS
Phase 1 is complete with suggestions to improve pre-hospital pain
management including addressing barriers, modifying the available
drugs and developing a pre-hospital pain management protocol
supported by training for staff. The second phase is expected to
produce a pain management tool ready for validation and testing.
EMAS Led
Research
Barriers and facilitators
to evidence based
assessment of
asthma: exploring the
perceptions and
beliefs of ambulance
paramedics to the
assessment of asthma
Closing the Gap:
Ambulance Service
Quality Improvement
Initiative
The aim of the study was to understand the factors which prevent or
enable ambulance assessment guidelines for asthma being followed.
The study has now been completed and has identified issues relating
to clarity of ambulance guidelines, conflicts between training and
guidance, misconceptions about the importance of objective
assessment and over- reliance of non-objective assessment. Our
findings have informed improved systems of care and training for
asthma, and have led to improvements in asthma indicators.
EMAS Led
Quality
Improvement
A two year funded study looking at the use of quality improvement
initiatives to improve the delivery of the stroke and heart attack care
bundle across all English Ambulance Services.
Deborah Shaw
Funded by: NIHR,
RDS
Niro Siriwardena
Anne Spaight
Funded by:HF
Preliminary results show significant improvements in care for heart
attack and stroke across ambulance services in England. We have
also developed a model to improve pre-hospital care which is
transferable to other conditions.
Engaging Ambulance
Clinicians in Quality
Improvement (QI)
Initiatives
EMAS Led
NIHR Portfolio
Research
The study aims to achieve a measure of Quality Improvement (QI)
leadership behaviour, culture and methods used in ambulance
services in England. The study also aims to identify potential barriers
to achieving and maintaining clinician engagement.
Niro Siriwardena
Funded by: HF
Data is currently being collected and analysis will shortly begin.
Strategic Reperfusion
Early After Myocardial
Host Site
Industry
Research
The aim of the study is to compare the outcomes of pre-hospital
patients presenting with a heart attack who receive either:
Prof Gershlick
29
infarction (STREAM)
Host Site
Acute Medicine
Interface Geriatrician
Outcome Study
(AMIGOS)
Host Site
NIHR Portfolio
research
NIHR Portfolio
Research
Trial of a Medical and
Mental Health unit for
Older People
Host Site
NIHR Research
Better Mental Health
Development Study
Care of older people
who fall: evaluation of
the clinical and cost
effectiveness of new
protocols for
emergency ambulance
paramedics to assess
and refer to
appropriate community
based care (SAFER 2)
Host Site
NIHR Research
Early (pre-hospital) thrombolysis (clot busting treatment) followed by
cardiac catheterisation or; Primary Percutaneous Coronary
intervention (immediate balloon and stent treatment to open the
blocked artery in the heart). EMAS participation in the study has now
finished and EMAS will await the final conclusion.
Funded by:
Boehringer
Ingelheim
The study’s overall aim is to conduct a randomised controlled trial
based at Queen’s Medical Centre, Nottingham to assess the impact of
the interface geriatrician compared to usual care of older people
attending the acute medical unit. EMAS’ participation in the study
involves gathering data about the ambulance resources used by
patients who have consented and been recruited to the study.
Prof John Gladman
The aim of the study is to evaluate whether a specialist
multidisciplinary Medical and Mental Health Unit for older people with
confusion admitted to general hospital as an emergency is associated
with better outcomes than standard care. EMAS’ participation in the
study involves gathering data (with consent) about the ambulance
resources used by patients recruited to the study.
Prof John Gladman
The main objective of the study is to describe and measure the health
problems of older people who are admitted as emergencies to general
hospital and who additionally have mental health needs. The study
also aims to measure the management of patients and their outcomes
to facilitate the development and of a specialist in-patient unit for the
management of such older patients. EMAS’ participation in the study
involves gathering data (with consent) about the ambulance resources
used by patients recruited to the study.
Prof John Gladman
The principle objective of the research is to assess the benefits and
costs for patients and the NHS of new protocols allowing paramedics
to assess and refer older people who have fallen to community based
care.
Prof Helen Snooks
Funded by: NIHR
Funded by: NIHR
Funded by: NIHR
Funded by: HTA
Patients who have suffered a fall are being assessed by paramedics
and where appropriate are being referred to a community falls services
reducing Emergency Department attendances
30
Evaluating High
Quality care for All:
Quality and Safety in
the NHS (QSN)
Host Site
Host Site
Research
(Portfolio
Study)
Research
Rapid Intervention with
GTN in Hypertensive
Stroke Trial
Host Site
Research
Evaluation of three
digit number (3DN)
Avoiding Isolation: A
study of relationships
between NHS
Commissioners and
Providers
Host Site
Investigating whether
any barriers affect
ethnic minority
consumers’ (EMCs)
take-up of Products or
Services designed and
delivered in UK
Host Site
Student
Research
Student
Research
The overall study aim is to identify clinical team processes and how
these are linked to patient care. The study also aims to assess how
the team working processes impact on decisions made about the
quality and safety of patient care. All NHS trusts have been invited to
participate in the study. Study in progress.
Professor Michael
West
The aim of the trial is to determine whether it is possible to conduct a
trial in stroke patients in the first few hours after onset by using the
ambulance service to assess, consent, randomise and administer
medication. The trial is complete and has demonstrated the feasibility
of pre-hospital invention studies in hyper-acute stroke. This is being
used to inform future studies.
Professor Philip
Bath
The learning outcomes of the project are expected to be around:
(1) whether the three digit number simplifies the process of
accessing urgent care
(2) whether the new service results in increased satisfaction of
service users;
(3) the impact of the three digit number on other services;
(4) the costs and consequences of the new service
(5) The advantages and disadvantages of different models of
provision to identify lessons on the best ways of developing
the service and rolling it out.
Janette Turner
This study will examine the relationship between commissioners and
providers in the NHS and what can be done to improve this. This has
recently been approved in the Trust and is yet to begin.
Peter Cross
The study aims to identify whether staff face or are aware of any
barriers in the provision of services to ethnic minority consumers. The
study is also looking at how an inclusive design solution could benefit
stakeholders which may lead to time-cost savings. The study is at the
analysis stage and an interim report is currently being written.
Shena Parthab
Taylor
Funded by: NHSPR
Funded by:
Nottingham
University Hospital
Trust
Funded by: DH
Funded by: Self
funded
Funded by:
Loughborough
University and self
funded
31
Participation in Clinical Audit 2011/12
During 2011/12, EMAS participated in several national clinical audits covered NHS services that we provide. There were no national confidential enquiries which we
were eligible to participate in. Additionally we are completing our own clinical audit programme, as described in the table below.
2011/2012 AUDIT
MINAP
National Clinical
Performance Indicators
National Ambulance
Quality Outcome
Indicators
TYPE
National
TIME-SCALE/
STATUS
NOTES
Check of data I MINAP (National Myocardial Infarction Audit Project) data is collected by hospitals to look at how
Quarterly
quickly patients suffering with a heart attack receives clot busting drugs. This allows us to evaluate where
ONGOING
dealys occur and has led to improved processes for evaluation and alert of hospitals.
National
Continuous
ONGOING
This reviews the care given to patients with STEMI (a group of heart attacks), stroke, hypoglycaemia (low
blood sugar) and asthma. As well as reporting on these CPIs nationally every 5 months, data from the
Electronic patient report form system has been collected within the Trust and validated local monthly reports
have been produced from these allowing better tracking of progress. The results of these audits have been
distributed to clinical staff and actions for improvement put into place which has improved care for patients
National
Continuous
ONGOING
This is a group of new indicators which services report on nationally where data is collected and analysed
for all patients with stroke, cardiac arrest, or STEMI. The outcomes are then reported and fed-back to
clinicians and specific improvement work has been put into place to improve patient outcomes in these
areas
This audit reports on the compliance of Patient Report form (PRF) completion. The results from the audit are
fed-back to clinicians so that improvements on the recording of the patient’s assessment and treatment can
be made ensuring that when care is passed to either a GP or hospital that they have all the information
available to give the right on-going care.
Local
Quarterly
ONGOING
Oxygen Guidelines
Local
Annual
COMPLETE
Audit of the accuracy of oxygen guidelines being followed since they were changed nationally.
Where the guideline was not followed, the most common point of failure was that the patient did not require,
but had still received, oxygen (40 patients). This suggests that old practices of oxygen administration still
persist and has led to discussion with staff to target those not complying to ensure the best care for patients.
Stroke Care
Local
Annual
COMPLETE
This Audit was focussed around the times spent at the various stages of the patients journey when a call
was made for a suspected stroke. It identified potentially prolonged on-scene times and this has been
communicated to staff with work to try and improve this position.
STEMI Care
Local
Annual
ONGOING
This Audit was focussed around the times spent at the various stages of the patients journey when a call
was made for a suspected STEMI (type of Heart attack). It is yet to report
Intubation/use of
supraglottic airways in
patients
Local
Annual
COMPLETE
This audit compared the rate of survival when a supraglottic (a type of airway management device) airway
(LMA) was utilised compared to endotracheal intubation (ETT). During the five month period examined, far
more intubations were performed using an ETT (88%) than using an LMA (12%). There was little or no
PRF Compliance
32
difference found in survival between the two methods. With the introduction of a new LMA this will be
reviewed again.
Evaluation of the Clinical
Safety of downgrading
Red 2 calls
Local
Quarterly
ONGOING
This audit was designed to support the introduction of telephone assessment for some of the red calls
(potentially life-threatening) where it was felt they may have been over-prioritised by the computer system
utilised in the control room. This demonstrated a 93% safety and areas where safeguards could be put in
place to further improve the process which have been implemented.
Following the publication of ‘Innovation, Health and Wealth, Accelerating Adoption and Diffusion in the NHS’ (Department of Health, 2011), EMAS developed an
Innovation strategy .This strategy aims to promote the spread and adoption of innovation across the organisation to ensure transformational change and the delivery
of quality and productivity improvement. The strategy also focuses on the need to strengthen the contribution of Health Research and Development to promote the
Trust as a centre of excellence for health and healthcare-related research and development. EMAS’ Research and Development Strategy supports both regional and
ambulance sector innovation. The approach aims to increase the quantity and quality of health and healthcare-related research and development through:
•
•
•
Enhancements in collaborative working
Innovative approaches between sectors (particularly health, universities and industry)
Promoting continual improvement in everything that we do.
The research community in EMAS is a key part of the innovation landscape and many joint initiatives are underway as a result of our partnerships.
33
Our local improvement priorities
(what we pledged to do)
A proportion of EMAS’ income in 2011/12 was conditional on achieving quality improvement and innovation
goals agreed between EMAS and Derbyshire County PCT (our lead commissioners) through the
Commissioning for Quality and Innovation payment framework. Further details of the agreed goals are
available on request (see the end of this document for contact details).
Patient Safety
Patient
Experience
Clinical Effectiveness
Through use of the Commissioning for Quality and Innovation (CQUIN) framework, the total value of our
CQUIN indicators was £1.9 million. Our CQUIN Goals for 2011/12 are provided in the following table.
Stroke
Improve the care for stroke patients
Hypoglycaemia
(low blood sugar)
Improve clinical performance indicators for patients suffering with low blood
sugar (hypoglycaemia)
Myocardial Infarction
(heart attack)
Improve the care we give to patients suffering from a heart attack
Asthma
Improve the care we give to asthma patients
Diabetes
Improve the care given to patients with diabetes
Return of
spontaneous
circulation following
cardiac arrest
Restore circulation after the heart stops
Patient Experience
Strategy
Improvement in three areas:
• safety-netting of patients not conveyed to hospital
• Explore the expectations of General Practitioners
• Staff attitude
Safeguarding training
Improve safeguarding procedures through safeguarding training Learning
Disability level 1
Patient safety
strategy
Improvement in three areas:
• The introduction of a Trigger Tool to improve safety
• The introduction of risk management audits
• The development of a work book which supplements Essential
Education
EMAS achieved all 2011/12 CQUIN targets for patient safety and patient experience. In relation to clinical
effectiveness, we have improved on all of our CQUIN targets based on our baseline at the start of the
financial year; we have achieved significant improvement in the care given to asthma patients which was
highlighted by an improvement to over 80% on peak flow recording exceeding the performance target set.
This has been mirrored across the CPIs with care bundles which was a new approach for the ambulance
service. However, it was embraced by front-line clinicians and we have achieved all of these to date, the last
one being STEMI care which again we exceeded. The Clinical Quality leads in our divisions have looked at
innovative ways of raising awareness; these have ranged from developing stickers and posters prompting
care which have been placed in ambulances, to staff being sent letters highlighting good care given and
where appropriate highlighting shortfalls in performance. Whilst improving on all areas, we have fallen short
of our targets in a couple of areas – specifically oxygen saturation monitoring and recording of two pain
34
scores. These areas are subject to a detailed review to understand the reasoning and improve care in future.
We have also linked with our healthcare partners to set up pathways for referrals of patients in attempt to
provide the right care at the right time in the right place. This approach has been well received by front-line
staff. Engagement has remained a priority throughout 2011/12 and will continue as we look to enhance the
care given to patients.
What others said about us: Care Quality Commission (CQC)
On the 19 July, 2011, the Care Quality Commission undertook a responsive review and examined 4
Outcomes:
Outcome 04 - Care and welfare of people who use services
Outcome 07 - Safeguarding people who use services from abuse
Outcome 12 - Requirements relating to workers
Outcome 16 - Assessing and monitoring the quality of service provision
The CQC reviewed all the information they held about EMAS, checked records, looked at records of people
who use services and reviewed information from stakeholders.
What people told the CQC
The patient survey results showed very high levels of satisfaction with our accident and emergency and
patient transport services. The vast majority of people said the service met or exceeded their expectations.
People said the staff had explained their treatment, involved them in decisions and assessed their pain. They
felt reassured and safe with the staff and most people said the staff were caring and professional. We found
that the Trust took action when things went wrong and stood down staff so that the matters could be
investigated and the public and staff protected. However, we found that the Trust had work to do to make
sure that recruitment processes were in line with legal requirements and that patients were fully protected.
What we found out about the standards we reviewed and how well Trust was meeting them
Outcome 04: People should get safe and appropriate care that meets their needs and supports their
rights
People receive safe and appropriate care treatment and support which meets their needs.
Outcome 07: People should be protected from abuse and staff should respect their human rights
People are protected from abuse or the risk of abuse because staff know how to identify and respond in
accordance with local procedures.
Outcome 12: People should be cared for by staff who are properly qualified and able to do their job
People are not fully protected because not all staff employed before the regulation requirements in 2002
have been subject to a criminal record bureau check. Some staff files of staff and volunteers employed
before 2005 are not well organised making it more difficult to find information relating to staff members
recruitment history and performance.
Outcome 16: The service should have quality checking systems to manage risks and assure the
health, welfare and safety of people who receive care
The Trust takes steps to try and ensure that people receive safe, quality care and treatment.
Action taken by EMAS
35
A risk assessment was carried out and an action plan developed to ensure staff were CRB checked
according to the level of risk. This included:
All staff within the same role prior to CRB processes being introduced in 2002.
Re-checking all staff who were solo responding, where no tracking data was available.
Re-checking all other staff in patient facing roles (including bank) appointed to role prior to end of
September 2008.
The Department of Health Self Declaration form was introduced for staff whose CRB checks were
outstanding
A project commenced in April 2011 to carry out retrospective CRB checks for all staff for whom the
Trust could not evidence a check being carried out (1,671 staff in total) as set out above.
What others said about us: Local Involvement Networks (LINKs)
Leicester, Leicestershire and Rutland Local Involvement Networks
Joint Response to East Midlands Ambulance Service’s Quality Account 2011/12
Leicester, Leicestershire and Rutland LINks welcome the opportunity to comment on the East Midlands
Ambulance Service’s Quality Account.
The LINKs have continued to have a strong working relationship with EMAS and are very grateful for the
cooperation and openness from officers at EMAS. This has been very helpful in relation to the work of the
Joint LINks EMAS Task Group. The group has been able to develop a better understanding of the
pressures that EMAS experience in many areas and the actions that they have put in place to resolve the
issues. We also recognise that some of the issues highlighted in our response to the 2010/2011 Quality
Account have been positively incorporated in this year’s account.
We would like to express our disappointment that EMAS lost the PTS contract to Arriva but recognise that
they had done everything in their power to retain the contract. We are sure that they will continue to
maintain a quality service until the end of the contract and facilitate a smooth transition to the new provider.
We also recognise that EMAS has a new management team in place. This has resulted in a much more
open and transparent approach to communicating with the stakeholders, a very positive and welcome
development. This is particularly important as the Trust is about to start a major ‘Change Programme’
designed to ensure that they can provide high quality care that is financially sustainable in an effectively
managed organisation
We agree and commend, in principle, the priorities highlighted in the Quality Account.
We note that there have been improvements in certain areas of the Trusts performance, for which they too
are commended. These include meeting essential education targets, reducing sickness rates, responding to
adverse and serious incidents and improvements in the Clinical Performance Indicators.
However we note that EMAS is still not meeting all targets whether they are aspirational targets set by the
Trust or those set nationally. We do however note that the Trust recognise these areas of poor performance
and have been very proactive in seeking solutions, with their partners, to improve their performance in all
areas where problems still exist. These plans are clearly included in the Integrated Board Reports presented
at the Public Board meetings and are summarised in the Quality Accounts.
In conclusion, The LINks recognise the significant changes that have occurred within EMAS over the last
year and their potential impact on the way the service will be structured and delivered in the future.
We feel that it is imperative for EMAS to continue to work with all stakeholders, including LINKs, so that we
can support the development of the proposals contained in the Quality Account designed to improve the
quality of services provided to the people of Leicester, Leicestershire and Rutland.
Derbyshire LINk’s comments to East Midlands Ambulance Service NHS Trust Quality Accounts
2011/2012
EMAS has clearly established themselves with the regional LINks, including Derbyshire, and it is through our
own relationship with them that we are easily able to feed in the voice of the Derbyshire community in
36
respect of the services provided by EMAS.
Through our engagement activities, comments collated regarding EMAS are fed back through their
involvement as a Derbyshire LINk Stakeholder. These comments are provided by way of a formal and
confidential report, on a bi-monthly basis. Attendance by EMAS at LINk’s quarterly Stakeholder meetings
continues to show their willingness to maintain an open communication channel.
However, in addition to this, Derbyshire LINk has also exercised their power to formally write to EMAS
concerning an individual issue which was identified as having the potential to impact on the wider population
of Derbyshire. We are pleased to report that a satisfactory response was received from EMAS within the
obligatory response period of 20 working days.
It is reassuring to us, as LINk, that each and every user experience of the EMAS service highlighted by
Derbyshire LINk will be taken seriously, responded to and acted upon (where necessary).
Influencing service providers through collating patient experience is at the core of the LINk remit and it is
therefore encouraging to read of EMAS’ commitment to delivering Priority 4: Continue to engage with
Stakeholders across local communities to enable patient experience to influence service improvement and
development.
Derbyshire LINk was pleased to be invited to participate in the regional LINk EMAS/EDS event. This enabled
a further opportunity for LINk to represent and provide input from the patient perspective, which further
evidences that EMAS is receptive towards gaining intelligence on the issues of most concern to the
Derbyshire public.
It is interesting to read that one of the ways in which EMAS capture patient experience is by inviting patients
and carers to their Trust Board meetings, where participants are encouraged to share their experiences.
Although recent media publicity has, at times, been somewhat damning, the content of these Quality
Accounts, in Derbyshire LINk’s opinion, demonstrates that EMAS is committed to continually improving
patient satisfaction.
Northamptonshire LINks comments on EMAS’ Quality Account
LINk is very concerned with the on-going poor performance of category A, 8 minute responses. We
recognise however that a large part of this relates to ‘stacking’ at the acute trusts beyond the statutory 15
minute handover target. We further recognise following the NCC Scrutiny Committee review which
involved all of the health partners involved in the County, that a substantial investment has been approved in
order to address this problem.
We now await the final outcome of all the corrective action. The improvement to date is slower than we had
expected, influenced we believe to a large degree by the on-going problem of slow patient handover at the
acute trusts.
In other regards LINk's experience of EMAS has been good and we are able to see a substantial increase in
their endeavours to assess public and patient involvement and reactions to their services."
We have worked well with the engagement leads at EMAS, organising a successful event at the
Northampton Saints where we were able to bring a large and diverse range of individuals and groups from
across the ability, age and ethnic spectrum. We have an on-going dialogue with EMAS to input the issues
and concerns of the community, which has involved some specific activity around working with the traveller
and gypsy community.
We look forward to developing with EMAS in the development of a joined up engagement model for
Northamptonshire which will involve EMAS, to ensure that all organisations and communities across the
County have a common understanding of involvement and engagement and can support each other to
enable services to be even better”
37
What others said about us: Overview and Scrutiny Committees (OSC)
Health Scrutiny Committee for Lincolnshire
Priorities for 2011/12
The Lincolnshire LINk and the Health Scrutiny Committee for Lincolnshire are disappointed that EMAS has
failed to meet the response time targets for both Categories A8 and A19 in the county of Lincolnshire. We
note that EMAS acknowledges that falling short of national response targets provides the potential for an
adverse impact on patients. However, we are surprised that the Quality Account refers to measures
introduced during 2011 leading to “improvements in response times to patients with life-threatening
conditions”, as Category A19 performance for 2011/12 is recorded at 92.3%, compared to 93.5% in 2010/11,
which represents a decline in performance. Our concerns with response time performance have been raised
at a national level.
We are pleased with the progress reported on Priority 5 (Treating Patients with Dignity, Respect and
Compassion) and we would not like to see this progress lost.
Priorities for 2012/13
Improving ambulance response times is not stated explicitly as one of EMAS’ priorities for 2012/13. We
believe that this is a serious omission by EMAS, as the Operating Framework for the NHS in England 201213 states that the Categories A8 and A19 targets should be met or exceeded. This is particularly pertinent
given EMAS’ decline in Category A19 performance during 2011/12.
We recognise the further development of clinical performance indicators during 2012/13, but would like to
see clarification on who sets the “regional priorities” for these indicators. We look forward to benchmarking
EMAS with other ambulance trusts on the clinical indicators.
Care Quality Commission – Criminal Record Bureau (CRB) Compliance
The Care Quality Commission’s compliance report (October 2011) referred to the fact that not all staff
employed prior to 2002 had a current CRB disclosure in place. We have been concerned that whilst most of
the outstanding CRB disclosures were in place by 31 December 2011, a small number of disclosures
remained outstanding several months after that date, which represented a risk to the patients. The Health
Scrutiny Committee for Lincolnshire continues to pursue this.
The Patient Experience – Complaints and Compliments
The inclusion of a selection of complaints and compliments in the Quality Account is welcomed and provides
a voice for patients. However, we would like to see some information on the overall number of complaints
and compliments received by EMAS, and any general lessons learned from these complaints.
Engagement on the Development of Quality Account
We would like to see engagement on the development of the content of the Quality Account broadened to
include all LINks and health scrutiny committees in the region.
Inclusion of More Local Performance Information
EMAS serves eleven upper-tier council areas. Whilst we acknowledge that there are constraints on the
length of the Quality Account, the absence of local information on areas such as Lincolnshire does not
necessarily serve readers well, who might be expecting some local information on performance, complaints
and compliments, to provide some local context to a regional service.
Conclusion
At a time of change in the NHS, we look forward to EMAS delivering its local and national priorities, so that
ambulance services not only improve in Lincolnshire, but throughout the region as a whole.
38
Leicestershire Adults, Communities and Health Overview and Scrutiny Committee
The Adults, Communities and Health Overview and Scrutiny Committee welcomed the opportunity to
comment on the Quality Account for the East Midlands Ambulance NHS Trust (EMAS) at its meeting on 24
April 2012. The Committee would like to thank officers for their helpful and open attitude when attending
Overview and Scrutiny Committee meetings.
The Committee is not aware of any major issues that have been omitted from the Quality Account.
However, the Committee has made comments on a number of areas included in the Quality Account and
these are set out below.
The Committee welcomes EMAS’ commitment to the training and development of its staff. The clinical
development evening sessions, with a focus on a single topic, appear to be particularly valuable for front line
staff.
The Committee is pleased to note that EMAS participates fully in the national initiative to introduce dignity
champions.
The Committee suggests that EMAS undertakes further work to manage public expectations. The work with
local media outlets around this is welcomed, as is the intention to develop measurable benchmarks for
communications.
Finally, the Committee is of the view that the report is readable and easy for a lay person to understand.
The timelines used are sometimes too short to enable the identification of trends; however they give a
flavour of EMAS’ performance.
In conclusion, based on the Committee’s knowledge of the provider, the Committee is of the view that the
Quality Account provides a fair reflection of the healthcare services provided.
Nottinghamshire City and Nottinghamshire County joint Overview and Scrutiny Committee
Representatives from five healthcare providers attended the Joint City and County Health Scrutiny
Committee’s May 2012 meeting last week to present for comment their organisation’s Quality Account – this
followed on from discussions at the Committee’s January 2012 meeting.
The Committee appreciates the opportunity to comment on your Quality Account, and its formal response for
inclusion in the Quality Account is appended to this letter. However, and in keeping with Department of
Health guidance, the Committee would request that all presenting organisations check that their Quality
Account so that it avoids overly-technical, unexplained medical language, and provides a range of quotes
about the patient experience, where available.
At the meeting, the Committee requested that next year’s Quality Account provide information on work with
NEMS on social care referrals.
The Committee is conscious that presenting and commenting on Quality Accounts is becoming a more
cumbersome exercise, as the numbers of organisations required to produce them increases. We will be
giving consideration to how we might revise our arrangements for next year, and any comments or
observations you have to inform this would be very welcome.
Comment for inclusion in Quality Account – East Midlands Ambulance Service NHS Trust
The Joint Health Scrutiny Committee believes that the Quality Account 2011-12 is a fair reflection of the
services provided by East Midlands Ambulance Service NHS Trust, based on the knowledge the Committee
has of EMAS.
The information contained in the Quality Account is well presented and we are pleased to see the use of
clear and accessible language and layout. The use of case studies makes the document more accessible to
the public, and we commend the inclusion of numerous examples of actions taken in response to service
user feedback, both positive and negative. The document clearly demonstrates the involvement of key
stakeholders in determining priorities and reflecting what quality means to them.
We are pleased to note that EMAS has achieved all 2011/12 Commission for Quality and Innovation
39
(CQUIN) targets for patient safety and patient experience.
We welcome the inclusion of a priority on training front-line staff to recognise and deal effectively with victims
and perpetrators of Domestic Violence in support of the introduction of the organisation’s Domestic Violence
Policy, and look forward to hearing more about the impact of the Policy in the coming year.
The Committee recognises that the EMAS service covers both major urban centres of population and more
isolated rural communities. We therefore welcome the tailoring of performance indicators more closely to the
needs of the communities served by EMAS, and the provision of performance information on a County by
County basis, from next year.
The Committee looks forward to continuing to develop its relationship with the Trust over the coming year.
What others said about us: Our Lead Commissioners
Statement from our Lead Commissioner - NHS Derbyshire County (on behalf of associate commissioners):
General Comments
The Trust’s Quality Account is well written with clearly defined priorities for 2011/12. Views from a wide
range of patients, staff and groups have been used to evaluate the priorities. Data contained within the
report reflects the information received through contract monitoring arrangements. Overall the report is well
presented, and is written in language that should be accessible to the general public.
Measuring & Improving Performance
The organisation has worked hard to improve the quality of services, and the various initiatives that have
been introduced to improve the quality of services are encouraging. The Trust has had regular clinical quality
review meetings with the commissioners where progress against an agreed quality schedule is monitored.
In its 2010/2011 Quality Account report, the Service identified five priority quality measures which were
matched against the three domains of quality (Patient Safety, Clinical effectiveness and Patient experience).
The Trust has made significant progress in Infection Prevention and Control and safeguarding.
In 2011, Care Quality Commission undertook a responsive review of the organisation and inspectors raised
concerns regarding criminal record bureau checks for staff employed before 2005. The trust has
implemented a detailed action plan to address the concerns raised and this was monitored by the
commissioners through regular quality meetings.
The report reflects the loss of the Patient Transport Service contracts following the competitive tendering
process to 2 private operators (NSL & Arriva). The new contract is due to commence on 1 July 2012.
Sickness absence continues to be an issue within EMAS. The Trust has developed a revised action plan
supported by Directors within Workforce and Operations. Implementation of the action plan and reducing
sickness levels will be monitored by the commissioners.
EMAS had agreed a number of quality measures with the PCT, some of which attract a quality incentive
payment. Over this last year EMAS achieved all CQUIN targets for patient safety and patient experience.
The Trust has improved on targets based on baseline at the start of the financial year for clinical
effectiveness.
These achievements showed improved care for patients, for example an improvement to over 80% on peak
flow recordings for asthma patients. However, additional work is required to improve oxygen saturation
monitoring and the recording of two pain scores.
The report contains ‘patient stories’ which have been heard at the Board. One of the accounts relates to a
patient who suffered a stroke and did not initially receive a response. The follow up details the failings in
responding the patient but does not outline how the Trust were going to prevent a similar occurrence for
stroke patients in the future.
Although the report outlines the criteria for the new national targets (introduced 1 April 2011) for ambulance
40
services, there is no indication to show how the Trust measured up to them. Following on from the previous
year it would have been positive to show that that the organisation achieved the A8 target but failed to meet
the A19 target. A priority for the coming year is to continue to improve the processes for call handling,
Clinical Assessment and the deployment of resources but there is no indication how this is going to be
achieved.
The Trust has continued to work hard to engage and support its staff. The Quality Account outlines the many
staff support and wellbeing initiatives available to the workforce. Engagement with the NHS Staff Survey
showed an increase from last year (a score of 3.35, average when compared with trusts of a similar type).
However, according to the survey, the number of staff receiving appraisals has fallen since last year and is
below the national average for ambulance trusts.
In 2012/13 the trust will continue to drive forward their quality improvement initiatives with priority’s linked to
the three safety domains. Progress will be monitored through the Quality and Governance Committee, of
which the commissioners attend. Further quality measures have been agreed through quality incentive
payments on both national (safety thermometer) and regional (Independent review) areas of safety that the
Trust has agreed and where it can make a real difference.
Data Quality
Good quality information underpins the effective delivery of patient care
and is essential if improvements in quality of care are to be made.
EMAS relies upon quality information to undertake its various duties and
responsibilities allowing us to deliver the highest possible level of patient
care. EMAS’ Business Intelligence Unit (BIU) plays a key role in allowing
the Trust to achieve these aims.
Accordingly, the A&E activity performance data provided in this
Quality Account has been provided by the BIU and data relating to ‘other’ activity areas within EMAS has
been validated by experts in each subject area for relevance and accuracy prior to inclusion within this
document.
Based on proper checks and controls we have in place relating to data collation and reporting, the BIU can
confirm data accuracy and surety and also that data compiles with the Department of Health’s KA34
guidelines and our Ambulance Services Annual Return for period 2011/12.
EMAS was not subject to the Payment by Results clinical coding audit during 2011/12 by the Audit
Commission.
Information Governance Toolkit attainment levels
EMAS’ Information Governance Assessment Report overall score for 2011/12 was 88% and was graded
satisfactory. The Information Governance Manager is responsible for maintaining the evidence to support the
information governance toolkit for the Trust. Assurance on the process to collect the evidence is overseen
by the Information Governance Group which is accountable to the Audit Committee.
41
Our Quality Account
2011/2012
Part 3
42
How we developed our Quality Account
(what you said)
How we developed our Quality Account (what you said)
Last year’s Quality Account featured a strong contribution from community groups. This took in the process
we followed in compiling the Quality Account and also the content of the finished document. The creation of
a summary document - a ‘first’ for an ambulance trust – our use of plain language and the use of an
appropriate title (we selected Our pledge to you because it is more accessible than Quality Account 2010/11)
were all prompted by our contact with community groups.
As a consequence, last year’s edition was well received and we therefore set out to build upon this solid
foundation as we created the 2011/12 edition.
That foundation included workshops with six of our Local Involvement Networks (LINks) last year. They
encouraged us to engage with people other than themselves during 2012 and so we gained the perspectives
of carers at two workshops in April 2012.
We also gained views from 5 focus groups held for people under the Trust’s Equality Delivery System.
We have not overlooked LINks this year, as their contributions last year helped us greatly. We have carried
out a questionnaire survey, plus attend one LINks by invitation. This approach allowed EMAS to talk to other
groups to gain their perspectives on quality.
We have also approached our Health Overview and Scrutiny Committees to gain their views on the content
of this Quality Account and the approach that we have taken in compiling it.
Staff Engagement
In 2010/11 we invited staff to comment on our Quality Account through a number of mechanisms. We set up
a web based dialogue, we invited comments though in-house media and we delivered a presentation
through the Essential Education programme with responses obtained via a short survey.
EMAS published a summary document and sent this to all staff with their pay slips. We also launched the
Quality Account internally through our internal media, a screen saver on all laptops and through local
engagement in divisions.
This year we have issued an updated survey to staff through the Clinical Quality Managers in Divisions and
through Essential Education. The Quality Account survey also featured at the ‘Local Conversations’ events
led by the Clinical quality managers.
Feedback from staff
A range of thoughts have been put forward by staff. They have told us they would like to see:
Shorter handover times at hospital Emergency Departments
Public education about EMAS and when to call 999
Increase education/training opportunities
Greater emphasis on staff welfare
Improved use of our resources
A review on the use of some equipment
What we have done as a result of the feedback we have received
We have listened to the views received and as a result we have:
43
Identified Hospital turnaround as a key priority. We have a designated Director for turnaround and
have been working with hospital Directors and Commissioners to develop plans to work together to
improve times.
We have included a communications campaign as one of our key priorities. This also includes
promoting our service to other healthcare professionals.
2012/13 will be our third consecutive year for delivering a comprehensive essential education
programme. This is included again as a key priority for next year.
EMAS continues to address the feedback from staff in a variety of ways. For example there is an
equipment working group where issues regarding equipment are discussed.
44
Review of quality performance
(how we did last year)
EMAS is required to achieve a range of performance outcomes specific to the nature of the services we
provide to the public. In addition, we are required to achieve many other organisational responsibilities as
laid down by the Department of Health.
The following information provides evidence that EMAS is performing very well in relation to certain quality
measures and that, compared to other ambulance trusts, we are making significant progress in the areas
where further improvement is necessary for EMAS to achieve its aims.
Our priorities in 2011/12 were:
Priority
Quality measure
Priority 1: Communication and Joint Working
Patient safety
Priority 2: Developing our workforce
Priority 3: Effectiveness of treatment (Clinical Performance Indicators - CPI)
Clinical effectiveness
Priority 4: Response to our patients (Accident and Emergency - A&E)
Patient experience
Priority 5: Treating patients with dignity, respect, care and compassion
Priority 1:Communication and Joint Working
Aim
We committed to
improve communication
between staff and
between organisations.
What we did
We introduced a
structured
communication tool
SBAR (Situation,
Background,
Assessment and
Recommendation) to
improve the way we
communicate patient
information within
EMAS and to other
organisations.
What we have
achieved
Quality Indicators
SBAR: Checklists
produced for staff to
ensure a structured
handover
Forms produced using
the SBAR principle to be
left with the patients
when managed at
home.
45
Sustain Infection
Prevention and Control
(IPC) compliance
against policies,
procedures and
practices.
Sustain compliance
against Safeguarding
Vulnerable Adults and
Children policies,
procedures and
practices.
We have a robust
audit process in place
to monitor cleanliness
of our vehicles and
premises. We also
rigorously assess
compliance with IPC
policy through our
observed practice
audits.
Excellent alignment of
IPC practice with best
practice guidance
(Hygiene Code, DH
2008) to maintain our
compliance with Care
Quality Commission
standards.
Audit results for
vehicles
staff
premises
against a target of
85% compliance
We have a robust audit
process to ensure that
frontline practice
reflects best practice
guidance and meets
statutory requirements.
An increased number
of referrals of ‘at risk’
patients to EMAS’
safeguarding team.
Full compliance with
safeguarding
standards in Care
Quality visit in October
2011. Several areas of
best practice were
identified with EMAS
receiving regional and
national recognition for
its work with
vulnerable adults.
Audit results for policy
and practice
compliance against an
85% target
EMAS Observed Practice: Divisional Percentage Compliance
100.00%
20.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
HART
Q4 Jan - Mar 2012
Air Ambulance
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Lincolnshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Leicestershire &
Rutland
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Derbyshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
40.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
60.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
80.00%
0.00%
Northamptonshire Nottinghamshire
Training Centres
HQs
EMAS %
Compliance
46
60.00%
40.00%
20.00%
0.00%
Derbyshire
Leicestershire &
Rutland
Lincolnshire
Northamptonshire Nottinghamshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Northamptonshire Nottinghamshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Air Ambulance
HART
Training Centres
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q3 Oct - Dec 2011
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Air Ambulance
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Lincolnshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Leicestershire &
Rutland
Northamptonshire Nottinghamshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
0.00%
Derbyshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Lincolnshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Leicestershire &
Rutland
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
20.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
0.00%
Derbyshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
40.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
60.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
20.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
40.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
60.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
EMAS Station Premise: Divisional Percentage Compliance
100.00%
80.00%
HART
Training Centres
HQs
HQs
Air Ambulance
HART
Training Centres
HQs
EMAS %
Compliance
EMAS A&E Vehicle Cleanliness: Divisional Percentage Compliance
100.00%
80.00%
EMAS %
Compliance
EMAS PTS Vehicle Cleanliness: Divisional Percentage Compliance
100.00%
80.00%
EMAS %
Compliance
>= 85%: Compliant with acceptable practices
>= 75.1-84.9%: Partially Compliant, requires action
<= 75%: Minimal Compliance, URGENT ACTION / ORGANISATIONAL PRIORITY
The Infection Prevention and Control (IPC) audit outcomes show that IPC is well embedded in clinical
practice. Consistently high compliance rates for premises, vehicles and observed practice audits show that
there is close alignment of IPC policy to practice. This ensures that the risk of acquiring health care
associated infections is minimised. The IPC Team maintain a high visibility in the field to provide specialist
47
IPC advice and support. They conduct regular validation audits to provide additional assurance of
compliance with required standards for optimum patient care.
EMAS Safeguarding: Divisional Percentage Compliance
100.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
20.00%
Q4 Jan - Mar 2012
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Leicestershire &
Rutland
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
Derbyshire
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
40.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
60.00%
Q1 Apr - Jun 2011
Q2 Jul - Sep 2011
Q3 Oct - Dec 2011
Q4 Jan - Mar 2012
80.00%
0.00%
Lincolnshire NorthamptonshireNottinghamshire Air Ambulance
HART
Training Centres
HQs
EMAS %
Compliance
>= 85%: Compliant with acceptable practices
>= 75.1-84.9%: Partially Compliant, requires action
<= 75%: Minimal Compliance, URGENT ACTION / ORGANISATIONAL PRIORITY
Safeguarding audit results provide evidence that staff are able to recognise and respond appropriately to
safeguarding concerns. The audits show that staff have an awareness of appropriate communication
methods, are able to manage allegations and understand how to deliver care with dignity and respect. The
safeguarding team completed validation audits during the year which reiterates Trust compliance with
statutory requirements.
Priority 2: Developing our workforce
Aim
Increase staff numbers
to ensure a paramedic
on every frontline
vehicle.
What we did
Increase our
paramedic workforce
through education and
training and HEI
commissions
What we have
achieved
At the end of March
2012, our relief rate is
27% and we have
achieved a skill mix of
60:40
Quality Indicators
Achieve Workforce
Plan targets of 28%
relief element in staff
rotas and a 60:40
(Paramedics to
Ambulance
Technicians or Care
Assistants) skills mix
ratio in all A&E
divisions.
48
Implement year 2 of our
Essential Education
programme with its
underpinning theme of
patient safety.
Implement year 2 of our
Clinical
Supervision/Observed
Practice framework to
provide staff with
appropriate support and
development to
maintain their practice.
Implemented year 2 of
essential education
which included 3 days
face to face training for
A&E staff and 2 days
for PTS staff.
At the end of March
2012, 92.35% of A&E
staff and 92.51% of
PTS staff have
completed the
programme.
Number of staff
attending Essential
Education programme.
Implemented year 2 of
clinical supervision
framework
At the end of March
2012, 73.29% of A&E
staff and 45.94% of
PTS staff have had
clinical supervision.
Number of staff
receiving Clinical
Supervision.
The above interventions have ensured that the Trust is resourced in line with the workforce plan and that
patients receive care from skilled and competent clinicians. It also ensures that our staff receive ongoing
supervision to support their continued development and assure that essential standards of quality of safety
are met. In order to strengthen the number of staff who receive clinical supervision in 2012/13, we have
further developed the clinical supervision framework to ensure it is more comprehensive, accessible and
user-friendly.
Priority 3: Effectiveness of treatment
Aim
What we did
EMAS will improve our
performance against the
Clinical Performance
Indicators (CPI) are
national indicators
developed to allow
clinical skills and patient
outcomes to be
measured rather than
timeliness of response
alone.
Improved scrutiny via
monthly validated
reports from the
Electronic Patient
Report Form
The measures cover:
Clinical Bulletins to
promote the care
bundles
STEMI (ST
elevation
myocardial
Scrutiny at individual
practitioner level and
feedback on areas of
concern
Checklists on vehicles
to remind staff of the
elements
Targeted interventions
to support staff in
What we have
achieved
EMAS has delivered
improvement across
all areas of the Clinical
performance Indicators
although seeing little
change in the results
for Return of
Spontaneous
Circulation (ROSC) in
Cardiac arrest.
EMAS uses monthly
performance data from
the electronic patient
report form to monitor
progress, recognising
there will be some
variation month on
Quality Indicators
Measured from
ambulance patient
records and submitted
to a national database
for comparison with
other UK ambulance
services.
We will benchmark our
performance against
the results achieved by
other UK ambulance
services.
49
infarction)
Coronary care
(heart attack)
Stroke
Diabetes
Cardiac Arrest and
ROSC (return of
spontaneous
circulation,
following
resuscitation)
Asthma care.
understanding the
rationale for the
changes
month but looking to
improve the average
over time. The latest
results for the care
bundle performance
are shown below (note
scale variation).
Deep dives into areas of
concern to get to the
root cause
Quality indicators:
Decreased incidents
occurring at the point of
handover
Delivery of improvement across the Clinical Performance Indicators has been a very positive story for EMAS
demonstrating the commitment to high quality care. There are a couple of areas of lower performance as
highlighted in the Narrative for the Clinical Quality Indicators, however, specific work is being undertaken to
review and manage these areas of care. The success has been down to application of robust Quality
Improvement methods and the involvement of front-line staff in supporting care delivery.
Cardiac Arrest remains an area of huge variation nationally and due to this was removed from the clinical
performance indicator set in- year (although it remains as part of the ambulance quality indicators). A
National Cardiac Registry is being set up to try and understand the variation but in the meantime, EMAS is
looking at ways to continually review this area to try and improve clinical outcomes.
% compliance
Care Bundles are a series of indicators for a clinical area e.g. Stroke. For a complete care bundle each of the
individual elements must be present, failure to achieve one is a failed care bundle. On the charts below the
green line is the EMAS average and the blue dots show our monthly performance. Once we get 7 blue dots
above the green line we adjust the green line and call this a step change in performance. The Red lines
show the limits of normal variability around the average as you expect variation month on month around any
average figure.
F
F
F
All Divisions Stroke Care bundle
100
98
96
94
92
90
88
86
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
80
Apr-11
82
May-11
84
Month
50
80
94
92
90
88
86
84
82
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
Feb-12
96
Feb-12
98
Jan-12
All Divisions Hypoglycaemia Care bundle
Jan-12
100
Dec-11
Month
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
% compliance
10
Jun-11
May-11
Apr-11
0
100
F
F
% compliance
All Divisions STEMI Care bundle
90
80
70
60
50
40
30
20
Month
51
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
E
E
AE
May-11
% compliance
Apr-11
100
90
80
70
60
50
40
30
20
10
0
All Divisions Asthma Care Bundle
Month
All divisions - Return of spontaneous circluation (ROSC) at
hospital
all patients
Special Cause Flag
50
45
40
% ROSC
35
30
25
20
15
10
5
Feb-12
Jan-12
Dec-11
Nov-11
Oct-11
Sep-11
Aug-11
Jul-11
Jun-11
May-11
Apr-11
0
Month
Priority 4: Response to our patients
Aim
Provide a timely
response to Category A
Red and Category
Green emergency calls.
What we did
Implemented new
demand sensitive rotas
across all divisions
What we have
achieved
Strengthen our
Category A response
times through the
implementation of the
new rotas.
Quality Indicators
Performance in
relation to
national/local
standards.
52
Introduce a new
telephony solution that
streamlines the call
answering process.
Increased the capacity
within the Clinical
Assessment Team to
enable EMAS to ensure
the patient gets the
most appropriate
response.
A virtual telephony
environment was
implemented in May
2011 which has
strengthened our call
answering standards
and resilience
We will benchmark our
performance against
the results achieved by
other UK ambulance
services.
A third of our Green 3
& 4 incidents are dealt
with through telephone
advice without the
need for a resource to
be sent.
The data shows that the measures EMAS introduced during 2011 have led to improvements in our response
times to patients with life-threatening conditions. The additional investment in our clinical assessment team
has also led to more appropriate management of non life-threatening calls via telephone assessment and
referral to local community services.
EMAS recognises that where we fall short of meeting national response targets there is potential for adverse
impact on patient experience and patient safety. In 2012 EMAS will build on the measures introduced in
2011 to ensure continuous improvement against all national performance targets.
Priority 5: Treating patients with dignity, respect, care and compassion
Aim
EMAS will comply with
health inequalities
policies, procedures and
guidance which apply
across the NHS.
What we did
Developed our
services for service
users with learning
disabilities and
implemented a Trust
wide ‘Dignity in Care’
campaign
What we have
achieved
We received a national
Innovation Award for
Emergency Services
as well as recognition
in Department of
Health guidance for
our pioneering work
with patients with
learning disabilities
Quality Indicators
Number of Dignity
Champions
At the end of March
2012, EMAS had over
400 Dignity champions
from every level. Over
80% of these staff
have direct patient
contact.
53
Number of staff
attending learning
disability level 2
module training (within
Essential Education
programme) during
2011/12.
At the end of March
2012, 92.35% of A&E
staff and 92.51% of
PTS staff have
completed Learning
Disability level 2
training
Safeguarding training
figures
Through the above interventions, EMAS staff have greater understanding of how to care for patients
holistically taking account of their individual needs and family relationships. Our engagement with service
users and carers has enabled us to identify ways to make our service more accessible to all.
Conclusion
This quality account is intended to set out our ambitions for improving and sustaining quality during the
2012/13 performance year, we hope that readers will see that we have kept quality as our main priority and
have taken action to improve where we can. We hope that we have been able to tell you that we know where
we have further improvements to make and where we have not been able to make the progress that we had
planned.
In producing this report, it has involved contributions from a wide range of stakeholders and I would like to
pay tribute to their input, this has helped us to ensure that our ambitions for quality improvement match those
who use, observe and/ or commission our services. Next year we will continue to work with our stakeholders
so that we can ensure that our approach to quality is grounded in their expectations.
Chief Executive
East Midlands Ambulance Service NHS Trust
54
Glossary
A&E
Accident and Emergency – Accident and Emergency (A&E) is a hospital or primary care department that
provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be
life-threatening and require immediate attention. Also referred to as ED, Emergency Department.
AMPDS
Advanced Medical Priority Dispatch System – is a medically-approved, unified system used by EMAS to
dispatch appropriate aid to medical emergencies including systematized caller interrogation and pre-arrival
instructions.
Audit
A continuous process of assessment, evaluation and adjustment.
Board
EMAS Trust Board of Directors made up of Executive and Non-Executive members responsible for all that
EMAS does.
CQC
Care Quality Commission – The Care Quality Commission (CQC) regulates all health and adult social care
services in England, including those provided by the NHS, local authorities, private companies or voluntary
organisation. It also protects the interests of people detained under the Mental Health Act.
CQI
Clinical Quality Indicators - These are a set of eleven indicators introduced to the ambulance service by the
Government from April 1st, 2011 as measures of clinical quality.
CPI
Clinical Performance Indicator – A way to measure quality.
Commissioners
The NHS organisations who effectively purchase services from EMAS, based on the identified health needs
of their local population. Derbyshire County PCT is the ‘lead commissioner’ for EMAS. That is, they (on
behalf of all the PCTs in our area) negotiate what level of income EMAS will receive – and, alongside this,
what quality measures we are expected to achieve as set out in our service level agreement.
CQUIN
Commissioning for Quality and Innovation (CQUIN) – The CQUIN payment framework makes a proportion of
NHS service providers' income conditional on quality and innovation. Its aim is to support the vision set out in
High Quality Care for All of an NHS where quality is the organising principle. The framework was launched in
April 2009 and helps ensure quality is part of the commissioner-provider discussion everywhere.
CAD
Computer Aided Dispatch – Software used for ambulance dispatch.
DIVISION/S
Operational areas with autonomy to make decisions about the provision of local services under the umbrella
of EMAS’ corporate vision, goals and objectives. Our divisions are aligned to the counties we serve (see
below)
55
EMAS
East Midlands Ambulance Service – East Midlands Ambulance Service (EMAS) is part of the NHS and
provides emergency and urgent care and patient transport services for the six counties of Derbyshire,
Leicestershire, Rutland, Lincolnshire (including North and North East Lincolnshire), Northamptonshire and
Nottinghamshire.
EMICS
East Midlands Immediate Care Scheme – Made up of a group of volunteer doctors who assist the
Ambulance Service on emergency call-outs.
ECA
Emergency Care Assistant – Respond to emergency calls as part of an accident and emergency crew or at
times as a first responder, using skills and procedures that they have been trained and directed to do.
ECP
Emergency Care Practitioner – The role of emergency care practitioners (ECPs) utilises the skills of
paramedics and other professionals (such as specialist nurses with additional skills) to support the first
contact needs of patients in unscheduled care. They are employed primarily by ambulance service trusts.
HPC
Health Professions Council – A UK health regulator. It was created by the Health Professions Order 2001 to
protect the public by setting and maintaining standards for the professions it regulates.
IPC
Infection Prevention and Control – Provides specialist infection prevention and control support and advice for
all clinical and support services.
IG
Information Governance – The way by which the NHS handles all organisational information - in particular
the personal and sensitive information of patients and employees. It allows organisations and individuals to
ensure that personal information is dealt with legally, securely, efficiently and effectively, in order to deliver
the best possible care.
JRCALC
Joint Royal Colleges Ambulance Liaison Committee - its role is to provide robust clinical speciality advice to
UK ambulance services and other interested groups
NHS
National Health Service - Established in 1948 to provide free state primary medical services throughout the
United Kingdom.
NICE
National Institute for Health and Clinical Excellence – The health technology assessment body in the UK
providing guidance to clinicians relating to authorised treatments, devices, diagnostics and techniques.
NHS Institute for Innovation and Improvement
Supports the NHS to transform healthcare for patients and the public by rapidly developing and spreading
new ways of working, new technology and world-class leadership.
PALS
Patient Advice and Liaison Service – Offers confidential help, advice, support and information and are
responsible for any compliments and complaints.
56
PPI
Patient and Public Involvement – Aims to support patient, user, carer and public involvement in health care.
PTS
Patient Transport Services - Conveys patients to and from their homes to out-patients’ appointments, clinics,
physiotherapy or non-urgent inter-hospital transfers.
PCT
Primary Care Trust – Part of the NHS responsible for the planning and securing of health services and
improving the health of a local population.
ROSC
Return of Spontaneous Circulation - Following a period when the heart stops, providing life support is aimed
at restoring the body’s circulation.
SBAR
Situation, Background, Assessment, Recommendation - A structured communication tool used to share
clinical information
SHA
Strategic Health Authority – Responsible for developing plans for improving health services in its local area
and increasing the capacity of local health services so they can provide more services.
STEMI
ST Elevation Myocardial Infarction - heart attack.
VCS
Voluntary Car Service – A group of volunteers within our Patient Transport Service who use their own car to
provide a door to door service to medical appointments.
57
Our Quality Account
2011/2012
We welcome your comments about our Quality Account.
Please contact us using the details below:
East Midlands Ambulance Service NHS Trust
Trust Headquarters
1 Horizon Place
Mellors Way
Nottingham Business Park
Nottingham
NG8 6PY
Call
Email
Visit
0115 884 5000
communications@emas.nhs.uk
www.emas.nhs.uk
communications@emas.nhs.uk
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information in
large print, audio
or in another
language,
please call us58on
0845 299 4112.