Quallity Ac
ccoun
nt 201
14-15
1
Contents Page
Part 1
Contents
Statement on Quality from the Chief Executive and Chairman
Statement on Quality from the Medical Director and Director of Nursing
Introduction
Page
3
4
5
Part 2
Contents
Priorities for Improvement 2015-16
Patient Experience
Patient Safety
Clinical Effectiveness
Statements from the Board
Geographical Area & Population
Our Services
Participation in National Audit
Local Trust Audit
Learning From Audit
Clinical Performance Indicators
Participation in Research
Goals agreed with Commissioners - CQUIN
What others say about us
Data Quality
Performance against Key Quality Indicators
What our Staff Say
Workforce and Organisational Development
Page
6
7
8
9
10
10
11
12
12
13
14
15
17
18
19
20
22
24
Part 3
Content
Performance against priorities 2014-15
Patient Safety
Medication Errors
Infection Prevention & Control
Safeguarding
Serious Incidents
NHS 111
NHS 111 – Patient Safety and Experience
Complaints and Contacts
Page
26
30
32
32
33
34
35
36
37
Annex 1: Statement from the Lead Commissioning Group
Annex 2: Statement from the Council of Governors
Annex 3: Local Healthwatch and Overview & Scrutiny Committees
Annex 4: Statement of Directors’ responsibilities
Annex 5: External Audit Limited Assurance report
Annex 6: Glossary of Terms
39
40
41
51
52
55
Further Information
Appendix – Divisional Profiles
56
57
2
Part 1 - Statem
ment on Quality ffrom the
e Chief Ex
xecutive
e and Cha
airman
We are
e pleased to presentt the Westt Midlands Ambulanc
ce Service NHS Foundation
Trust’ss Quality Re
eport which reviews 2014-15 and
a sets ou
ut our priorrities for 20
015-16.
de ourselvves on the quality of care that patients
p
re
eceive from
m our service, and
We prid
quality remains at
a the foreffront of evverything we
w do. We
e provide a high qua
ality and
respon
nsive servicce, howeve
er we are not complacement and
a we reccognise tha
at there
is alwa
ays more th
hat we can do.
At the end of eacch financia
al year, it iss always appropriate to look baack and reflect on
the passt 12 montths. This quality
q
acccount demonstrates the qualityy of care patients
p
receive
ed from ou
ur service and detailss those arreas where
e improvem
ments need to be
made.
2014-15 has been a very
y busy and
d challeng
ging year, with dem
mand on services
s
increassing. This puts additional presssure on staff
s
who continue
c
too deliver ex
xcellent
care to
o our patien
nts, and we would likke to comm
mend our staff
s
for theeir continue
ed hard
work and committment.
During the year we have seen an increase in front-line staff, aand a sig
gnificant
ment in ne
ew vehicles
s and equ ipment. The
T clinical outcomess we achie
eve are
investm
among
gst the besst in the co
ountry, and
d we are committed
c
to maintaiin or impro
ove this
position
n year on year.
y
We arre continu
uing to work
w
with commiss
sioners an
nd stakehholders to
o make
improvvements accross the wider
w
heallth econom
my. We are active m
members of local
System
m Resiliencce Groups that bring commissio
oners and providers together to make
improvvements to the urgentt care servvices.
ge the inforrmation co
ontained in this report
rt is an accurate
To the best of myy knowledg
accoun
nt.
Dr Anth
hony C. Ma
arsh
QAM S
SBStJ DSci (Hon) MBA
A MSc FAS
SI
Chief E
Executive Officer
O
Sir Gra
aham Meldrrum
CBE OS
StJ
Chair
3
Statem
ment on
n Quality
y from tthe Medical Dire
ector an
nd Director of
Nursing, Quallity & Clinical Co
ommissio
oning
Ambula
ance serviices are be
eing used by more and more people ass the pointt of first
contactt with the NHS.
N
Peo
ople, often when they
y are mostt vulnerabl e call us fo
or help,
and it is our responsibility to make sure that we provide a servicce that me
eets the
need o
of the perso
on.
Increassingly, peo
ople call our service
e for health
hcare need
ds that aree not traditionally
those p
provided by
b an emerrgency serrvice and our
o challen
nge is to ennsure that we are
able to
o respond to
t such callls in a wayy that is prroportionate to the peerson’s nee
ed. We
are a significant provider within the
e health ec
conomy, and
a
it is im
mportant that our
e continuess to develop to makke sure we
e provide the best sservice, ba
ased on
service
people
e’s needs and
a ensurin
ng the bestt possible outcome frrom the ressource we
e use.
Ambula
ance services do nott work in issolation; we are part of a large health and
d social
care syystem, and
d we can only
o
provid
de exceptio
onal servic
ces if all paarts of the system
work to
ogether. Patient
P
experience d
does not happen
h
in isolation, and good clinical
outcom
mes are only achieved if everyb
body strives
s for excellence.
We are
e aware tha
at we need
d to chang e how we work, and we are thiis year embarking
on a ne
ew system
m of electro
onic record
d keeping that
t
will en
nable us too view the primary
care re
ecords of patients,
p
en
nabling us to view th
he primary care recorrd so that we can
ensure
e that patients receive
e the mostt appropriate care and treatmennt.
Where patients need
n
to be taken to a
another healthcare fa
acility we aare able to ensure
that the
ey go to the right plac
ce, first tim
me.
Our sta
aff are the greatest asset for de
elivering high quality care, and we are gra
ateful to
them fo
or the efforrts they pu
ut in to enssuring that the care re
eceived byy patients is of the
highestt standard. We are keen
k
to su pport our staff
s
in their professioonal development
to ensu
ure that our standards of care rremain high
h.
Dr And
dy Carson
Medica
al Director
Mark D
Docherty,
RN MS
Sc BSc (HO
ONS) Cert MHS
Directo
or of Nursin
ng, Quality
y & Clinical Commissioning
4
Part 1 - Introd
duction
We havve a vision
n to deliverr the right patient carre, in the right
r
place,, at the right time,
through
h a skille
ed and committed
c
workforce
e, in parttnership w
with local health
econom
mies. Putt simply, patients
p
mu
ust be cen
ntral to all that we ddo. This means
m
a
relentle
ess focus on
o patient safety, exp
perience and clinical outcomess.
At Wesst Midlandss Ambulan
nce Service
e NHS Fou
undation Trust
T
we pllace quality
y at the
very centre of everything
e
that we do. We work clos
sely with ppartners in
n other
emerge
ency services, differrent sectio ns of the NHS and communitty groups. These
include
e General Practitione
ers, menta
al health workers,
w
trade assocciations an
nd local
commu
unity group
ps. Togeth
her we enssure that the
t patientts remain aat the fore
efront of
service
e provision
n through uncompro mising foc
cus on imp
proving paatient expe
erience,
safety and clinica
al quality.
The Quality Acco
ount is a yearly
y
rep
port that highlights th
he Trust’s progress against
quality initiatives and impro
ovements m
made overr the previous year aand looks forward
f
to prio
oritising ou
ur ambition
ns for the year ahead.
We understannd as a provider
p
organissation thatt to continu
ue to imprrove qualitty it is essential that our patien
nts and
staff are fully en
ngaged with the qua
ality agend
da. We continue
c
too reinforce
e these
through
h our curre
ent values.
Vision
D
Delivering the right patient care, in the rigght place, at the
t right time,
th
hrough a skilleed and committed workforcce, in partnersship with local
health economiees
Values
Straategic Objectivves
•
•
•
Achieeve
Qualityy and
Excelleence
Accurately asse
ess
nd
patient need an
d
direct
resource
es
appropriatelyy
Estaablish market
poosition as an
EEmergency
H
Healthcare
Provider
•
•
•
World Class
e
Service
Patientt Centered
Dignityy and
Respecct for All
Skilled Workforce
work
Teamw
Effectivve
Communication
Worrk in
Partnership
5
Part 2 - Prioritties for 2015/16
2
In deciding our quality priiorities forr 2015-16 we have again choosen to ke
eep the
overarcching obje
ectives of improving patient ex
xperience, patient saafety and clinical
quality. This enssures thatt our quallity prioritie
es are aligned withh both Tru
ust and
nationa
al objectivves. In determining
g our prio
orities we
e have taaken acco
ount of
recomm
mendations from the
e Francis report as well as the new foocus of th
he Care
Qualityy Commisssion. We have liaised
d with patients, users
s and com
mmunities with
w the
guiding
g principle “no decis
sion abou
ut me, witthout me”. Most impportantly we
w have
assesssed our progress during the ye
ear agains
st last yea
ar’s prioritiees (see pa
age 26)
and ha
ave agreed
d that therre is still m
much to be
e done and
d that we need to continue
c
some o
of these prriorities for the comin g year.
In orde
er to develop our Qu
uality Acco
ount we communicate
ed with staaff via our weekly
brief in
nviting them
m to comm
ment and su
uggest prio
orities for improvemeent. We arrranged
a meetting with our Genera
al Managerrs to review
w priorities
s and perfoormance frrom the
previou
us year an
nd again request
r
re
ecommenda
ations from
m a Divisi onal persp
pective.
The Trrust organ
nised 2 en
ngagemen
nts events where we
e invited Healthwattch and
Health Overview
w and Scru
utiny Comm
mittees to ask their opinions aand views on the
s provided an opportunity to
potential content of this year’s Qualitty Accountt. This has
heir views of
o quality and
a the priiorities we should be
e setting foor the year ahead.
gain th
Engage
ement with
h commiss
sioners, sta
akeholders
s, staff, pa
atients andd the public
c is ongoing.
P
Patient
periencce
Exp
• Improve
ed engagem
ment withh
Learningg Disabled Service U
Users
• Workingg with Public Health
England to reduce
e Health
Inequalitties
Patient
SSafety
• Reduce the risk of harm from
m
delays in ambulancce attendaance
earnt and
• Publicise lessons le
good practice from
m incidentss,
claims an
nd complaints
C
Clinical
Effecctivene
ess
• Ensuringg the care delivered on
scene is timely and effectivee
• Continue
e to impro
ove all clinnical
outcome
es
6
Patient Experience
Patient Experience
Priority
WHY WE HAVE CHOSEN THIS priority
WHAT WE ARE TRYING TO IMPROVE WHAT SUCCESS WILL LOOK LIKE
Improved engagement with
Learning Disabled Service Users
We recognise the importance of
Communication with Learning
ensuring we communicate effectively
Disability Users
with Learning Disability Servicer Users,
• An understanding of Learning
the Trust would now like to ensure that
Disability Service Users
they undertake engagement events with
Experiences with the Trust
this service user group to find out their
• Is it a good/Bad experience
experiences of the service, do we
can lessons be learnt
communicate effectively and all key
communication documents are in an
easy read format, expanding on the
work recently undertaken by the Trust
Working with Public Health
England to reduce Health
Inequalities
(3 Year Project)
We know that "Health inequalities are
preventable and there are unfair
differences in health status between
groups, populations or individuals. They
exist because of unequal distributions of
social, environmental and economic
conditions within societies
We are trying to improve equal
access to services for all members of
society regardless of their social,
environmental or economic
background
• A positive experience by
Learning Disability Service
Users
• To be able to meet
expectations of service users
• To be able to communicate in
an effective way
Improve engagement for 3 key
disadvantaged groups.
How we will monitor progress:
Reporting frameworks have been established for each priority to be assessed against performance on a monthly basis and progress reported to the
Quality Governance Committee
Responsible Lead:
Consultant Paramedic (RC) and Head of Patient Experience, Senior HR Manager
Date of completion: March 2016
7
PATIENT SAFETY
Patient Safety
PRIORITY
WHY WE HAVE CHOSEN THIS
PRIORITY
WHAT WE ARE TRYING TO
IMPROVE
WHAT SUCCESS WILL LOOK LIKE
Reduce the risk of avoidable
harm from delays in
ambulance attendance.
We recognise the importance of
providing safe and timely care to
ensure the best clinical
outcomes for our patients.
We aim to proactively ensure
that the right resource is
allocated to the right patient at
the right time; first time without
contributing to further harm to
the patient.
Reduction in incidents, claims and
complaints that result in moderate
harm or above as a result of delayed
attendance.
Increased learning from audit of
delays resulting in harm.
Publicise lessons learnt and
good practice from incidents,
claims and complaints.
We want to demonstrate our
commitment to being open and
candid with both patients and
staff when mistakes are made
but also when achievements are
realised.
We aim to improve the way in
which we share lessons we have
learnt
from
investigations,
complaints and claims with all of
our stakeholders to ensure we
are able to demonstrate our
candidness.
Compliance with Statutory Duty of
Candour
Monthly Patient Safety Bulletin
Monthly published information on
web site
How we will monitor progress:
Reporting frameworks have been established for each priority to be assessed against performance on a monthly basis and progress reported to
both the Learning and Clinical review Group.
Responsible Lead:
Head of Patient Safety
Date of completion: March 2016
8
Clinical Effectiveness
Priority
CLINICAL OUTCOMES
Ensuring the care
delivered on scene is
timely and effective
WHY WE HAVE CHOSEN THIS PRIORITY
With the pressure on the Hospital
Emergency Departments there is a drive to
deliver appropriate care to patients who
call 999 which may not require transfer to
ED.
WHAT WE ARE TRYING TO IMPROVE
Transfer decisions are made quickly.
Time on scene is reduced where
appropriate.
We want to be sure that the care we give is
the right care first time using NHS resources
safely and effectively.
Continue to improve all
clinical outcomes
We have a number of Clinical Performance All Ambulance Clinical Performance
measurements will improve based on
measurements that provide us with an
indication that treatment given is
2014/15 data
appropriate and effective. We have decided
that all of these are equally important to
our patient care.
WHAT SUCCESS WILL LOOK LIKE
Patients requiring immediate
transfer are taken to hospital
quicker.
Care delivered on scene
including referrals to other
agencies is safe and results in a
positive patient experience.
Patients receive high quality
care.
How we will monitor progress:
Reporting frameworks are well established for each priority to be assessed against performance on a monthly basis. Progress is, and will, continue to
be monitored within the Trust Committees and to our Commissioners. Reports will be sent to the Trust Board of Directors and these will be published
on our website.
Responsible Director:
Director of Nursing, Quality & Clinical Commissioning
Date for Completion: March 2016
9
Statements from the Board
During 2014/15 West Midlands Ambulance Service provided NHS services as
above. The Trust sub-contracted to 2 Voluntary Urgent Care Providers. WMAS
provides Patient Transportation Services to other NHS Trusts. To ensure excellent
business continuity during times of surges in demand or in support of major
incidents, the Trust has the facility to call upon a small number of Ambulance Subcontractors to supplement service delivery. Sub-contractors are subjected to a
robust governance review before they are utilised.
The Board of Directors has strong governance arrangements in place that have been
embedded over a number of years, the Board of Directors has reviewed all of the
data available and is assured that this account is an accurate account on the quality
of care in all of these services.
The total service income received in 2014/15 from NHS sources represents 98% of
the total service income for the Trust. More detail relating to the financial position of
the Trust is available in the Trust’s 2014/15 Annual Report.
Geographical Area & Population
The Trust serves a population of 5.6 million who live in Shropshire, Herefordshire,
Worcestershire, Coventry and Warwickshire, Staffordshire and the Birmingham and
Black Country conurbation. The West Midlands sits at the Heart of England, covering
an area of over 5,000 square miles, over 80% of which is rural landscape.
The West Midlands is an area of contrasts and diversity. It includes the second
largest urban area in the country, covering Birmingham, Solihull and the Black
Country where in the region of 45% of the population live.
The Region is also well known for some of the most remote and beautiful
countryside in the Country including the Welsh Marches on the Shropshire / Welsh
borders and the Staffordshire Moorlands.
10
Our Services
West Midlands Ambulance Service became a NHS Foundation Trust on 1st January
2013.
The Trust has a budget of approximately £215 million per annum. It employs over
4,000 staff and operates from 15 Operational Hubs and over 100 Community
Ambulance Stations together with other bases across the Region. In total the Trust
utilises over 800 vehicles including Ambulances, Response Cars, Non-Emergency
Ambulances and Specialist Resources such as Motorbikes and Helicopters.
The Trust is supported by a network of Volunteers. More than 800 people from all
walks of life give up their time to be Community First Responders (CFRs). CFRs are
always backed up by the Ambulance Service but there is no doubt that their early
intervention has saved the lives of many people in our communities. WMAS is also
assisted by Voluntary organisations such as the British Red Cross, St. John
Ambulance, BASICS doctors, water-based Rescue Teams and 4x4 organisations.
During 2014 -15 West Midlands Ambulance Services Foundation Trust provided 5
core services:
1. Emergency and Urgent: This is perhaps the best known part of the Trust and
deals with the 999 calls. Initially, one of the two Emergency Operations Centres
(EOC) answers and assesses the 999 call. Emergency Operations Centres
deal with approximately 76,000 999 calls each month, over 95% of which are
answered within 5 seconds. Each 999 call is triaged through NHS Pathways in
order to ensure that the correct categorisation is reached to meet the needs of
the patient.
2. Patient Transport Services (PTS): A large part of the organisation deals with
the transfer and transport of patients for reasons such as hospital appointments,
transfers between care sites, routine admissions and discharges and transport for
continuing treatments such as renal dialysis. The Trust completed approximately
640,000 PTS patient journeys during 2014/15.
3. Emergency Preparedness: This is a small but important section of the
organisation which deals with the Trust’s planning and response to significant
incidents within the Region as well as co-ordinating a response to large
gatherings such as football matches and festivals. It also aligns all the Trust’s
Specialist assets and Operations into a single structure.
4. Make Ready is a dedicated ambulance preparation system operating
successfully in most of the Trust that was implemented during 2013. Under the
Make Ready system, specialist non–clinical staff clean, prepare and stock the
ambulances ready for the start of each shift.
5. NHS 111 Service which covers Birmingham, Solihull, the Black Country,
Shropshire, Herefordshire, Coventry and Warwickshire. The service has more
than received 940,000 calls in the previous 12 months.
11
Participation in National Audit
WMAS recognises as a Foundation Trust the importance of ongoing evaluation of
the quality of care provided against key indicators. As a member of the National
Ambulance Service Clinical Quality Group (which develops National Clinical
Performance Indicators and National Clinical Audits), we actively partake in both
national and local audits to identify improvement opportunities. As a result, the Trust
has a comprehensive Clinical Audit Programme which is monitored via Clinical Audit
& Research Programme Group. The Trust has participated in 100% of national
audits and zero of national enquiries.
The Trust submits data to the Department of Health Ambulance Quality Indicators
and to the National Co-coordinator for Clinical Performance Indicators.
National Audits
Audit
National Non‐Conveyance Audit
(NANA)
WMASFT
Eligible
WMASFT
Participation

100%
Ambulance Quality Indicators
(Clinical)
Clinical Performance Indicators

100%

100%
Myocardial Infarction National Audit
Programme (MINAP)

100%
Number of Cases
Submitted
The final AQI results
are dependent on
external information
and will be available
and published by the
Trust in June 2015.
Local Trust Audit
In addition to these submissions, the Trust produces Local Performance indicators to
enable local areas to implement improvements. The Trust is committed to
developing links with Local Hospitals to access patient outcomes for patients in prehospital cardiac arrest.
Trust Local Clinical Audits
Local Audit
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Management of Mental Health
Deliberate Self‐Harm
Patients Discharged at Scene
Feverish Illness in Children
Management of Head Injury
Management of Asthma
Management of Peri‐Arrests
Management of Obstetric Emergencies
Clinical Records Documentation
Appropriateness of Medicines Management
Management of Acute Coronary Syndrome Audit
Management of Pediatric Pain
Paediatric Medicine Management
Paediatric Patients Discharged at Scene
Hear and Treat
12
Learning from Audit
During 2014-2015 the Trust undertook the third clinical audit to measure the quality
of the documented assessment and management of patients with Acute Coronary
Syndrome.
Acute Coronary Syndrome describes a number of conditions affecting the Heart,
these include:






Angina
Unstable Angina
ST Elevation Myocardial Infarction
Non ST Elevation Myocardial Infarction
Heart Failure
Sudden Cardiac Death
The Ambulance Service has a significant role in the assessment and management of
Acute Coronary Syndrome, the appropriate assessment and management can
significantly reduce mortality and morbidity. Following the previous clinical audit
improvement plan, which included a 2 year training plan, there was an increase in
the following.



Documentation of key timings i.e. onset of the symptom, time of ECG
Assessment of the patient’s pain
Oxygen administration
The following recommendations were made to continue improvement:




Communication to staff to explain the rationale for key treatments
Review of the on line educational pack
Work with local managers to develop local strategies
Develop clinical guidelines for the management of ACS patients.
Management of Paediatric Pain
This was the first clinical audit the Trust has undertaken to examine the management
of paediatric pain in the pre-hospital environment.
Controlling pain is essential in order for the ambulance practitioner to be able to
assess the patient. Children have differing needs to the adult patient. Their ability to
understand and cope with pain varies greatly with age.
The key area of concerns the clinical audit highlighted for the management of
paediatric pain surrounded the assessment and documentation of pain, the
administration of analgesia and that the administration is as per guidelines.
The improvement plan that was identified following this clinical audit was:




Inclusion of Paediatric pain management within training for 2015/16
Review the online educational pack on VLE
Develop a reference guide for staff relating to the assessment and management of
pain in the paediatric patient.
Communication to staff regarding the results of the clinical audit.
13
Clinical Performance Indicators
The Trust takes part in the National Clinical Performance Indicators which look at the
following conditions:
Asthma
Over 5 million people in the UK have asthma and there are almost 4 million
consultations and 74,000 hospital admissions for asthma each year in the UK. Asthma
sufferers are prone to an over-sensitive immune system and an asthma attack can be
precipitated by a number of things, which are known as ‘triggers’. A trigger is anything
that irritates the airways and causes the symptoms of asthma to appear. On average,
4 people per day or 1 person every 6 hours dies from asthma. It is estimated that
approximately 90% of asthma deaths could have been prevented if the patient, carer
or health care professional had acted differently.
Trauma Care – Single limb fracture
Extremity fractures are commonly seen in pre-hospital care. They demonstrate a wide
variety of injury patterns which depend on the patient’s age, mechanism of injury, and
pre-morbid pathology.
Febrile Convulsion
A febrile convulsion is a seizure associated with fever occurring in a young child. Most
occur between 6 months and 5 years of age, and onset is rare after 6 years of age.
Febrile seizures arise most commonly from infection or inflammation outside the
central nervous system in a child who is otherwise neurologically normal. Seizures
arising from fever due to infection in the central nervous system (e.g. meningitis and
encephalitis) are not included in the definition of febrile seizure. Fever is usually
defined as having a temperature of more than 37.5°C.
Elderly Falls (Pilot)
Falls and fall-related injuries are a common and serious problem for older people.
People aged 65 and older have the highest risk of falling, with 30% of people older
than 65 and 50% of people older than 80 falling at least once a year.
Falls are associated with increased morbidity, mortality, and nursing home placement.
The human cost of falling includes distress, pain, injury, loss of confidence, loss of
independence and mortality. Falling also affects the family members and carers of
people who fall. Falls are estimated to cost the NHS more than £2.3 billion per year.
Therefore falling has an impact on quality of life, health and healthcare costs.
These patients are at potential risk of major trauma as there is evidence of the impact
of falls <2m on traumatic head injuries and undiagnosed subdural haemorrhages.
These patients may re-contact the service following a fall, which would indicate that
leaving patients safely at home has not been achieved.
Care Bundle Performance
Asthma
Trauma – Single Limb
Febrile Convulsion
Elderly Falls
The CPI run 3 months behind for submission to the
national group and so actual won’t be ready for
submission until June.
14
Participation in Research
A key focus for the National Institute for Health Research is the development and
delivery of quality, relevant, patient focused research within the NHS. WMASFT
continues to be committed to supporting research within pre-hospital care, thus
providing evidence to support improved patient care, treatment and outcomes. To
achieve this we work with Universities within the West Midlands and further afield as
well as acute hospitals, pharmaceutical companies etc. We also work with the
Clinical Research Network West Midlands to ensure all research we take part in
complies with the Research Governance Framework thus safeguarding participants
in research.
During 2014-15 WMAS has supported several portfolio studies1 the number of
patients receiving relevant health services provided or sub-contracted by WMAS in
2014-15 that were recruited during that period to participate in research approved by
a research ethics committee was number of recruits and graph showing all
ambulance trusts to be added when available in May.
Highlights of some research studies which took place during 2014-15
Warwick Spinal Immobiliser – A new spinal immobilisation device has been
designed at Warwick University which aims to determine if the new device is more
effective than the existing devises used to immobilise patients with suspected
spinal/neck injuries. If effective this device will remove the need to apply cervical
collars, thereby reducing patient anxiety/ claustrophobia. Paramedics took part in
assessing the new working prototype device on healthy volunteers. Work now
continues at Warwick University to further develop the device.
Out of Hospital Cardiac Arrest (OHCA) – Run by Warwick University and funded
by the Resuscitation Council (UK) & British Heart Foundation, this project will try to
establish the reasons behind such big differences nationally in outcome from Cardiac
Arrest. It will develop a standardised approach to collecting information about OHCA
and for finding out if a resuscitation attempt was successful. The project will use
statistics to explain the reasons why survival rates vary between regions. It will
provide feedback to ambulance services to allow ambulance services to learn from
one another and promote better outcomes for patients.
Brain Biomarkers after Trauma
Traumatic Brain Injury is a major cause of illness, disability and death and
disproportionally affects otherwise young and healthy individuals. Biomarkers are
any characteristic which may be used to gain insight into the person either when
normal or following injury or disease. The study will look at biomarkers taken from
blood, from fluid in the brain tissue and from new types of brain scans and
investigate whether any biomarkers can give us insight into novel therapeutic
strategies. WMAS and Midlands Air Ambulance are working with University of
Birmingham to support this study.
1
The National Institute for Health Research (NIHR) portfolio comprises clinical research studies of
high quality and clear value to the NHS.
15
The Development of a Parental Suicide Bereavement Training Pack
The aim of this study was to develop a training pack for health professionals to
support them in dealing with a parent bereaved by suicide. Paramedics took part in
interviews which focused on their perception of caring for a patient who has
attempted suicide and subsequently died; the perceived implications when dealing
with and informing parents bereaved by suicide; the paramedics perceived needs
when caring for those bereaved by suicide and their views of what guidance they
would require in a parental suicide bereavement training package.
Results from 2 studies which the trust have previously taken part in Prehospital Assessment of a mechanical compression device - The aim of this trial
was to evaluate the effect of using a LUCAS 2 device rather than manual chest
compressions during resuscitation by ambulance clinicians after out of hospital
cardiac arrest.
The LUCAS 2 device undertakes chest compressions on patients whose heart has
stopped i.e. have had a Cardiac Arrest. The trial aimed to show whether use of such
a device improved outcome for patients over manual compressions performed by a
paramedic.
We took part in this study run by Warwick Clinical Trials Unit (Warwick University) in
conjunction with 3 other ambulance trusts. Out of the 4471 patients included in the
trial WMAS recruited 2723 (61%). The results were published in the Lancet in
November 2014 with the conclusion that the introduction of LUCAS-2 did not
improve the primary outcome of survival to 30 days. These results will now be
reviewed by relevant national and international bodies leading to guidance for NHS
Trusts on the use of mechanical compression devises.
ATLANTIC
This was an international, randomized, parallel-group, double-blind, placebo
controlled phase IV study by AstraZeneca. The trial looked at whether giving a drug
called Ticagrelor (normally given in hospital) to patients suffering a heart attack was
more effective if given earlier i.e. in the ambulance. We took part in this study in
collaboration with University Hospitals Coventry and Warwick. The global recruitment
target of 1,870 patients we met, 14 of which were recruited by WMAS paramedics.
Results were published in The New England Journal of Medicine in Sept 2014 and
showed that Prehospital administration of Ticagrelor in patients with acute STEMI
(type of heart attack) appeared to be safe but did not improve pre-PCI coronary
reperfusion.
16
Goals Agreed with Commissioners CQUIN Indicators
Indicator Name
Friends and Family Test –
Implementation of staff FFT ‐ NHS
Trusts Only
Friends and Family Test ‐ Early
Implementation
Friends and Family Test ‐Phased
expansion
2. Hear and Treat CPGMs (2 Year)
Indicator Weighting
(% of CQUIN scheme
available)
Expected Financial
Value of Indicator
Achieved
1.
3. Timely Facilitation of EPR system.
4. Pre‐Alert hyper‐acute stroke
pathway
5. Learning from Safeguarding
Concerns
6. See and Treat CPGMs (2 Year)
Total
6.67
£278,691
100%
6.66
£278,273
100%
6.67
£278,691
100%
20
18
£835,655
£752,089
100%
100%
22
£919,220
100%
10
£417,827
100%
10
£417,827
100%
100.00%
£4,178,273
100%
Commissioning for Quality and Innovation (CQUIN) is a payment framework that
enables commissioners to agree payments to NHS providers based on agreed
quality and innovation work. A proportion of WMAS income during 2014 – 15 was
based on achievement of quality improvement and innovation as detailed in the
CQUIN framework to ensure positive outcomes result in an improved quality of
service.
1. This CQUIN is a national requirement to promote and improve feedback from patient’s
regarding their experience with WMASFT.
2. This CQUIN is designed to identify regional DOS gaps in Primary Care service provision
by conducting an analysis of all Hear & Treat re-contacts made to the Trust.
3. This CQUIN is designed to promote and support the timely implementation of the
Electronic Patient Record (EPR) system within the Trust, which will result in numerous
quality improvements to the service.
4. "A pathway is in place between WMASFT and the receiving Hyper-Acute Stroke Unit
(HASU), in line with the Midlands and East Stroke service specification The Ambulance
Paramedic service links with the receiving hospital when they have a suspected stroke
patient, providing a system of pre-alert to enable potential stroke patients (FAST positive)
to be met on arrival.
5. There is a need to ensure safeguarding practices support the needs of vulnerable
children and adults. Therefore this indicator is aimed at ensuring that providers continue
to embed safeguarding into practice, implement lessons learnt following a safeguarding
event, reflect on practice and ensure that the voice of the child/adult is heard.
6. This CQUIN is designed to identify regional DOS gaps in Primary Care service provision
by conducting an analysis of all See & Treat re-contacts made to the Trust.
17
What Others Say
S About Us
The Trrust has been
b
registtered with the CQC without conditions
c
since 2010. This
include
es complia
ance with the
t
Health
h and Sociial Care Act
A 2008 a nd Hygien
ne code
(HC200
08).
The C
Care Qualitty Commission hass not take
en enforce
ement actioon agains
st West
Midlands Ambula
ance Servic
ce during 2
2014/15. During
D
January 2014,, the CQC carried
out a rreview of the
t service
e that inclu
uded; inspe
ections of premises and ambu
ulances,
intervie
ews with patients,
p
sttaff and m
managers, feedback from partnner organiisations
and lo
ocal authorrity scrutin
ny and sa
afeguarding
g committees and rreview of all our
complia
ance with other
o
regulatory bodiies.
The ffinal repo
ort availa
able from
m www.c
cqc.org.uk or the Trust website
w
www.w
w31mas.nh
hs.uk confirrms the Trrust remain
ns complia
ant with all the requirrements
of regisstration exxcept for a minor fai lure in Outcome 4 - 'Care & W
Welfare of people
who usse our Service'. The
e CQC
determ
mined the
e Trust was
require
ed to proviide a shorrt term
plan
for
imp
provements
in
operatiional perfo
ormance targets
t
Thank youu!
as
ssome
pa
atients,
whilst
On Sundayy 8th Februa
ary 13:30 I w
was unconsciious my wifee
receivin
ng excellent trea
atment
dialled 999.
9 The Lady
y answeringg the call, sta
ayed on the
from staff, ha
ad experiienced
phone
re
eassuring
my
y
wife
until
th
the
Paramed
dics
arrived;
delays in respon
nse times. The
THANK YOU
U
Trust a
agreed a plan to im
mprove
respon
nse times by July 2014
Two Param
medics arriv
ved 13:45 ishh They were
e re‐assuring
g
which w
was achievved.
West
Midlands
Ambu
ulance
Service
e did not submit re
ecords
during 2014/15 to
o the Seco
ondary
Service forr inclusion in the
Uses S
Hospita
al Episode
e Statistics which
are included in the latest
publish
hed data. The
T
Trust is not
require
ed to subm
mit this data as it
relatess to admisssions, outp
patient
appointments
and
A&E
attenda
ances in NHS Hospittals.
, they carried
c
out all the tests re
required with
h Layman
explanatiions, an ano
omaly on thee ECG require
ed a second
confirrming the firrst, again re‐‐assuring they then
recommen
nded that I should
s
have further inve
estigation att
Russell’ss Hall I agre
eed . They deelivered me to
t the ECG
ro
oom they cam
me wishing me all the best.
b
We hear so
s much critiicism of our N
NHS I felt th
he other sidee
need
ded to be recorded. THAN
NK YOU to the
t two
18
Data Quality
West Midlands Ambulance Service takes the following actions to assure and improve
data quality for the clinical indicators, the Clinical Audit Department completes the
data collection and reports. The patient group is identified using standard queries
based on both the paper Patient Report Forms and the Electronic Care
System. These clinical records are then audited manually by the Clinical Audit Team
using set guidance. The data is also clinically validated and then analysed following
an office procedure that is available to the Clinical Audit Team and is held on the
central Clinical & Quality network drive. The process is summarised as:







For the clinical indicators, the Clinical Audit Team completes the data collection and
reports.
The Patient Report Forms/Electronic Care Summary records are audited manually by the
Clinical Audit Team.
A process for the completion of the indicators is held within the Clinical Audit Department
on the central network drive.
A Clinician then reviews the data collected by the Clinical Audit Team.
The data is then analysed and reports generated following a standard office
procedure. A second person within the Clinical Audit Team checks for any anomalies in
the data.
The results are checked against previous month’s data checking for trends and
consistency.
The Clinical Indicators are reported through the Trust Clinical Performance Scorecard
The reports are then shared via Quality Governance Committee to the Trust Board,
Commissioners and Service Delivery meetings.
NHS Number and general Medical Practice Code Validity
The Trust did not submit records during 2014/15 to the
Secondary Uses service for inclusion in the Hospital
Episode Statistics to be included in the latest
published data.
Information Governance Toolkit Attainment Levels
West Midlands Ambulance Service Information
Governance Assessment Report overall score for
2014/2015 was 80% and was graded satisfactory
Clinical Coding Error Rate
West Midlands Ambulance Service was not subject to the Audit Commission’s
Payment by Results Clinical Coding Audit during 2014/2015
19
Performance against key quality indicators
To ensure patients of the West Midlands receive quality care from their Ambulance
Service a set of key Performance Indicators and Ambulance Quality Indicators have
been set nationally. These help set our policies and guidelines and develop our
organisational culture that places quality at the top of the Trust’s agenda. The
following details the figures for each CPI/AQI and highlights the national mean
percentage and the position of WMAS against other Trusts.
All Ambulance Trusts are required to report the following mandatory Quality
Indicators:
Red Ambulance Response Times
Percentage of Category A telephone calls (Red 1 and Red 2 calls) resulting in an
emergency response by the trust at the scene of the emergency within 8 minutes of
receipt of that call during the reporting period.
Percentage of Category A telephone calls resulting in an ambulance response by the
trust at the scene of the emergency within 19 minutes of receipt of that call during
the reporting period.
Care of ST Elevation Myocardial Infarction
Percentage of patients with a pre-existing diagnosis of suspected ST elevation
myocardial infarction who received an appropriate care bundle from the trust during
the reporting period.
Care of Stroke Patients
Percentage of patients with suspected stroke assessed face to face who received an
appropriate care bundle from the trust during the reporting period.
Ambulance Response Times
WMAS WMAS National Highest
2014‐15 2013‐14 Target
Nationally
2014‐15
Red 1 response within 8 minutes 77.5%
80.0%
75%
80.9%
Red 2 response within 8 minutes 74.3%
73.6%
75%
75.4%
Red ‐ 19 Min Performance
96.8%
97.0%
95%
96.8%
Green 2 ‐ 90%‐30mins
88.3%
88.6%
90%
N/A
Green 4 ‐ 90% ‐ triage in 60mins 99.4%
99.6%
90%
N/A
Lowest
Nationally
67.2%
59.7%
91.2%
N/A
N/A
Significant efforts were made to achieve all of the operational performance targets
during 2014/15. We will continue to work with our Commissioners and other
Providers such as Acute Hospital colleagues to ensure improvements in the
provision of healthcare for the people of the West Midlands. WMAS continues to
employ the highest Paramedic skill mix in the country with a Paramedic present in
over 95% of crews every day. We are actively recruiting student and graduate
Paramedics this year, which will further boost our capacity to respond and our
clinical performance for patients.
20
STEMI (ST-elevation myocardial infarction)
This is a type of heart attack. It is important that these patients receive:
Care bundles have been developed to ensure patients get the best care based on
current evidence. Care bundles include a collection of interventions that when
applied together can help to improve the outcome for the patient.
The STEMI Care Bundle requires each patient to receive each of the detailed
interventions below. Aspirin - this is important as it can help reduce blood clots
forming.





GTN – this is a drug that increases blood flow through the blood vessels within the heart.
(Improving the oxygen supply to the heart muscle and also reducing pain).
Pain scores – so that we can assess whether the pain killers given have reduced the
pain.
Morphine – a strong pain killer which would usually be the drug of choice for heart attack
patients.
Analgesia – Sometimes if morphine cannot be given Entonox, a type of gas often given
in childbirth, is used.
Call to Balloon - 75% of patients that have Primary Percutaneous Coronary Intervention
(PPCI) should do so within 150 minutes of the initial call. This treatment is provided at a
specialist heart attack centre.
The Care Bundle requires each patient to receive each of the above. The AQIs
include measurements for the management of STEMI cases:
Year-to-date Clinical Performance relating to STEMI and Stoke AQI’s
Mean (YTD)
Ambulance Quality
Indicators / Clinical
Performance
Indicators
STEMI Care Bundle
WMAS
(13‐14)
WMAS
(14‐15)
National
Average
Highest
Lowest
75.28%
75.05%
80.50%
83.16%
69.57%
Stroke Care Bundle
94.24%
93.73%
97.10%
95.58%
91.13%
Stroke Care Bundle
A stroke care bundle includes early recognition of onset of stroke symptoms and
application of the care bundle to ensure timely transfer to a Specialist Stroke Centre.
Clinical managers continue to improve work in this area by;



Facilitating ASQUI workshops throughout the region
Auditing cases where stroke may not have been diagnosed
Ensuring the correct resource is sent to stroke patients
21
What our Staff Say?
As in previous years, the National Staff Survey was conducted for WMAS by Quality
Health. A total of 850 questionnaires were sent to randomly selected staff across the
whole of the Trust. There were weekly reminders in the Weekly Briefing, together
with reminder letters sent out by Quality Health to individuals to help the return rate.
The Survey closed on the 1st December 2014.
The responses from staff are reported as 28 key findings and include the calculation
of an overall staff engagement score. The staff engagement score incorporates
staff’s perceived ability to contribute to improvements at work, whether they would
recommend the Trust as a place to work or receive treatment, and the extent to
which they feel motivated and engaged in their work.
The Trust’s overall staff engagement score in 2014 was 3.30 out of 5, compared to
3.15 in 2013. The national average staff engagement score in the ambulance service
trusts in 2014 was 3.21.
The key findings in which the Trust has shown the largest improvement are:



Percentage of staff appraised in last 12 months (up 12%)
Staff motivation at work (up from 3.3 to 3.51)
Percentage of staff reporting errors, near misses or incidents witnessed in the
last month (up 4%)
The Trust achieved scores which placed it in the best 20% of ambulance service
trusts in half of the 28 outcomes. However the areas where the Trust’s performance
is outside of this 20% are a clear indicator of where improvements need to be made.
As part of the Trust’s action plan, following the national staff survey for 2013, the
Trust has developed an aligned bespoke survey to further delve into the findings.
The full Survey results were published on the 26th of February 2015 on the NHS
Employers websitehttp://www.nhsstaffsurveys.com/Page/1006/Latest-Results/2013-Results/
Follow the link for a copy of the WMAS Summary Report for survey results
http://www.wmas.nhs.uk/Pages/QualityAccounts.aspx
Equality and Diversity is built into everything the Trust does including policies,
practices and strategies, public engagement and consultation events, where the
Trust regularly asks local communities how it can improve services and practices.
Diversity in employment produces a workforce sensitive to the different needs of the
community and the Trust has developed a vision for ensuring equality, diversity and
inclusion, in both employment and service delivery which reflects `respect, dignity
and fairness to all`.
22
The Trust has endorsed the Equality Delivery System (EDS), which is an NHS
Equality and Diversity Framework, to assist in delivering better outcomes for patients
and staff. We have been able to identify and consider further steps which will meet
the needs of our staff and service users who share the relevant protected
characteristic group.
We have also published our Equality Data Analysis report 2014/2015 and will
continue to publish our data with comprehensive analysis annually, in order to meet
our Public Sector Equality Duty (Equality Act 2010).
As demonstrated within the report, we will improve the way we make informed
decisions about our policies and practices, which are based on evidence, and the
impact of our activities on equality and the protected characteristic groups. For
further information please follow the link Equality Data Analysis report 2014/15
http://www.wmas.nhs.uk/Pages/EqualityDataAnalysis.aspx
23
Workforce and Organisational Development
Our People
The Trust is making progress
The Trust aims to achieve an
2013/2014 by increasing the
1657 i.e. 65% of Operational
representing 70%.
towards the achievement of 70% Paramedic skill mix.
average increase in Paramedic skill mix from 61% for
number of Paramedics from an average of 1322 to
Staff by 2016/2017 and 1878 paramedics in 2017/18
The Trust has worked hard to avoid vacancies in key areas that can lead to
operational difficulties and adverse patient outcomes. In order to achieve this, the
Trust has reduced the average time from advert to appointment from 20 to 15 weeks.
2014/15
WMAS
Appraisals
43.26%
Mandatory Training
63.75% YTD* Programme running until
September 2015
Staff Development
Graduate Paramedic Recruitment
Technician to Paramedic Conversion
Student Paramedic L1
Student Paramedic L4
ECA to Tech
HCRT to Tech
2014/15
Planned
50
40
250
295
21
30
2014/15
Trained
30
23
248
127
0
18
24
Health and Wellbeing
Working in partnership with Staff side
the Trust continues to develop a
Health and Wellbeing Strategy and
action plan to ensure that health and
well-being of staff is supported.
Managers and staff are being
supported to update and develop
their skills. The Trust are supporting
up to 50 Managers to complete an
Engaging Leaders Programme of
Management Development.
The Trust wants to see a 5%
improvement in staff recording that
they feel valued and engaged in Staff
survey results as well as assurance
that there is an Increase in the
number of staff with reviewed
personal development plans. The
Trust also wants evidence that staff
are supported to receive the
appropriate level of training as per
the training plan.
25
Patient Experience
Part 3 - Review of Performance against 2014-15 Priorities
Priority
Progress
Successful implementation
joint working/engagement
with other NHS Trusts
within the West Midlands
area of the Friends and
Family Test (FFT)
NHS England released guidance on 21 July 2014 on the implementation of the
Friends and Family Test (FFT) question for Ambulance Services. FFT was
advertised and promoted through local press and radio but also through utilisation
of social media.
How we have
done
Achieved
"How likely are you to recommend our service to friends and family if they
needed similar care or treatment?"
Engagement with stakeholders has been facilitated though:




Posters displayed in Vehicles and GP Surgeries -Posters have been
devised and will be placed in GP Surgeries and Emergency Departments
advising how to make contact with the Patient Experience Team. There is
also a QR code that patients can scan which will take them to the Survey
page on the internet which features the FFT question.
Healthwatch -The Patient Experience Team have liaised with Healthwatch
advising of the implementation of the FFT question in Ambulance
Services.
Foundation Trust Members – An article featured in the December
addition of the newsletter.
Staff - We have raised awareness of the importance of offering this
question to patients through the Trust Weekly Brief.
We capture FFT feedback via?
 Website -The FFT question features on the home page of the Trust
website and allows people to complete and submit on line.
 Patient leaflet -The Trust has also devised a leaflet which can be returned
to the freepost address.
Work to date has been in advance of the national implementation of April 2015
and therefore there are no metrics published.
26
Priority
Progress
How we have
done
Addressing Health
Inequalities (3 year
project)
During 2014/15 this priority established how we can support our Public Health
Colleagues to improve the health of the homeless and travelling, and migrant
communities. The focus during 2015/16 will be on making every contact with
these groups count.
Achieved
Patient engagement
focusing on the under
18s
We have successfully engaged in variety of events targeted at under 18’s. The
Patient Experience Team has been involved in 12 events across the region
during this financial year. Organisation Development have also attend events
awaiting confirmation of number.
Achieved
Example of the types of events attended:
• Gypsy Traveller Day
• 999 Fun days with other services
• Fire Service Open Day
• Careers Events
• School Visits
• Young Carers Event
‘Lloyd the Paramedic Turtle’ all schools were asked to design a mascot for the
Trust. Two young designers from Rugeley & Walsall area were successful in the
creation of ‘Lloyd’ who will attend future engagement events in the future.
We have distributed 1745, junior paramedic packs following events with the local
community including schools, cubs and scouts. We have received 62,743 hits
on the new website since December 2014. There is a Junior paramedic iPad
app available for download on the WMAS Commercial website along with
published news articles.
27
Priority
Progress
How have we done
During 2014/15 we did not achieve significant improvements in this priority Not achieved
therefore we will be continuing the focus as part of the overall priority for
improvements in Clinical Care.
Maintaining Neonate
Temperatures
Achieved
Promoting skin to skin contact during transfer:
As there was no product on the market that met both European Safety standards
and the requirement of the ambulance service, WMAS worked with a company to
develop a product that complies with European Safety standards and the
requirement of the ambulance service. WMAS engaged with WMAS staff,
Midwives and a mothers group to develop a harness device that encourages skin
to skin transfer for mother and baby. This device is now on trial to consider the
logistical elements of its use and is awaiting evaluation to determine
implementation.
Patient Safety
Single limb fractures
Accurately measuring neonatal temperatures:
New thermos scans have been sourced and purchased in order for the accurate
temperature of new born babies can be achieved. Audit tools have been
developed and agreed to monitor compliance with recording new born
temperatures. Figures will be monitored via the audit and clinical review
committees.
General Pain
Management
During 2014/15 we did not achieve significant improvements in this priority
therefore we will be continuing the focus as part of the overall priority for
improvements in Clinical Care.
Not achieved
28
Clinical Outcomes
Priority
Timely and Effective
Transfer
Progress
How have we done
This priority was implemented in order to improve the response times between Partially Achieved
the first clinician on scene and the arrival of a double crewed ambulance able to
transport our patient to hospital.
There has been an improvement
Timely and Effective care
delivered on scene commissioning
This priority identified the delays crews experienced when trying to access other Achieved
services for patients in their own homes. We will continue to work with
Commissioners and other Providers to identify gaps in services.
Timely and Effective Care The work done during 2014/15 identified areas for improvements, we will Partially Achieved
on scene - clinical and
continue this work as part of the priorities for 2015/16 to ensure the service we
training
provide to our patients is timely and effective.
29
Patient Safety
Reporting, monitoring, actioning and learning from patient safety incidents is a key responsibility
of any NHS provider. At WMASFT, we actively encourage all of our staff to report post patient
safety and non-patient safety incidents so that we are able to learn when things go wrong. This
helps us to recognise where improvements are required and make changes.
- Combined Performance
We encourage staff to report all incidents, near misses, issues and concerns, particularly where
there has been no actual Harm. These present the Trust with the opportunity to learn lessons
before a patient is actually harmed. This is important both to resolve the immediate issues that
have been raised and to identify the wider themes and trends which need more planning to
address. Analysis of all incidents takes place and is supported by triangulation with other
information such as complaints, claims, coroners’ inquiries and safeguarding cases. These are
discussed monthly at the Learning Review Group. The meeting is chaired by the Deputy Director
of Nursing & Quality and attended by clinicians from across the organisation. Themes and trends
are also reported quarterly to Clinical review Group, Quality Governance Committee and the
Trust Board. A positive safety culture is indicated by high overall incident reporting with few
serious incidents and we continue to work towards achieving this.



Incidents: An incident is any
unplanned event which has
given rise to actual personal
injury, patient dissatisfaction,
property loss or damage, or
damage to the financial standing
or reputation of the Trust.
Near Miss: Any occurrence,
which does not result in injury,
damage or loss, but had the
potential to do so
Issue/Concern: If it does not fit
into any of the above definitions
30
Total Number of Patient Safety Incidents reported by month
Birmingham
Black Country
Coventry & Warwickshire
West Mercia
Staffordshire
PTS
EOC
Air Ambulance Providers
111 ‐ WMAS
Other
Total
Total Number of Harm Incidents
Total Number of No/ Harm Near
Misses
Apr 14
9
8
5
4
9
8
3
0
1
0
0
47
7
May 14
2
3
13
8
10
9
2
0
0
0
0
47
4
Jun 14
5
13
4
2
3
6
2
0
2
0
0
37
5
Jul 14
5
13
9
12
6
5
6
0
0
0
0
56
9
Aug 14
8
9
12
14
5
8
4
0
0
0
0
60
8
Sep 14
8
7
7
9
2
5
3
0
1
1
0
43
9
Oct 14
4
2
7
8
4
5
1
1
1
0
2
35
6
Nov 14
4
7
12
3
6
6
4
0
1
0
3
46
2
Dec 14
4
4
10
11
10
6
1
1
0
0
6
53
4
Jan 15
4
14
5
5
7
7
4
0
0
0
5
51
6
Feb 15
7
5
1
2
2
1
0
0
0
0
18
36
4
Mar 15
1
0
0
5
0
0
0
0
0
0
2
8
0
Total
61
85
85
83
64
66
30
2
6
1
36
519
64
40
43
32
47
52
34
29
44
48
45
26
7
447
31
Themes
The most frequently reported themes relate to access, admission and transfer
delays, patient accidents and missing unavailable clinical equipment are also cited
as primary issues. The most frequent reported harm incidents relate to ambulance
delays, patient falls and other injuries whilst transferring/ transporting.
Medication Errors
During 2014/15 no medication errors were reported that resulted in an SUI or patient
harm.
Following several reports (Francis, CQC, MHRA etc.) which indicated that patient
harm could result if staff were not open and honest in reporting issues, the
medicines team have put into place (in conjunction with staff side) an anonymous
medicines reporting system . This system whilst in its infancy is working well with
staff reporting medicine incidents anomalously at the rate of an average of three per
month.
The amount of morphine administered by WMAS paramedics has increased by
approximately 15% (this is as a result of allowing staff to administer morphine I.M in
addition to I.V; together with an improvement in managing patient’s pain) however
the loss and breakage rate has reduced by 7%.
All medicine incidents reported (from all sources) are reviewed to establish trends,
causation etc. and as a result of this information the following change have been
made;



Ampoule holders are being replaced with a more robust design which are
square and not round, this will reduce breakages if dropped and stop the
holders rolling off surfaces.
The procedure for restocking Controlled Drugs at CAS sites drugs has
been alerted to reduce crews down time.
The security of all Categories of Drugs has been improved by reviewing
and amending storage arrangements at all locations. Locality managers
carryout Controlled Drug audits weekly, this is in addition to the medicines
team carrying out random Controlled Drugs audits.
Infection Prevention and Control
Each quarter across the region for hand hygiene, cannulation, vehicle and premises
cleanliness. The hand Hygiene audits are split between at hospital observations and
at the point of care observations by Clinical Team Mentors (CTMs) with a minimum
of 1,000 observations done each year. Cannula insertion observations are also
done by CTMs with a minimum of 400 done each year. The results (below) have
shown a consistent rise in compliance year on year.
32
Premises and vehicle cleanliness audits are completed by the Area Teams every
quarter, with verification audits completed by the IP&C team. Any variations in audit
scores are investigated, then actions take place to rectify any issues found.
In 2014/15 one challenge faced was to ensure all staff were aware of procedures to
follow if any suspected cases of Ebola were identified in the West
Midlands. Processes, kit and information were produced in conjunction with the
Emergency Planning department to ensure all staff and the population of the West
Midlands would be kept safe if we were to have any cases in this area.
Safeguarding
Safeguarding for Adults and Children is embedded in WMAS throughout Policies and
Procedures and literature. All staff within WMAS are encouraged to report
safeguarding concerns to the single point of access Safeguarding Referral Line.
Adult
Referrals
2013‐2014
YTD
10,328
Children
Referrals
2013‐2014
YTD
2183
2014‐2015
13,589
2014‐2015
2709
% variance
32%
% variance
24%
Engagement with the 27 Safeguarding Boards across the West Midlands continues
to grow and develop.
With the Care Act 2014 WMAS is developing and aligning processes and guidance
for all staff. Referrals are monitored on a monthly basis as a way of demonstrating
effective engagement and awareness of staff of such issues.
Domestic Abuse Reporting
In April 2014 WMAS introduced Domestic Violence in the
mandatory training program. This included referring domestic
violence and informing the Police. Key engagement with all
Police Force Domestic Leads were developed across the West
Midlands
33
Serious Incidents
Serious Incidents (SIs) include any event which causes severe harm or death; a
scenario that prevents or threatens to prevent a provider organisation’s ability to
continue to deliver healthcare services; Allegations of abuse; adverse media
coverage or public concern about the organisation or the wider NHS.
A total of 25 serious incidents have been reported by WMASFT over this reporting
period.
All serious incidents are investigated using Root Cause Analysis
methodology to determine failures in systems and processes. This methodology is
used to steer away from blaming operational staff at the sharp end of the error, to
ensure the organisation as a whole learns from mistakes and that systems are
reinforced to create a robustness that prevents future reoccurrence.
Following investigations into serious incidents, it has been highlighted that the Trust
needs to improve;



Access to equipment to enable crews to practice skills where their exposure
to real life situations is minimal
Improve local awareness in relation to management of posterior stroke
Agree a systematic approach for prioritising category green 2 calls
National Framework for
Reporting and Learning from
Serious Incidents Requiring
Investigation
Total number of SI's by Division
Birmingham
Black Country
C&W
West Mercia
Staffs
Patient Transport Services
EOC
Air Ambulance
Commercial Services
Other
4
3
2
1
0
34
NHS 111
Since WMAS stepped in to run the NHS 111 service in the West Midlands in
November 2013, the Trust has received over 1.25m calls. In doing so, we continue to
perform above target of answering at least 95% of calls within 60 seconds. As public
confidence continues to be restored in the service, call levels have continued to rise
with more than 940,000 coming into the service in the previous 12 months alone.
The demand on the local health care economy has been well documented in recent
months, which makes the work we are doing in our call centre more essential than
ever. The Trust works closely with local emergency departments and the 999 service
to try and relieve some of the pressure on the healthcare system with more
enhanced clinical intervention. Born out of that desire, the Ambulance Liaison Desk
has been created to clinically screen Green 2 ambulance endpoints.
Similarly, the Clinical Intervention Desk screens emergency department outcomes.
111 has been able to clinically screen up to 70% of all Green two end points and up
to 80% of all Emergency Department endpoints therefore making significant
reductions in the number of patients sent to Emergency Departments across the
region.
Christmas proved to be the busiest time for the service when the Trust received 50%
more calls compared to same time in 2013. This was highlighted by the two days the
Trust has experienced when a total of 15,880 calls were received across December
26 (7263) and December 27 (8617).
Despite the continuous busy nature of the service, WMAS has been the best weekly
performing 111 provider on many occasions, including successive weeks at the end
of January and start of February.
As the number of people using 111 continues to rise, the Trust is keen to enhance
the service for patients and attempts to ease the pressure on the wider healthcare
economy at the same time. As a result, dental nurses have been introduced into the
call centre together with the Trust taking part in a number of innovative pilots.
These include:





GP early intervention.
The use of pharmacist and pharmacy endpoints.
Installing a mental health nurse within the 111 call centre.
GP in-hours booking.
A 111 online service.
In order to learn through patient feedback, the Trust developed a 111 patient survey
which as well as being posted out to users of the service, will be available to all on
the new WMAS website. The results from the surveys returned across the last six
months have been encouraging with almost 94% of patients saying they were very
satisfied or satisfied with the service they received whilst just over 94% said they
were extremely likely, or likely, to recommend the service to others.
35
If any patients raise concerns in their responses, we respond to them to allow us to
investigate the concern, feedback to the patient and address any issues we find.
The Trust is currently in the middle of the tender process to win the new NHS 111
West Midlands contract which will last for five years. We have put a great deal of
hard work into developing the service during the last 18 months and hope to
continue to be able to do so when the contract is awarded in May 2015.
111 – Patient Safety and Experience
111 ‐ Incidents, Complaints, Concerns and
Compliments
100
80
60
40
20
0
PS Incidents
Complaints
PALS
Compliments
There is an overall satisfaction with the service. Often specific staff are identified as
being particularly helpful. Patients report being happy with assessment and advice
provided. We also receive praise relating to referral to other services.
PALS and Formal Complaints
Key themes for PALS and formal complaints relate to

Unhappy with other Health Care Provider - is a large section of our
complaints and refers mainly to complaints about the OOH Service, other
services like A&E or own GP Surgery. WMAS Paramedics are included in this
section. All complaints are logged for the different services and passed to the
service for investigation and direct response to the complainant – we don’t get
involved any further.

Staff Attitude and Engagement - as it suggests, refers to concerns with
communication skills like not listening, tone of voice, talking over patients, lack
of empathy etc. Where the complaint is upheld the individuals receive further
support from Line managers who look specifically at improving customer care
skills. We also monitor via random call audit to see if learning has been put
into place.
36
Complaints and Contacts
Complaints
The Trust has received to date (1 Apr – 28 Feb) in 2014/15 353 complaints
compared to 377 in 2013/14, a decrease of 6.4% (24). The main reason for a
complaint being raised relates to Response (Delay in the arrival of an Emergency or
Non-Emergency vehicle).
Breakdown of Complaints by Service Type YTD:
EOC
EU
PTS
OOH
Other
Total
2013‐2014
2014‐2015
Variance 13/14 - 14/15
135
188
88
0
6
377
100
163
83
0
7
353
‐26%
‐13%
‐6%
17%
‐15%
Justified Complaints
The table below indicates that of the 237 closed complaints, 157 were classed as
justified or part justified. If a complaint is justified, learning will be noted and actioned
locally and will also be fed into the Learning Review Group for regional learning to be
identified and taken forward.
Call Management
Attitude and Conduct
Clinical
Driving and Sirens
Response
Other
Total
Total
Justified
Non Justified
Part Justified
23
39
65
1
85
24
237
11
11
19
1
59
3
104
8
18
29
0
34
18
107
4
10
17
0
19
3
53
PALS Concerns have increased year on year with 1075 concerns raised in 2014/15
compared to 1051 in 2013/14, an increase of 2.2% (24). The main reason for a
concern being raised related to ‘response’ which includes response emergency
ambulance delays and issues with non-emergency patient transport arrangements.
Ombudsman Requests
The majority of complaints were resolved through Local Resolution and therefore did
not proceed to an independent review with the Parliamentary and Health Service
Ombudsman. During 2014/15 9 independent reviews were carried out compared to
12 in 2013/14. 4 were closed with no further action, 5 remain under investigation by
the Ombudsman.
37
Patient Feedbac
ck/ Survey
ys
The Trrust has re
eceived 126
6 complete
ed surveys
s through the
t Trust w
website relating to
Emergency Servvices and 9 relating to the Pa
atient Tran
nsport Serv
rvice. During this
year th
he Patient Experienc
ce Team h
has been attempting
a
to implem
ment and promote
p
the Frie
ends and Family
F
Tes
st (FFT) priior to its offficial launc
ch on 1 Appril 2015.
The FF
FT should be offered to patientts that dial 999, receiive an emeergency re
esponse
but are
e not convveyed to ho
ospital and
d patients that use the Non-Em
mergency Patient
Transp
port Service. Patientt are offere
ed a freepost leaflet to return tto regional HQ or
they ca
an complete the retu
urn on onli ne through
h the Trustt website. To date we
w have
receive
ed the follo
owing respo
onses:


Patie
ent Transpo
ort Service
e 15 paperr, 2 online
Emergency Services 2 pa
aper, 7 online
Patient Engagem
ment
The Pa
atient Expe
erience Te
eam contin
nues to en
ngage with Renal Paatients, with focus
meetings being undertaken
u
n at Wood gate Dialy
ysis Unit. The
T Team
m objective was to
e with un
nder 18 year old, w
with 12 events
e
atte
ended thaat have in
ncluded
engage
attenda
ance at Yo
oung care
ers, Emerg
gency Serv
vices Open days, S
School visitts, Cub
visits.
Complliments
The Trrust has recceived 112
21 complim
ments in 20
014/15 com
mpared to 972 in 201
13/14. It
is plea
asing to note
n
that the Trustt has see
en an inc
crease of 15.4% (1
149) in
Compliiments recceived. Th
he Trust ha
as a dedica
ated
complim
ment emaiil address:
complim
ments@wm
mas.nhs.uk which iss available
e to
membe
ers of publlic via the Trust
T
webssite and PA
ALS
leafletss.
62, 743
Hits
H on the
website
w
sin
nce
December
D
2
2014
1745 Junio
or
Paaramedic paacks
distributed
38
Annex 1: Statement from the Lead Commissioning Group
Co-ordinating Commissioner Response
This report demonstrates WMAS NHSFT achievement of its visions and values to
deliver responsive and quality services to the West Midlands population.
The urgent and emergency ambulance service in the West Midlands is
commissioned across 22 CCGs, which provides opportunities to deliver both
economies of scale and performance at operational quality thresholds level,
however, can cause performance challenge at individual CCG level.
Most noticeable has been the trusts struggle in the period in their ability to deliver
against operational quality performance targets in certain CCG areas and indeed
regional outturn on the Red 2 key performance indicator. This has been a result of
significant reductions to workforce capacity throughout a period of sustained
industrial action during the Autumn and Winter months.
During 2014-15 significant work has been undertaken by WMAS and the 22 West
Midlands CCGs to identify where benefits can be realised across care pathways to
support and shape the local urgent care agenda. Commissioner and provider
combined efforts has enabled us to focus on some key areas essential to the future
success of the five year forward view. As a result the CQUIN schemes included in
the 2015/16 contract period should support innovative change and facilitate changes
in service delivery that provides improved access to care closer to home over the
coming years The workforce within WMAS now includes a high percentage of highly
skilled paramedics, and a variety of vehicle types that provide a response, the
paramedic-led clinical care available to patients now reflects the changes in services
required to respond to callers of 999, who are predominantly 60% “green” urgent
activity. With only 40% of activity being real emergency and categorised into the
Red activity bracket. The CQUINs that have been agreed between WMASFT and
Commissioners in 2015/16 will support fast effective conveyance for those patients
that require speedy response and transport to hospital. However, it will also better
support the higher volume of patients that call with urgent but not emergency care
needs, and pathways will be put into place to ensure that appropriate responses are
made to those patients, and where that response is a need for social care support,
access to mental health services or support from primary care or community
services, then this will be made available to patients direct from their contact with the
ambulance service.
The West Midlands CCGs are committed to working with WMAS in a collaborative
and proactive way to deliver mutually beneficial outcomes for patients.
The West Midlands CCGs consider this Quality Account to demonstrate a successful
set out outcomes for WMAS NHFT, acknowledging the pressures within which the
organisation has operated.
39
ANNEX 2: STATEMENT FROM THE COUNCIL OF GOVERNORS
Chair of Patient Quality Panel on behalf of the Council of Governors
This year’s report is offset against what has been a very challenging year for the
service. As trust governors we have seen first-hand the issues caused by increased
demand, winter pressures, hospital reconfiguration and industrial action. What is
pleasing to note is the strategic planning and dedication of the workforce, which has
helped the service through this difficult period. We do of course recognise
improvements are still to be made and are reassured with the current Student
Paramedic recruitment programme, decreasing the process from 20 down to 15
weeks and increasing the Paramedic skill base regionally which will have a benefit to
patients care. We note that ECA to Tech conversions are yet to take place and
would hope this does happen within 2015.
The Commissioning for Quality and Innovation Performance Indicators each of which
were achieved at 100% has led to the service receiving an additional £4 million in
funding which highlights the work carried out across the trust to meet these
benchmarks. If we are to seek the reassurance of the areas the service covers we
wish to see a breakdown of performance by area/jurisdiction as requested by
Healthwatch organisations and this information should be provided to them.
The Patient Quality Panel will continue to analyse quality data and meet with trust
directors and strategic staff to ensure the best possible service is provided
proportionally and fairly across the region.
40
ANNEX 3: LOCAL HEALTHWATCH AND OVERVIEW & SCRUTINY
COMMITTEES
Shropshire Health & Adult Social Care Scrutiny Committee
Members of Shropshire Council’s Health and Adult Social Care Scrutiny Committee
commend WMAS on achievement of the priorities identified in last year’s Quality
Account, and agree with the priorities identified for 2015–2016.
They believe the Quality Account demonstrates a commitment to continuous,
evidence-based quality improvement and identifies where improvements need to be
made. Members felt it would be useful for the Quality Account to include
comparative data from other Ambulance Services.
Members were pleased to find the report accessible and easy to read. The inclusion
of a glossary is welcome but it is suggested that this be included at the very
beginning of the document rather than at the end.
Members acknowledge that the challenge of meeting rural targets will never go
away. The efforts of WMAS in providing measures to mitigate this are positive.
Members concurred with the prioritisation of patient experience and outcome over
targets.
Members would like to thank the Trust for its generosity in officer time, information
dissemination, and candour in responding to requests from the Committee. They
have requested 3 monthly updates on progress on the Key Performance Indicators
and progress against the Quality Account priorities
The Committee looks forward to continuing working with the Trust to ensure the best
possible outcomes for the people of Shropshire.
Healthwatch Shropshire
Healthwatch Shropshire is pleased to be invited to consider and comment on the
Trust’s Quality Account review of 2014-15 and forward plan for 2015-16.
We welcome the breakdown of Red 1, Red 2 and Red 19 figures for Shropshire,
however, we are concerned to note that these are significantly lower than the WMAS
performance overall. Based on comments we have received, of specific concern for
Shropshire residents is response times in rural areas.
It is disappointing that at the time we were invited to consider and comment on the
Account, details of achievement against commissioners’ quality improvement and
innovation goals were not available for comment. Similarly, the National Audit table
is incomplete and the information on the national and local audits doesn’t tell the
reader about the impact on patient care and experience.
41
In the priorities for 2015-16 we welcome the focus on engagement and patient
experience, however, ‘what success will look like’ for the three priorities needs to be
better qualified and more specific, for example what would improved engagement
look like for disadvantaged groups (and which groups – does this include rural?). In
addition, on page 9 we don’t know what the clinical performance measurements are
and how these are linked to outcomes for patients and response times.
A minor failure is stated in compliance with CQC registration: Outcome 4: Care and
Welfare of people who use our service’. We would like to see this explained and
addressed.
Review of performance against 2014-15 priorities – middle column shows what has
been done (output) but the final column ‘how had we done’ doesn’t show what
different has been made (outcomes). In addition, some of the activities do not seem
to relate to the priority. Where improvements have not been made against priorities,
it would be good to understand the reasons why and use the learning going forward.
For some priorities it is not clear what the aim is to achieve.
When reporting on Ombudsman requests, we are concerned that outcomes of the
outstanding cases mentioned in last year’s Quality Account do not appear to have
been reported upon in this year’s Account.
We note that you list among your pilots a 111 online service. We hope this utilises
the existing NHS Choices website rather than a new website which could potentially
cause the public confusion.
We noted that demand for WMAS’ services has increased, so it would be interesting
to see that referred to under complaints and contacts as the number of complaints
has gone down and the number of PALS concerns have slightly increased. Also, it is
positive that learning is noted and actioned when a complaint is upheld, but it would
also be good practice to learn from complaints which are not upheld.
Healthwatch Shropshire is keen to develop its relationship further with the Trust and
we would welcome more of WMAS meetings being held across the area including
Shropshire.
Worcester Health, Overview & Scrutiny Committee
The improved readability of this year's Quality Account is welcomed.
However, further commentary and context is needed to give the public a real sense
of the main headlines behind the organisation's work this year, and the particular
issues experienced in Worcestershire – the extreme pressures on emergency
services across the health economy and impact on ambulance response times.
42
It would be helpful to understand the basis for priorities and how they will be
measured, although it is understood that they reflect national targets and that this
information will be added once the national priorities are finalised.
Divisional reports are welcomed, having been requested by us for several years.
HOSC's links with the Ambulance Trust work is assisted by two lead members
attending public board meetings. They report being overall impressed with the
Trust's work to improve performance targets for ambulance response times,
however, the Board's paperwork is very complex and does not present a clear
message of its work; greater use of more accessible communication channels, such
as video, would be beneficial to the public.
The performance gap between rural and urban areas is concerning and whilst
acknowledging the greater challenge in rural areas, it is important to improve
performance.
The reported drops in hospital conveyance rates as a result of more patients being
treated at the scene will contribute to increasing demand on Worcestershire's
hospitals. The HOSC will be continuing its scrutiny of patient flow over the coming
year.
Worcestershire has experienced a significant rise in activity (13%), against typical
rises of 5-7%, with increased 999 calls a contributing factor. We understand the
Trust is working alongside colleagues from the Acute Hospitals' Trust on this matter,
and this is something HOSC will also monitor.
Healthwatch Telford & Wrekin
Healthwatch Telford and Wrekin is pleased to be invited to consider and comment on
the Trust’s Quality Account 2014-15. We were pleased to read that the number of
official complaints has decreased; however, it is disappointing that the number of
PALS concerns has increased, it appears that themes around response time are the
focus of the issues raised. We acknowledge that the Trust is working towards
addressing the issues raised.
We are encouraged to see that there is continued focus on patient experience and
engagement in the Trust’s priorities for 2015-16.
It is encouraging that the Trust has a strong commitment and involvement in
research studies and audit. We pleased to see the focus on young people has been
highlighted in several areas of the report including attending several community
events.
The report highlighted the improved performance in delivery of the NHS111 service
and the innovative ways being piloted to enhance the service for patients, we look
forward to hearing the results of the pilots.
43
We note that WMAS performance figures have been broken down into areas; and
we note the good response times in certain ares of Telford and Wrekin but there
continues to be challenges in others, the delivery of the service to our patients in
these areas will need to be addressed.
We are pleased to acknowledge the Trust commitment to mandatory training on
Domestic Abuse and the continued engagement across a multidisciplinary team.
We look forward to continuing to develop the working relationship with the Trust and
using our patient experience data to contribute to the ongoing improvement in patient
care.
Telford & Wrekin Health & Adult Care Scrutiny Committee
The Telford and Wrekin Council’s Health and Adult Care Scrutiny Committee is
unable to provide comments on the 2014/15 Quality Account due to the fact that the
national timetable for the HOSC to comment on the Quality Account coincides with
the pre-election period for the Borough elections and the appointment of the new
Scrutiny Committee at Annual Council.
Healthwatch Herefordshire
Some specific issues which we believe are particularly important are as follows:The Draft report shows a high degree of engagement and drive to improve patient
care, with inter-agency working, evidence-based care improvement, and partnership
with academia and medical suppliers.
The priorities in Part 2 can be welcomed and supported by Healthwatch
Herefordshire, particularly for:
- Learning Disability engagement and communications
- Stroke Patients
- Child and Adult Patient Safeguarding
There is a weakness in the description of Workforce and Organisation Development
(p22)
The target for achieving Paramedic mix of Ambulance staff is given as 70% for the
year 2017/18.
An achieved figure of 61% is reported for 2013/14.
The figure for the year the Quality Account is about (2014/15) is not given! but is
presumably less than the 65% target for 2015/16.
If the improvement 13/14 - 14/15 is something less than 5%, it does seem credible to
achieve a few more % to reach 65% for 15/16.
44
However, the subsequent 5% jump required up to 16/17 seems unlikely to be
achievable, particularly in light of the bigger base number involved. This was not
evident in Part 3.
Part 3 – How WMAS did
Performance against a priority for last year of focusing on the under-18s (p25) seems
very good and something HWH can applaud.
P28 Patient Safety, and p31 Serious Incidents, still bury Herefordshire in a group of
counties which WMAS refers to as West Mercia (Herefordshire, Shropshire,
Worcestershire etc) rendering these figures of no use to us. Reporting at West
Mercia level is a relic of WMAS legacy reporting systems and WMAS internal
convenience.
This practice was changed last year in the monthly performance reports WMAS
sends out to Healthwatches and HOSC. There is no technical reason why this could
not be applied to all reporting and this Quality Account Report.
(P49 and 50 do give a little more detail, but again in the form of very high level wholeyear averages, with huge variations within them, so they don’t actually inform much.)
P34 – Complaints - Actual numbers of complaints mean little unless set against a
baseline of numbers of “calls” dealt with – producing, say, complaints per 10,000
calls.
Finally, the report does describe WMAS territory as including a very large proportion
of rural areas. However, it says virtually nothing about the big variation in
performance in places like Herefordshire, and nothing about improving it.
Warwickshire County Council’s Adult Social Care and Health
Overview and Scrutiny Committee, Nuneaton & Bedworth Borough
Council, Healthwatch Coventry and Healthwatch Warwickshire
It is the belief of this and other QA Task and Finish Groups across Coventry and
Warwickshire that the intended audience for this document is the public, and that
NHS Trusts have to face the dilemma every year of producing a document that
answers a broad range of conflicting demands from different audiences. An added
challenge for this Trust is the vast geographical area covered by WMAS and the
many different local authorities and Healthwatch organisations included in that area.
It is therefore difficult to engage with the Trust to review and identify quality themes
and issues that members believe should be both current and future priorities that
reflect local priorities.
45
We welcome the commitment in the QA to demonstrate how the priorities for 2015/16
have been identified and what success will look like in each case. The priorities are
clear and reflect the aims of an ambitious and a learning organisation, but are difficult
to translate into different areas with different challenges.
Members of the Group were invited to spend time with local ambulance crews and
the commitment and professionalism of the staff was commendable.
In the single instance where data is divided into different areas, we were concerned
at the high rate of Patient Safety Incidents recorded for Coventry and Warwickshire.
The Group are committed to their role in monitoring quality assurance at a local level
and would welcome more local content in the QA.
The following additional comment is included from Healthwatch Warwickshire:
Healthwatch Warwickshire (HWW) fully supports the general comments made on
behalf of the joint Quality Accounts Task and Finish Group, established to consider
the WMAS Quality Accounts from a Coventry and Warwickshire perspective. On
behalf of consumers in Warwickshire there is an additional issue to be considered.
HWW represents consumers in a County which has significant rural areas and which
presents very different challenges to Coventry, for an ambulance service. We were
very impressed by our visit to the Coventry Hub in 2014. However, there is no
information in the Quality Accounts draft that enables us to consider performance in
our County. Even in the single instance where data is divided into separate areas we
are not able to determine whether the high rate of Patient Safety incidents is an issue
that should concern consumers in Warwickshire or Coventry or both.
Being openly accountable to relatively small communities must be a significant
challenge to a regional Ambulance Trust. An answer will have to be found, if they are
to retain the confidence of consumers in these local areas. HWW is committed to
working with all relevant parties to resolve this issue and ensure that more informed
comment will be possible next year.
Staffordshire Health Scrutiny Committee
We are directed to consider whether a Trust’s Quality Account is representative and
gives comprehensive coverage of their services and whether we believe that there
are significant omissions of issues of concern.
There are some sections of information that the Trust must include and some
sections where they can choose what to include, which is expected to be locally
determined and produced through engagement with stakeholders.
46
We focused on what we might expect to see in the Quality Account, based on the
guidance that trusts are given and what we have learned about the Trust’s services
through health scrutiny activity in the last year.
We also considered how clearly the Trust’s draft Account explains for a public
audience (with evidence and examples) what they are doing well, where
improvement is needed and what will be the priorities for the coming year.
Our approach has been to review the Trust’s draft Account and make comments for
them to consider in finalising the publication. Our comments are as follows.
Introduction. We support the inclusion of the Trust’s Vision, Values, and Strategic
Objectives an explanation of what a QA is, why produced and who has been
involved in the preparation. We note the statement from the Board summarising their
view of the quality of services provided or subcontracted and the Statement of
Quality from the Chief Executive and Chairman is to be included. The presence
narrative containing and outlining a list of services is acknowledged.
Priorities, we note that Account includes details of the Priorities for Improvement,
how they were chosen, links to the three domains of Patient safety, Clinical
effectiveness Patient experience, how to be achieved and links to reviews and
strategy. Progress since the last QA is present with systems to monitor measure and
report progress.
Statement of Assurance, we note the number of services provided/ subcontracted
and reviewed. Detail of income is present but we feel that the document would be
enhanced by the inclusion of more detail.
We are pleased to note the recognition of the importance and value of participation
in local and national clinical audits, subsequent outcomes and lessons learned.
The goals agreed with the Commissioners, CQUIN Indicators are present; we note
that the financial achievement against indicators is to be included. We are of the
view that an e-weblink to further information and the inclusion of more case studies
would add value to the document. In relation to the Priorities for Improvements we
are pleased to see the level of detail included and the presence of the Work Force
and Organisational Development.
CQC registration, it is noted that there are no conditions, enforcement action other
outstanding reviews or investigations. In relation to hospital episodes, payments by
results clinical coding we acknowledge that these do not apply and that information
concerning Information Governance and Data Quality is available to the reader.
47
Review of quality performance, there is an explanation of how the contents
/priorities have been determined who has been involved and the rationale for
selection. There is information about specific services and specialities as well as
what the patients say about them. In respect of accuracy of Patient Safety data we
suggest that it should be revisited before publication. Indicators and evidence
including from complaints, patient and staff surveys inspection and benchmarking is
present together with performance against key national priorities.
Referring to the Stroke care bundle ,clinical managers continue improve work in this
area by facilitating workshops, auditing cases and correct resources being deployed
to stoke patients. We are of the view that the value of the document would be added
to with the inclusion of a number of the resultant outcomes. The provision of
information within the document to supplement NHS Employers website- staff
surveys would assist the reader.
Safeguarding, as Safeguarding for Adults and Children is embedded through
policies, procedures and literature we suggest that the document would benefit with
the inclusion of more factual detail concerning this area.
The relationships between the respective CCGs within the Staffordshire Division are
clearly integral to the overall effectiveness of the Trust. We recommend more detail
of the frequent interaction between parties be advantageous.
We are pleased that there is a clear pathway to enable readers to provide feedback
or to offer suggestions for the content of future reports.
We note that this is a draft document but would expect that evidence and information
awaited as indicated throughout will be added to the final document before
publication.
To conclude considering the purpose and nature of the document, you may consider
that the inclusion of a photograph of an ambulance be appropriate.
Healthwatch Coventry
Healthwatch Coventry is the consumer champion for local health and social care
services, working to give local people and users of services a voice in their NHS and
care services. Local Healthwatch welcomes its role in producing commentaries on
NHS Trusts’ Quality Accounts.
Is the document clearly presented for patients/public?
The version of the draft quality account Healthwatch Coventry received to enable us
to compose this commentary was not complete; some text was missing from
paragraphs etc.
48
The intended audience for this document is the public, but NHS Trusts face the
dilemma every year of producing a document that answers a broad range of
conflicting demands from different audiences and meets a template from the
Department of Health.
The document would flow better if it began with the report on last year’s priorities and
then moved on to the priorities for the coming year.
It would also benefit from an expanded glossary to include all medical terms and
acronyms used.
Trust Priorities for 2015-16
An added challenge for this Trust in producing its Quality Account is the large
geographical area covered by its services and the many different local authorities
and Healthwatch organisations included in that area. The local Quality Account Task
Group (of which Healthwatch Coventry is a member) has found it difficult to engage
with the Trust to review and identify quality themes and issues that members believe
should be both current and future priorities and reflect local priorities.
We welcome the commitment in the document to demonstrate how the priorities for
2015/16 have been identified and what success will look like in each case. Some
priorities would benefit from further detail (we do not know if this is because we have
an early draft of the document). For example: Patient experience priority regarding
disadvantaged groups - it would be useful to know which 3 groups are the focus of
this work.
Regarding patient safety priorities: evidence within the document illustrates that the
most frequent theme of harm incidents also covers falls and other injuries whilst
patients are transported or transferred. This should be reflected in the priorities.
Adding benchmark data to the clinical effectiveness priorities would make it easier to
see progress against these.
The priorities focus on emergency ambulance services. WMAS provides Coventry
patient transport services and the 111 service, so we wonder why these are not
reflected.
WMAS has taken on a new patient transport contract for service provision across
Coventry and Warwickshire from 1 April 2015. Therefore, we would expect some
priorities around implementation of this service within the Quality Account, especially
in the light of quality challenges within the previous service (also provided by
WMAS). We would also expect some specific local engagement activity with patient
groups e.g. renal patients.
49
Involvement of patients and public in setting priorities
It isn’t clear from the document how patients and the public have influenced the
quality priorities.
Healthwatch Coventry was not able to attend the event WMAS held regarding its
Quality priorities, which came quite late in the quality cycle year.
Other performance information
We hope that sub-contractors are also subject to robust performance review whilst
they are being utilised.
The CQUIN information is not particularly clear and would not mean much to a
member of the public
What staff say: it is not clear what the areas for action are and what actions are
being taken by the Trust.
Regarding the health and wellbeing of staff the target set for increasing paramedic
skill mix is lower than the baseline without explanation.
The divisional profiles in the annexes are a useful feature of this quality account
document.
Last year’s priorities
Two priorities were not achieved: regarding single limb fractures and pain
management and one was partly achieved regarding timely effective care. Therefore,
these are being carried over into this year’s priorities.
There is no explanation of the Patient Safety Incidents data and the Coventry and
Warwickshire figures are some of the highest.
Safeguarding/domestic abuse reporting: the figures for referrals regarding Adult and
Children Safeguarding are 32% and 24% up on the previous year. No explanation is
given about the reasons.
Domestic Abuse referrals to Police were introduced in April 2014. It would be useful
to have some figures on referral rates.
Complaints data: the figures for upheld complaints don’t tally 159: out of 237, but the
table shows 157 justified or part justified. Those relating to ‘Responses’ (the largest
category) also do not tally.
50
Annex
x 4 - Stattement of
o Directo
ors’ Responsibilities
The Directors are
e required under
u
the Health Act 2009 and the Nationnal Health Service
(Qualityy Accounts)) Regulation
ns to preparre Quality Accounts
A
forr each finanncial year.
Monitorr has issue
ed guidance
e to NHS fo
oundation trust
t
boards
s on the foorm and co
ontent of
annual quality re
eports (whic
ch incorpo
orate the above
a
legal requirem ents) and on the
arrange
ements thatt NHS foun
ndation trusst boards should
s
put in place too support the
t
data
quality ffor the prep
paration of the quality rreport.
In prepa
aring the Quality Report, Directorss have take
en steps to satisfy
s
them
mselves thatt:
The content of the
e Quality Report
R
meetts the requirements se
et out in thee NHS Fou
undation
Trust A
Annual Repo
orting Manual 2014/15
The content of the
e Quality Report
R
is no
ot inconsiste
ent with internal and eexternal sources of
informa
ation including:













Board minuttes and pape
ers for the pe
eriod April 20
014 to May 20
015;
Papers relatting to Qualitty reported to
o the Board over
o
the period April 20144 to May 201
15
Feedback fro
om commiss
sioners dated
d 14th May 2015
2
Feedback fro
om the gove
ernors
Feedback fro
om Local He
ealthwatch orrganisations dated May 2015
2
The trust’s complaints report publisshed under regulation 18
1 of the Loocal Authoritty Social
Services and
d NHS Comp
plaints Regu lations 2009
9, dated 4 April 2015 and quarterly rep
ports
National pattient survey published
p
8 JJuly 2014
National stafff survey pub
blished Marcch 2015
The head off internal aud
dit’s opinion o
over the Trus
st’s control environment ddated 14/05/015
the Quality Report
R
presents a b
balanced picture
p
of the NHS foundation
n trust’s
d;
perfformance ovver the period covered
the performancce information reported
d in the Qua
ality Report is reliable aand accuratte;
per internal controls ovver the collection and reporting oof the meas
sures of
therre are prop
perfformance in
ncluded in the
t Quality Report, and these controls are ssubject to re
eview to
confirm that the
ey are work
king effectivvely in practice;
ance reporte
ed in the Quuality Report is
the data underpinning the measures of performa
robu
ust and relia
able, conforrms to speccified data quality
q
stand
dards and pprescribed
definitions, is subject
s
to ap
ppropriate sscrutiny and
d review; an
nd the Qualiity Report has
h
bee
en prepared in accordance with Mo
onitor’s ann
nual reportin
ng guidancee (which
inco
orporates th
he Quality Accounts
A
reg
gulations) as
a well as th
he standardss to supporrt data
qua
ality for the preparation
p
of the Qua
ality Report (available
www
w.monitor.govv.uk/annualre
eportingman
nual).
The dire
ectors conffirm to the best
b
of theirr knowledge and belie
ef they havee complied with the
above rrequirementts in preparring the Qua
ality Report.
By orde
er of the boa
ard
27 Mayy 2015
Date
Chairman
27 Mayy 2015
Date
Chief Exe
ecutive
51
ANNEX 5: EXTERNAL AUDIT LIMITED ASSURANCE REPORT
INDEPENDENT AUDITOR'S REPORT TO THE COUNCIL OF GOVERNORS OF WEST
MIDLANDS AMBULANCE SERVICE NHS FOUNDATION TRUST ON THE QUALITY
REPORT
We have been engaged by the Council of Governors of West Midlands Ambulance Service NHS
Foundation Trust to perform an independent assurance engagement in respect of West Midlands
Ambulance Service NHS Foundation Trust's Quality Report for the year ended 31 March 2015 (the
'Quality Report') and certain performance indicators contained therein.
Scope and subject matter
The indicators for the year ended 31 March 2015 subject to limited assurance consist of the
following two national priority indicators detailed on page 20:
•
Category A call - emergency response within 8 minutes
•
Category A call - ambulance vehicle arrives within 19 minutes
We refer to these two national priority indicators collectively as the 'indicators'.
Respective responsibilities of the directors and auditors
The directors are responsible for the content and the preparation of the Quality Report in
accordance with the criteria set out in the NHS Foundation Trust Annual Reporting Manual issued
by Monitor.
Our responsibility is to form a conclusion, based on limited assurance procedures, on whether
anything has come to our attention that causes us to believe that:
•
the Quality Report is not prepared in all material respects in line with the criteria set out in the
NHS Foundation Trust Annual Reporting Manual;
•
the Quality Report is not consistent in all material respects with the sources specified in the
Detailed Guidance for External Assurance on Quality Reports 2014/15 ('the Guidance'); and
•
the indicators in
assurance in the
accordance with
dimensions of data
the Quality Report identified as having been the subject of limited
Quality Report are not reasonably stated in all material respects in
the NHS Foundation Trust Annual Reporting Manual and the six
quality set out in the Guidance.
We read the Quality Report and consider whether it addresses the content requirements of the NHS
Foundation Trust Annual Reporting Manual and consider the implications for our report if we become
aware of any material omissions.
We read the other information contained in the Quality Report and consider whether it is
materially inconsistent with:
•
Board minutes for the period April 2014 to April 2015;
•
papers relating to quality reported to the Board over the period April 2014 to April 2015;
•
feedback from Commissioners, dated 28 May 2015;
•
feedback from local Healthwatch organisations, dated May 2015;
•
feedback from Overview and Scrutiny Committees, dated May 2015 ;
52
•
the West Midlands Ambulance Service NHS Foundation Trust's complaints report
published under regulation 18 of the Local Authority Social Services and NHS Complaints
Regulations 2009, dated 4 April 2015;
•
the 2014 national patient survey, dated 8 July 2014; and
•
the Head of Internal Audit’s annual opinion over the trust’s control environment, dated 22 May
2015.
We consider the implications for our report if we become aware of any apparent misstatements or
material inconsistencies with those documents (collectively, the 'documents'). Our responsibilities
do not extend to any other information.
We are in compliance with the applicable independence and competency requirements of the
Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team
comprised assurance practitioners and relevant subject matter experts.
This report, including the conclusion, has been prepared solely for the Council of Governors of West
Midlands Ambulance Service NHS Foundation Trust as a body, to assist the Council of Governors in
reporting the NHS Foundation Trust's quality agenda, performance and activities. We permit the
disclosure of this report within the Annual Report for the year ended 31 March 2015, to enable the
Council of Governors to demonstrate they have discharged their governance responsibilities by
commissioning an independent assurance report in connection with the indicators. To the fullest
extent permitted by law, we do not accept or assume responsibility to anyone other than the
Council of Governors as a body and West Midlands Ambulance Service NHS Foundation Trust for
our work or this report, except where terms are expressly agreed and with our prior consent in writing.
Assurance work performed
We conducted this limited assurance engagement in accordance with International Standard on
Assurance Engagements 3000 (Revised) - 'Assurance Engagements other than Audits or Reviews
of Historical Financial Information', issued by the International Auditing and Assurance Standards
Board ('ISAE 3000'). Our limited assurance procedures included:
•
evaluating the design and implementation of the key
managing and reporting the indicators;
processes and controls for
•
making enquiries of management;
•
testing key management controls;
•
reviewing analytical reports produced by the Trust;
•
limited testing, on a selective basis, of the data used to calculate the
indicator back to supporting documentation;
•
comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual
to the categories reported in the Quality Report; and
•
reading the documents
A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The
nature, timing and extent of procedures for gathering sufficient appropriate evidence are deliberately
limited relative to a reasonable assurance engagement
Non-financial performance information is subject to more inherent limitations than financial information,
given the characteristics of the subject matter and the methods used for determining such
information.
53
The absence of a significant body of established practice on which to draw allows for the
selection of different, but acceptable measurement techniques which can result in materially
different measurements and can affect comparability. The precision of different measurement
techniques may also vary. Furthermore, the nature and methods used to determine such
information, as well as the measurement criteria and the precision of these criteria, may change over
time. It is important to read the quality report in the context of the criteria set out in the NHS Foundation
Trust Annual Reporting Manual
The scope of our assurance work has not included governance over quality or non-mandated
indicators, which have been determined locally by West Midlands Ambulance Service NHS
Foundation Trust.
Conclusion
Based on the results of our procedures, nothing has come to our attention that causes us to believe
that, for the year ended 31 March 2015:
•
the Quality Report is not prepared in all material respects in line with the criteria set out in the
NHS Foundation Trust Annual Reporting Manual;
•
the Quality Report is not consistent in all material respects with the sources specified in the
Guidance; and
•
the indicators in the Quality Report subject to limited assurance have not been reasonably
stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting
Manual and the six dimensions of data quality set out in the Guidance.
KPMG LLP
Chartered Accountants
Birmingham
29 May 2015
54
ANNEX 6: GLOSSARY OF TERMS
Glossary of Terms
Abbreviation
A&E
AED
AFA
AMI
AQI
BASICs
CCGs
CFR
CPI
CPO
CPR
CQC
CQUIN
CSD
DCA
E&U
EMB
EOC
FAST
GP
HALO
HART
HCAI
HCRT
IGT
IM&T
IPC
JRCALC
KPIs
MERIT
MINAP
NED
NHSP
NICE
OOH
PALS
PDR
PRF
PTS
QIA
RIDDOR
ROSC
RRV
SI
STEMI
VAS
WMAS
YTD
Full Description
Accident and Emergency
Automated External Defibrillator
Ambulance Fleet Assistant
Acute Myocardial Infarction
Ambulance Quality Indicators
British Association of Immediate Care Doctors
Clinical Commission Groups
Community First Responder
Clinical Performance Indicator
Community Paramedic Officer
Cardio Pulmonary Resuscitation
Care Quality Commission
Commissioning for Quality and Innovation
Clinical Support Desk
Double Crewed Ambulance
Emergency & Urgent
Executive Management Board
Emergency Operations Centre
Face, Arm, Speech Test
General Practitioner
Hospital Ambulance Liaison Officer
Hazardous Area Response Team
Healthcare Acquired Infections
Healthcare Referral Team
Information Governance Toolkit
Information Management and Technology
Infection Prevention and Control
Joint Royal Colleges Ambulance Liaison Committee
Key Performance Indicators
Medical Emergency Response Incident Team
Myocardial Infarction Audit Project
Non-Executive Director
National Health Service Pathways
National Institute for Health and Clinical Excellence
Out of Hours
Patient Advice and Liaison Service
Personal Development Review
Patient Report Form
Patient Transport Service
Quality Impact Assessment
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
Return of Spontaneous Circulation
Rapid Response Vehicle
Serious Incident
ST Elevation Myocardial Infarction
Voluntary Aid Services
West Midlands Ambulance Service NHS Foundation Trust
Year to Date
55
Further Information
Further information and action plans on all projects can be obtained by contacting
the lead clinician named on the project.
Further information on performance for local areas is available as an Information
Request from our Freedom of Information Officer via the address below, email
foi@wmas.nhs.uk or telephone 01384 451662.
Progress reports will be available within the Trust Board papers every three months
with the end of year progress being given in the Quality Report to be published in
June 2015.
If you require a copy in another language, or in a format such as large print, Braille or
audio tape, please call West Midlands Ambulance Service on 01384 215 555 or write
to:
West Midlands Ambulance Service NHS Foundation Trust
Ambulance Headquarters
Millennium Point
Waterfront Business Park
Brierley Hill
West Midlands
DY5 1LX
You can also find out more information by visiting our website: www.wmas.nhs.uk
If you have any comments, feedback or complaints about the service you have
received from the Trust, please contact the Patient Advice and Liaison Service
(PALS) in the first instance; 01384 246370.
56
A
Appendix - D
Divisional Profiles
B
Birmingham
m Division
T
This overview is intended to pro
ovide relative infformation for varrious
b
bodies, in unde
erstanding the composition,
c
op
perational make
e up,
cchallenges that face the wes
st midlands am
mbulance servicce in
B
Birmingham and Solihull.
T
The Birmingham
m/Solihull popula
ation is circa 1.3
3 million residen
nts in
th
he area, and a large transient population that travels into the
e city
ccentre and returrns in evening on a daily bassis. The conurba
ation
sstretches across 445 sqKM, and
d is in the main a
an urban profile.
T
The Conurbation
n has 4 Clinical Commissioning Groups, with w
whom
th
he ambulance sservice interact on
o a frequent basis. The CCGss are
B
Birmingham Cro
oss city, Birmingham South and Central, W
West
B
Birmingham and Sandwell, Solih
hull.
T
The ambulance
e service has strategically lo
ocated its 2 m
main
a
ambulance hub
bs to facilitate both responsse times ease
e of
ssupplemental co
over, there is als
so a satellite com
mmunity Ambula
ance
sstation at Aston fire station whic
ch has a close proximity to the
e city
ccentre.
A
An ambulance hub is a centrre where staff report to centrally,
a
ambulances are
e prepared, cle
eaned and rep
paired, training and
e
education also takes place. From
F
these am
mbulance hubs, the
a
ambulances are
e deployed and strategically pllaced in line with a
d
dynamic operatio
onal plan, the plan changes ho
ourly and depictss the
cchanging activityy, this plan is based on eme
ergency activity and
h
historical data, a
and ensures thatt the ambulance
e resources are best
p
positioned to me
eet daily patient activity.
a
The
e Trust occupies a varied assortment of properties to support th
his
deployment, rangin
ng from prefabricated building to
t fixed building
gs
we also link in with
h the other eme
ergency services
s and health carre
prov
vider colleague
es in assisting
g with accommodation wherre
applicable and thatt is conducive to adherence to
o the operational
plan
n.
5
57
Performance
Overview by HUB
Birmingham has again achieved its national performance targets for
2014/15 which is a fantastic achievement and shows that patients
within Birmingham have received an excellent response to those life
threatening calls, this is down to the dedication of the staff and
management team to ensure that patients get the best possible
response.
Current Red performance (National Target=75%).
Division YTD %
Trust YTD
Red 1
83.3% YTD
77.5%
Red 2
76% YTD
74.3%
Red ‐ 19
98.5% YTD
96.8%
There is a Performance improvement plan in place across the
Division and the main Points are;







Reduce sickness to 4% to release manpower to A&E. Currently
3.97% YTD
Paramedic on every ambulance, increasing ability to treat patients in
the community.
Reduce Job cycle times on conveyance 99 min and non –
conveyance 69 min
Increase the staffing levels to ensure that the good performance
continues.
Increase staffing and resource to match the demand profile.
Report weekly to an operational board chair by the CEO.
Providing RRVs on the busiest postcodes to ensure a timely
response.
Erdington – Erdington Hub became operational in September
2013. The busiest postcode area B23 (Erdington) which is the
unfortunately not the best performing post code. Most challenged
post code B90 (Solihull area). The post activity is not a stable
measure as volume and performance changes continually by week,
Current challenges resource into the outlying areas of Birmingham
north due to the shift of resources to the city centre . 111 activities
during weekdays and at weekends is challenging in volume.
Insufficient alternative care pathways in the area resulting in more
transports to A&E and subsequent protracted delays in hospital
Performance
Hollymoor – Hollymoor Hub became operational in July 2013. The
busiest postcode area B31 (Northfield) B29 (Selly Oak) the best
performing post code.
Most challenged post code is B14
(Maypole). Other challenges increasing job cycle times across the
whole of Birmingham conurbation.
111 activities during weekdays and at weekend’s impacts on the
accident and emergency performance, current Operational
performance above national standards at 78.8%.
Aston satellite CAS Station – Aston replaced the existing site of
Henrietta Street and went live on the 21st May 2014. Aston is the
only interoperability site working closely with West Midlands Fire.
58
B
Black Counttry Division
T
This overview is intended to pro
ovide relative infformation for varrious
b
bodies, in undersstanding the com
mposition, opera
ational make up,, and
cchallenges that fface the West Midlands
M
Ambullance Service in
n the
B
Black Country.
T
The resident population of the Black Country iis approximatelyy 1.1
m
million people an
nd has seen po
opulation increasses in recent ye
ears;
th
here is also a large transient population that travels through
h the
a
area on a daily b
basis due to a bu
usy road and rail network.
T
The area stretcches across approximately 150
0 sq. miles, an
nd is
m
mainly urbanise
ed with multip
ple borough. T
The Black Cou
untry
o
operating divisio
on has 4 Clinica
al Commissioning Groups (CC
CGs),
w
with whom the ambulance serrvice works in p
partnership with
h the
S
System Resiliencce Groups (SRG
G’s) to improve the care provide
ed to
o
our citizens acro
oss all Health & Social
S
Care. The
e CCGs are Dudley,
S
Sandwell and We
est Birmingham, Walsall and W
Wolverhampton.
T
The ambulance sservice is strate
egically located in three areas w
where
th
he main ambula
ance hubs are sited. An ambula
ance hub is a un
nit or
b
building where sstaff report to centrally, ambula
ances are prepa
ared,
ccleaned and repaired, and wh
here training an
nd education takes
p
place. From tthese ambulan
nce hubs, the
e ambulances are
sstrategically placced in line with a dynamic ope
erational status p
plan,
b
based on the em
mergency activity, and ensure that the ambula
ance
re
esources are be
est positioned to meet the daily p
patient demand..
The
e Trust occupie
es a variety off locations acro
oss the area as
a
Com
mmunity Ambula
ance Stations an
nd standby sites
s. Many of thes
se
sites
s are based on
n existing estattes owned by other
o
emergenc
cy
serv
vice providers and
a
this encourages interoperrability and goo
od
working relationship
ps when attendin
ng the same incident.
Blac
ck Country is also the site of th
he Trust Headqu
uarters in Brierle
ey
Hill (Dudley area) which
w
accommodates one of the
e two Emergenc
cy
Ope
erations Centres, where emergency calls are received an
nd
triag
ged. The regions 111 service
e provision is under temporary
contract to the Trus
st and is also loc
cated in Brierley Hill.
5
59
Performance
Overview by HUB –
Post code activity is variable on daily basis, however, historical
data proves that certain areas are busier than others and the
status plan is adapted to meet the demand based on this data.
The following is a snapshot of current performance data:
Red 1
Red 2
Red ‐ 19
Division YTD %
82.9
75.7
98.9
Trust YTD
77.5%
74.3%
96.8%
Dudley - DY1 (Dudley) is the busiest in volume and best
performing area with over 88.4% of calls attended within targets,
DY5 (Brierley Hill) is the next busiest and performance is
consistently strong in this area. DY8 (Stourbridge) is the next
busiest postcode, which is historically challenged.
Current performance is challenged achieving year to date at
74.2%
Sandwell – DY4 (Tipton) lies between Sandwell Borough and is
the sixth busiest area in Black Country, performance is this area is
currently good. B70 and B71 (West Bromwich) are the next
busiest, followed by B66 (Smethwick). Performance is historically
strong in all areas, Sandwell covers the border between Black
Country and Birmingham.
Current performance achieving year to date at 76.8%.
Willenhall – WV10 (Bushbury), WS2 (Walsall) and WS3
(Bloxwich) are historically the 3 busiest areas of the Black Country
and performance has been challenging. The North area has 5 of
the 6 busiest post codes in the Black Country.
Current performance achieving year to date at 75.6% Walsall and
75.7% Wolverhampton.
There is a Performance Improvement Plan in place across the
Division and the main points are:





Reduce sickness to 4% to release manpower to A&E.
Paramedic on every ambulance, increasing ability to treat patients in
the community with plans to achieve 70% paramedic skill mix by
2017
Increase staffing and resource to match the demand profile
Report weekly to an operational board chair by the CEO
In addition to the above the Division is encouraged to use
appropriate alternative care pathways through a ‘clinical hub’ in the
111 call centre, allowing clinician to clinician referral and improving
Hospital avoidance for those patients that can be better cared for
elsewhere.
60
S
Staffordshire
e Division
T
This overview is intended to pro
ovide relative infformation for varrious
b
bodies, in unde
erstanding the composition,
c
op
perational make
e up,
cchallenges that face the wes
st midlands am
mbulance servicce in
S
Staffordshire.
T
The Staffordshirre population is 1.1 million ressident in the cou
unty,
a
and a large transsient population that travels thro
ough the county on a
d
daily basis. The county stretche
es across 1,050 sq miles, and h
has a
m
mixture of rural a
and Urban Comm
munities.
T
The County has six Clinical Com
mmissioning Gro
oups, with whom
m the
a
ambulance servvice interact on a frequent bassis. The CCGss are
hire, Stoke on
N
North Staffordsh
n Trent, Stafford and Surrou
unds,
C
Cannock Chase, East Staffords
shire, South East Staffordshire and
S
Seisdon Pennissula.
This is
s further group
ped into 2 Sysstem
R
Resilience Group
ps (SRG’S), North Staffordshire
e and Stafford b
being
o
one and South East and East Staffordshire being the other. The
fo
ormation of th
he University Hospital of No
orth Midlands (the
a
amalgamation o
of Royal Stoke and County) is part of the current
re
econfiguration of services ta
aking place in the county w
which
ccontinues to offe
er challenges to WMAS.
W
T
The ambulance sservice is strate
egically located in three areas w
where
th
he main ambula
ance hubs are sited. An ambula
ance hub is a ce
entre
w
where staff repo
ort to centrally, ambulances are
e prepared, clea
aned
a
and repaired, and where training
g and education takes place.
F
From the ambulance hubs, the ambulance
es are strategiically
d
deployed in line with a dynamic operational plan
n that changes e
each
h
hour, this plan iss based on emerrgency activity, a
and ensures tha
at the
a
ambulance resou
urces are best positioned to meet the daily pa
atient
a
activity.
The
e Trust occupy a varied assortm
ment of propertie
es to support th
his
deployment ranging
g from prefabric
cated buildings to fixed building
gs
and do link in with
h our sister em
mergency servic
ces colleagues in
assisting with acco
ommodation whe
ere applicable to the operational
plan
n. Staffordshire is also the site
e of one of the
e two Emergenc
cy
Ope
erations Centres, where emergency calls are received an
nd
triag
ged.
6
61
Performance
Overview by HUB –
Post code activity is a variable each week and is dependent on the
activity in that post code area. A snapshot is provided in this briefing
which indicates that instability.
Red 1
Red 2
Red ‐ 19
Division YTD %
72.4
71.9
95.2
Trust YTD
77.5%
74.3%
96.8%
Tollgate (Stafford) – busiest postcode area WS11 (Cannock)
which is the best performing post code also. Most challenged post
code ST15 (Stone north) and WS15 (Rugeley). The post code
activity is not a stable measure as volume and performance change
continually by week, Current challenges include the overnight
closure of Stafford hospital, this creates some deficit in
performance, 111 activity at weekends challenging in volume, and
reconfiguration of Services at the County Hospital. The
reconfiguration work consists of the movement of key specialities to
either the University of Royal Stoke, or Royal Wolverhampton which
as an effect on ambulance movements in the prehospital arena.
There is insufficient alternative care pathways in the area resulting
in more transports to A&E
Current Red 2 performance YTD figure is 70.35% which is below
the national Target of 75%.
Stoke - busiest postcode area ST5 (Newcastle), ST6
(Tunstall/Burslem) the best performing post code also. Most
challenged post code ST7 (Kidsgrove/Audley). Current challenges
in this area are the EMS operating level at Royal Stoke University
Hospital remains high which creates issues with handovers, support
to the Health Economy as a whole to assist with performance in
moving patients to alternative pathways, increased 111 activity at
weekends impacts on the accident and emergency. Future
developments- alternative sites have been sort to relocate the main
Stoke hub.
Current Red 2 performance YTD figure is 74.7% which is below the
national Target of 75%.
Lichfield - busiest postcode area B77 (Tamworth), DE14 (Burton)
the best performing post code also. Most challenged post code
DE13 (Tutbury). Other challenges the sesidon peninsula is covered
by Black County Ambulance crews rather than Staffordshire so
different dynamics. Majority of the hospitals positioned outside of
the Staffordshire Boundary; Reconfiguration of the Stroke pathway
in East Staffordshire will see a proportion of patients being taken to
Derby if not all Stroke patients from this catchment area being taken
to Derby.
Current Red 2 performance YTD figure is 68.7% which is below the
national Target of 75%.
A Performance improvement plan is in place across the
Division - Summary of main points





Reduce sickness to 4% to release manpower to A&E
Paramedic on every ambulance, increasing ability to treat patients in
the community
Reduce Job cycle times from current levels of 97 minutes to 80
minutes
Increase resources into South Staffordshire by demonstrating activity
increase
Review the daily resourcing plan, and relocate response posts where
applicable
62
W
West Mercia D
Division
Th
his overview is intended to prrovide relative information for various
bo
odies, in understanding the composition, o
operational ma
ake up,
challenges that face the Trust in the
t West Mercia
a Division. Westt Mercia
Divvision covers the
e counties of:



Herefordshire
hire
Worcestersh
Shropshire (Telford & Wrekin and Shropshire C
County)
Th
he population off West Mercia is
s in excess of 1.1 million and stretches
accross 2,868 square miles with a combination o
of both rural and urban
co
ommunities. Thiss area accounts for more than 5
50% of the geographical
sizze of the Trust.
We
est Mercia hass six Clinical Commissioning
C
Groups (CCG’s), with
wh
hom the Ambulance Service in
nteract with on a frequent bassis. The
CC
CGs are Shropshire, Telford and Wrekin, Herefordshire,, South
Wo
orcestershire, R
Redditch and Bro
omsgrove and th
he Wyre Forest.
Th
here are 5 ambulance hubs wh
hich are supple
emented by Com
mmunity
Po
osts. An ambula
ance hub is a lo
ocation where sstaff report to ccentrally,
am
mbulances are p
prepared, cleane
ed and repaired, and where train
ning and
ed
ducation takes pllace.
Fro
om these ambulance hubs, the ambulances are
e strategically p
placed in
line with a dynamic operational pla
an that changess each hour. Thiss plan is
ba
ased on emergen
ncy activity and ensures that the ambulance re
esources
are
e best positioned to meet the da
aily patient activvity. The Trust o
occupy a
varied assortmentt of properties to
o support this de
eployment rangiing from
pre
efabricated build
ding to fixed buildings, and we d
do link in with our sister
em
mergency services colleagues in
n assisting with accommodation
n where
ap
pplicable to the o
operational plan.. Many of these
e premises are o
occupied
byy Community Paramedics in Rap
pid Response Ve
ehicles.
erformance
Pe
Po
ost code activity
y is variable eac
ch week and is dependent
d
on th
he
ac
ctivity in that po
ost code area. A snapshot is provided in th
his
briiefing which rela
ates to the perfformance of eac
ch County for th
he
20
014-15 financial year-to-date. Many areas of West Merc
cia
pre
esent challenges due to the geo
ographical sprea
ad of communitie
es
an
nd maximising alternative community strate
egies to provid
de
pro
ompt response to
t patients are utilised.
u
Red
R 1
Red
R 2
Red
R ‐ 19
H YTD %
Hub
70.6
73.0
93.5
Trrust YTD
77.5%
74.3%
96.8%
9
6
63
Worcestershire
There has been a 13% increase in activity in Worcestershire this
financial year compared to last year.
The top three busiest postcode areas within Worcestershire are B98
(Redditch), WR11 (Evesham) and WR14 (Malvern).
The best performing postcode area within Worcestershire is WR1
(Worcester).
The most challenged postcode areas within Worcestershire are DY10
(Wyre Forest), WR9 (Droitwich) and WR10 (Pershore).
Performance in Worcestershire for the financial year-to-date is:
Red1 - 75%, Red2 - 75.5%, Red19 - 96.6%.
Herefordshire
There has been no change in the level of activity in Herefordshire this
financial year compared to last year.
The top three busiest postcode areas within Herefordshire are HR1
(central Hereford), HR2 (south west of Hereford city centre) and HR4
(north west of Hereford city centre).
The best performing postcode area within Herefordshire is HR1
(central Hereford).
The most challenged postcode areas within Herefordshire are HR9
(Ross) and HR6 (Leominster).
Performance for Herefordshire for the financial year-to-date is:
Red1 - 69.9%, Red2 - 73.6%, Red19 - 92%.
Shropshire
There has been a 1.5% increase in the level of activity in Shropshire
County and a 1.2% increase in Telford & Wrekin this financial year
compared to last year.
The top three busiest postcode areas within the county as a whole
are TF1 (North West of Telford town centre), TF2 (North East of
Telford town centre), SY3 (North West Shrewsbury).
The best performing postcode area within Telford & Wrekin in TF1
(North West of Telford town centre), in Shropshire County it is SY3
(North West Shrewsbury).
The most challenged postcode areas within the county as a whole
are SY11 (Oswestry), SY4 (North of Shrewsbury) and TF7 (South
of Telford town centre).
Performance for Telford & Wrekin for the financial year-to-date is:
Red1 - 75.1%, Red2 - 77.9%, Red19 -98%.
Performance for Shropshire County for the financial year-to-date is:
Red1 - 61.3%, Red2 - 64.4, Red19 - 87.8%.
A Performance improvement plan is in place across the
Division – Summary of main points
Every effort is made by local operational management teams to
constantly improve performance in order for patients to receive the
most timely response and clinical care. This includes aiming to
achieve:

A reduction in sickness to 4% to maximise available resources
64






Providing a Paramedic on every ambulance, increasing ability to
treat patients in the community – Current rosters are designed to
have a Paramedic on every vehicle. This will also reduce the
number of resources being sent to incidents, keeping them
available for other calls
Reducing Job cycle times
Recruit to achieve the budgetary establishment of requirement
staff for the area of 563 whole time equivalent Operational staff
(Paramedics and Technicians)
Recruiting Community Responders to challenged areas
Encouraging Defibrillation sites both within the Community and at
sites of high population and public concentration
Report weekly to an operational board chair by the Chief
Executive
Officer
Recruitment:
Since April 2014, the Trust has recruited an additional 22 frontline
staff in Shropshire, 30 in Worcestershire and 8 in Herefordshire.
65
A
Arden Divisiion
In
ntroduction
T
This overview iss intended to provide
p
informa
ation to supportt the
u
understanding o
of the compositio
on and operatio
onal challenges that
fa
ace the West Midlands Ambulan
nce Service in A
Arden.
A
Arden consists o
of a population of 845,000 residents in the co
ounty
w
with a large transsient population that travels thro
ough the county on a
d
daily basis. The
e county has a mixture of bo
oth rural and u
urban
ccommunities. Th
he population is
s continuing to
o expand in Ru
ugby,
N
Nuneaton and W
Warwick as ex
xamples with ne
ew housing esttates
b
being built.
T
The County has three Clinical Commissioning
C
G
Groups (CCGs), with
w
whom the ambu
ulance service in
nteract on a fre
equent basis. Th
hese
a
are:
1
1. Coventry & R
Rugby CCG
2
2. South Warwickshire CCG
3
3. Warwickshire
e North CCG
T
The Arden Divission Emergency
y & Urgent amb
bulance provisio
on is
lo
ocated at two h
hubs/buildings, one
o
in Coventryy and the secon
nd in
W
Warwick. An ambulance hub is a centre where staff report to a
at the
sstart of their shiift, where ambu
ulances are pre
epared, cleaned and
re
epaired (fleet on
n site) by the make
m
ready team
m and where training
a
and education ta
akes place. Am
mbulances are m
mobilised from th
hese
h
hubs to responsse posts situated
d at strategic po
oints throughout the
A
Arden County. T
The ‘Make Read
dy’ team ensure
e that all operational
vvehicles are fullyy equipped and cleaned, ready for the start of e
each
sshift to provide th
he correct enviro
onment for patie
ent care.
Amb
bulances are moved
m
on a dyn
namic basis and
d in line with ou
ur
System Status Ma
anagement operrational plan tha
at changes eac
ch
hour. This plan is based on emerrgency activity, and ensures that
the ambulance res
sources are best positioned to
o meet the daiily
patient activity.
6
66
The Trust occupies a varied assortment of properties to support this
deployment ranging from prefabricated to fixed buildings. We also
link in with our partner emergency services colleagues in assisting
with accommodation where applicable to the operational plan e.g.
Fire Service. All ambulances calls in Arden are received and
processed by our Emergency Operations Centre based at Stafford,
then assigned to the nearest ambulance to the incident.
Performance
Post code activity is variable each week and is dependent on the
activity that presents in that post code area each hour of the day.
This activity dictates the level of resources required. As stated
above, the increase in housing projects in Arden is likely to impact
on demand levels as people move into the area.
Red 1
Red 2
Red ‐ 19
Division YTD %
74.8
73.2
96.1
Trust YTD
77.5%
74.3%
96.8%
Coventry Hub Area
This includes Coventry City and Rugby and falls into the Coventry
and Rugby CCG service area. These are the busiest areas in terms
of activity and require greater resources than other areas. Activity is
challenged during weekends as 111 calls are assigned to 999
ambulances due to insufficient alternative pathways at weekends.
Post code activity is variable within these areas and resourcing is
achieved by identifying the busiest post codes to ensure calls are
serviced appropriately to maintain patient safety.
The main hospital for ambulance transports is University Hospital of
Coventry & Warwickshire, which is also the nominated Major
Trauma, Percutaneous Coronary Intervention (PCI) and Stroke Unit
for the whole of Arden and surrounding areas.
North Warwickshire sits in the North Warwickshire CCG area and
presents a problem in its geography as well as insufficient
alternative care pathways in the area, resulting in more transports
to hospital. This is further impacted by the restrictions in the type of
patient/conditions/injury that are accepted by George Eliot hospital
based at Nuneaton, therefore this group of patients are required to
be transported to University Hospital of Coventry & Warwickshire.
This has the effect of depleting resources available in the area.
Rapid responses cars are strategically based within the area 24
hours, seven days a week, to ensure cover is maintained at all
times.
For 2014-15 Red 2 performance was 76.4% (National Target=75%)
for Coventry & Rugby CCG area and 67.9% for Warwickshire North
CCG area. This was due to experiencing over contract activity as
the CCGs commissioned at o% growth, impacting on resource
availability to meet demand.
67
Warwick Hub Area
This hub sits in the South Warwickshire CCG service area and
services our largest rural area in Arden. Performance is challenged
due to travel distances and lower numbers of ambulances as the
activity is lower than that in the Coventry area. Post code activity is
again variable within these areas and resourcing is achieved by
identifying the busiest post codes for each day to ensure calls are
serviced appropriately to ensure patient safety. However, popular
towns for tourism, such as Stratford upon Avon has a transient
annual population, which places pressure on resources as activity
increases, especially in the summer months. Rapid responses cars
are strategically based within the area 24 hours, seven days a
week, to ensure cover is maintained at all times.
d) Increase/realign resources to match increase in predicted activity
levels to ensure the delivery of a safe service
e) Report to the Operational Management Board chaired by the Chief
Executive Officer.
We are continually working with health partners and the Health &
Overview Scrutiny Committees to further improve services together
for the benefit of our population.
Current year to date Red 2 performance is 70.9% (National
Target=75%). Again, the lack of appropriate commissioning
impacted on our ability to meet the high demand.
Performance Improvement Plan
This is in place to cover each hub area and include the following
points to introduce stability and the delivery of performance by
month and quarter.
a) Maintain sickness absence to below 5% to release manpower to
operations
b) Achieve a Paramedic on every ambulance, thus increasing the ability
to treat patients in the community more effectively through alternate
pathways to ensure the patient is treated at the right place for their
condition.
c) Reduction of job cycle times from current levels of 87 minutes to 80
minutes
68