Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Welsh Ambulance Services NHS Trust
Strategic Winter Framework & Detailed
Winter Delivery Plans 2014/15
Owner:
Approved:
Date:
Version:
Director of Service Delivery
Approved By Executive Management Team (1st October 2014)
1st October 2014
1.6
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Introduction
The historical demands brought about during the winter period are well known
and require health and social care providers to put into place joined up
arrangements to maintain effective health care provision across Wales.
The Welsh Ambulance Service NHS Trust (WAST) is a key partner in this,
requiring plans that underpin the provision of Emergency Medical Services,
Planned Patient Care Services and NHS-Direct Wales.
To ensure that robust and dynamic action plans are put into place, the Trust
has adopted a dual approach to winter planning and preparedness.
This document (the Strategic Winter Framework) sets out the key national
principles for the Trust to adhere to during the winter period. Underpinning the
‘Strategic Framework’ each Health Board Head of Service (HofS) has
developed jointly with Social Services and Health Boards detailed ‘local’
action plans.
Aim
The aim of the Strategic Framework is therefore:
“To ensure that the WAST is well placed to maintain safe and robust
patient services throughout the 2014/15 winter period.”
Objectives
In order to achieve the aim the Trust has identified the following key
objectives:
1. To provide a clinically safe and effective service that meets the clinical
need of the patient;
2. To work with health and social care partners in the development and
execution of our plans;
3. To ensure that our plans are well communicated throughout the
organisation, responsive in their delivery and based on sound
principles that have been tested against the core beliefs of the Trust;
4. That our plans are proportionate in their expectations and maximise on
both the financial and physical resources available to the Trust;
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Accountability and Governance
The owner of this ‘strategic framework’ is the Director of Service Delivery who
has discharged operational delivery to the respective health board area
Head’s of Service and functional Heads of Service.
Furthermore, the Director of Service Delivery is charged with ensuring that the
detailed delivery plans which underpin this framework are suitably supported
by our partners across the Health and Social Care sector.
Scope
This “Strategic Framework” has been developed with the sole intention of
demonstrating the actions the Trust will implement in order to provide robust
winter resilience. Therefore, it assumes that arrangements relating to major
incidents, detailed escalation plans and business continuity arrangements are
in place.
Therefore, this framework should be read in conjunction with the following:



WAST Major Incident Plan vrs0.5 (July 2014);
WAST Business Continuity Policy and Supporting Arrangements;
National Emergency Pressures Escalation and De-escalation Plan
(October, 2013) Version 1.2.
The ‘Strategic Framework’ is underpinned and supported by seven ‘Health
Board’ level Winter Plans. These plans have been developed in collaboration
between WAST, Social Services and the respective Health Board. The plans
are predicated upon outlining a robust multi-agency approach to ensure
health services are delivered safely and effectively during the winter period. A
copy of each plan is included in the appendix for information.
Planning Assumptions
This framework and underpinning plans have been developed based on the
following planning assumptions:
 That escalation into the winter period will commence on or around the
1st October 2014 and that it is anticipated de-escalation will occur
around the 31st March 2015, though it is recognised that early adoption
or extension beyond this date could occur.
 That the delivery of the strategic framework and underpinning plans will
occur within existing financial and physical resources.
 That each health and social care partner will work with the Trust in
achieving our stated aim by providing equally sound planning, strategic
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
leadership and arrangements which take account of the impacts their
actions may have on the pressures experienced by WAST.
 That the influence of an Influenza Pandemic or other similar disease
pathogens is not realised, though the Trust will continue to develop
arrangements to meet such a challenge using existing planning
arrangements.
 The Trust will adhere to the national plans / guidance regarding Viral
Haemorrhagic Fever (Ebola).
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Strategic Framework
Principle 1.
Objective:
To manage resource pressures through effective
application of the National Emergency Pressures Escalation
and De-escalation Plan
Description: WAST along with health board partners operate a shared
National Emergency Pressures Escalation and De-escalation
plan (October 2013 V1.2) which sets out the respective actions
incumbent on the organisation dependent upon the demands
being experienced across the health economy. Reaction to
escalation triggers brings about shared actions between WAST
and the health board which aim to prevent further escalation and
mitigate the effects of the demand being experienced at that
given time.
Benefit:
A reactive response to escalation levels ensure that appropriate
measures are taken to reduce the demands on the organisation
thus ensuring a safer clinical environment, improved patient
experience and reduced staff fatigue.
We will achieve this by:

The Trust will adhere to the National Emergency Pressures Deescalation action plan Oct 2013 (V1.2).

The operational manager for each health board area will use
WAST resource, demand and external influences along with
hospital situation reports to inform the decision making process
and escalate the need to move between levels, upwardly
reporting to the Head of Service (in hours) or on-call Gold (out of
hours).

The Trust will continue ensure appropriate representation on
daily (Bronze, Silver & Gold) conference calls. Ensuring that
issues are escalated appropriately to the right level to ensure a
pro-active timely response. Ad hoc teleconferences / meetings
may be arranged at short notice to address any immediate
concerns or issues for the Trust / wider health system.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure to apply the National
Emergency Pressures Escalation
and De-escalation plan
2
4
8
5
Residual
risk
score if objective
is achieved
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Principle 2.
To utilise and review the application of the ‘Clinical
Response Model’.
Objective:
Description: WAST operates within a clinical response model that is founded
on safe clinical practice and evidence based outcomes. Effective
application of this model ensures that the most appropriate
clinical response is provided to each presenting patient thus
ensuring maximum utilisation of resources and adherence to
performance standards.
Benefit:
A proportionate response model ensures that each presenting
patient receives the most appropriate intervention for their
respective condition in an appropriate timeframe thus allowing
WAST to direct its frontline resources to those patients with the
highest clinical need whilst maintaining a safe service to those
with a lower clinical acuity.
We will achieve this by:

Ensuring allocation decision making is consistent with the
Clinical Response Model thus exploit appropriate and safe
deployment of single responders, co-responders, Unscheduled
Care resources or call divert to NHS-Direct Wales.

Maximise patient referrals to NHS-Direct Wales for Nurse Staff
to triage and manage appropriate Red (2) and Green (1&3)
calls.

Ensuring Green 3 calls not passed to NHS-Direct Wales are
responded to using Urgent Care Services / St John to increase
capacity for Emergency Ambulances to respond to immediately
life threatening Red 1 & Red 2 calls and higher acuity green
calls.

Paramedic Pathfinder is a structured decision making tool to
support conveyance decisions and utilisation of alternative
pathways of care for field paramedics through a standardised
triage system. The Trust will continue to implement Paramedic
Pathfinder across all Health Board Areas. It is expected to be
fully embedded by December 2014.

Introduce a clinical desk that will provide robust, secondary
triage of higher acuity 999 patients so that a timely and
appropriate response can be given for a face to face
assessment. The clinical desk will also review all calls that arise
from a Health care professional so that the right care and
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
transport is provided. It is important that clinicians within the
CCC facilitate the opportunity to offer clinical support to
colleagues from within the operational environment. The clinical
desk will commence in operation in Vantage Point House (VPH)
in December 2014.

Continue to promote the use of ‘Taxis’ to convey clinically
appropriate low acuity patients to hospital following a clinical
assessment from a Paramedic / Advanced
Paramedic
Practitioner

Ensuring that at times of 999 calls holding, that all call handling
staff are utilising “Urgent Disconnect” in order to maximise call
handling capacity.

Clinical Contact Centre clinicians will actively screen Health
Professional and other low acuity calls and identify those
appropriate of Patient Care Transport
Risk Assessment:
Hazard
Failure to apply
Response Model
the
Clinical
Likelihood
Impact
Total Score
2
4
10
Residual
risk
score if objective
is achieved
4
Principle 3.
To maximize the utilisation of available ‘Alternative Care
Pathways’, reducing ‘unnecessary’ patient conveyance to
hospital to provide Right Service in the Right Place at the
Right Time.
Objective:
Description: WAST in collaboration with Health Board partners and key
stakeholders continues to develop a range of alternative patient
pathways which offer alternative dispositions other than
conveyance to hospital (Emergency Department).
Benefit:
Initiatives relating to providing alternative pathways will reduce
the number of ‘inappropriate’ patient conveyances to hospital
(Emergency Departments)
We will achieve this by:

Continue to implement the Alternative Care Pathway model for
non-injury falls / resolved hypoglycaemia / resolved epilepsy in
Betsi Cadwaladr and Cardiff & Vale Health Boards respectively.
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru

Ensuring operational crews fully utilise available Alternative
Care Pathways across all Health Board areas.

Standard Operating Procedures supporting access to Minor
Injuries Units are fully utilised

Ensuring that existing multi agency partnerships such as the
“Alcohol Treatment Centre’ in Cardiff” and “Help Point Plus”
scheme in Swansea and other schemes across all Health Board
areas are fully utilised.

Advanced Paramedic Practitioners will be used to provide
alternative clinical dispositions to those patients who fit within
their scope of practice.

Advanced Paramedic Practitioners will provide clinical
leadership, mentorship and guidance to the core paramedic
workforce to improve clinical decision making and confidence to
utilise alternative care pathways / safely resolve more patients’
on-scene.
Risk Assessment:
Hazard
Failure to
pathways
provide
alternative
Likelihood
Impact
Total Score
4
4
16
Residual
risk
score if objective
is achieved
12
Principle 4.
Objective:
To provide resource outputs that reflects anticipated
demand
Description: Utilisation of operational assets should be achieved on a
planned and proportionate basis, where shift patterns are
matched against peaks and troughs in demand. Therefore, a
smart risk assessed approach to determining which roster
vacancies would be filled or not provides a systematic approach
to ensuring staff resources matches anticipated demand.
Benefit:
Smart rostering allows staff resources to be targeted towards
known periods of high activity with the resultant benefit being
greater ability to react to call volume, reduced staff fatigue and
better utilisation of financial resources.
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
We will achieve this by:

Ensuring the Head of Resource, resource centre managers and
operational Heads of Service have daily access to anticipated
demand data to support the intelligent synchronisation of core
rosters to meet predicted demand.

Continue to review current rosters and implement demand led
frontline rosters Pan Wales for our Emergency Medical Service
(EMS) & Patient Care Services (PCS) workforce. The ‘first’
round of the roster review ‘Quick Wins’ is expected to be
implemented in November 2014.

Regular engagement between the Resource Centre staff and
operational managers to dynamically manage operational
resource levels to maintain optimum UHP levels.

Regularly assess predicted demand and where operational
capacity is below optimum levels, St Johns Ambulance and
other providers should be sought to provide resilience and
bolster resource levels.

In periods of operational pressure / escalation (where planned
resources falls below optimum staffing levels). Response
Capable Managers (staff that are clinically trained and
competent to respond to 999 calls) will be required to provide
frontline operational support.

Suitable managers will also be expected to support operational
delivery through undertaking roles such as HALO’s (Hospital
Ambulance Liaison Officers) to work with hospital colleagues to
manage patient flow. Where feasible non-clinical managers
should be utilised to undertake this role in the first instance to
ensure clinical response capable managers are available to
respond to incoming 999 calls.

Other tactics will be used dynamically to increase resourcing
levels, which includes the temporary ‘postponement’ of training
and Continual Professional Development (CPD) and the
cancelation / restriction of staff / trade union abstractions.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
To provide insufficient resource
output to met anticipated demand
4
4
16
9
Residual
risk
score if objective
is achieved
8
Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Principle 5.
Objective:
Seek to achieve or exceed compliance with Status Plan
Management and Status Deployment Planning
Description: Deployment of operational assets to known areas of high
demand at peak periods provides a more dynamic and flexible
resource profile. The Trust utilises Status Plan Management
(SPM) and Status Deployment Planning (SDP) to predict, preidentify, locate and performance manage its resources in this
way, adherence to these principles bring about better utilisation
of response assets.
Benefit:
SPM and SDP provides for the most efficient methodology in
utilisation of deployable assets and provides a consistent
planned approach that removes individual preconception
towards the volume of demand and most productive location to
achieve the best efficient timely response resulting in better
patient experience and enhanced performance.
We have achieved this by:

Ensuring Duty Shift Managers review missed Cat “A” activity,
dynamically challenging allocation or deployment and where
necessary escalating and managing poor performance.

Reviewing social deployment locations in order to ensure their
location matches the latest demand analysis and provides a
suitable deployment location to achieve the greatest
performance.

Ensuring coverage at Priority 1 postings moving resources
between plans.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure to apply Status Plan
Management and Deployment
2
3
6
Residual
risk
score if objective
is achieved
4
Principle 6.
Objective:
To provide intelligence led patient focused responses
Description: Critical to providing an effective patient focused response is
dependent on the whole of the health economy working in a coordinated and collaborative way. The Trust should utilise its first
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
line management assets to support a physical or virtual
presence at any planned or dynamic coordination arrangements
established by acute hospital sites thus ensuring a shared
situational awareness and ownership of systemic pressures.
Benefit:
The ability of the Trust to dynamically react to escalating
pressures with early deployment of management assets in
expediting demand lead pressures, allows the Trust to be more
dynamic in its load sharing, influential in expediting vehicle
delays and facilitating discharges thus leading to a better patient
experience, a more expedient capability to react to the next call
and reducing fatigue within the workforce.
We will achieve this by:

Ensuring that our Locality Managers are linked to the hospital
bed management teams in order to gain an appreciation of
pressures within the DGH and awareness of plans being
developed.

Ensuring operational management support is available locally to
attend in person or virtually, hospital bed management meetings
and when necessary support ambulance turnaround.

When demand or other influences indicate measures to
supplement on-call operational management will be activated
which could see these managers working out of hours or
doubling up availability.

Utilise Hospital Ambulance Liaison Officers (HALO’s) to work
with hospital staff to manage patient / ambulance flow.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure of the health economy to
work together in a collaborative
way
3
5
15
Residual
risk
score if objective
is achieved
8
Principle 7.
Objective:
To provide an effective co-ordinated resource utilisation
plan on a daily basis.
Description: Internal local control of resources provides a focus for the
establishment of a clear and communicated action plans for the
forthcoming 24 hours. The Trust will use these well versed
arrangements for utilising conference calls to communicate
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
across the health board area in terms of determining any
resource pressures, review performance standards along with
identifying internal and external operational influences which
facilitates setting out a micro daily operations plan. Furthermore,
the principles of local control will be used dynamically in order to
react to increasing pressures thus ensuring plans are reviewed
in line with new challenges or planning assumptions and
escalated through the organisation.
Benefit:
Clear well communicated plans lead to a better whole system
ability to meet the challenges of a highly fluid operational
environment which brings about clarity in terms of expectations
on staff and managers thus leading to a safer organisational
capability to react.
We will achieve this by:

Ensuring that daily (7 days per week) Bronze conference calls
are held which review the available resources, implement
measures necessary to mitigate shortfalls in performance,
review and action operational issues relating to fleet or estate
failures and assess live situational awareness relating to
hospital demands ensuring a well communicated plan is shared
between the Clinical Contact Centre, Operational Resources
and other key stake holders including the health boards.

Identify and implementing measures to limit lost hours i.e
through handover to clear.

Mobilise Clinical Team Leaders whenever possible to assess
face to face patient transfer requests for Paramedic crews
ensuring maximum suitability of WAST resource type.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure in providing a co-ordinated
resource utilisation plan
2
4
8
Residual
risk
score if objective
is achieved
6
Principle 8.
Objective:
To be proactive in sickness absence and workforce
abstractions management
Description: Robust management of short-term sickness improves the ability
of the Trust to utilise its work force in the most effective way,
which leads to reduced staff fatigue, a healthier work force and
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
improved financial control. It will be imperative that the Trust is
proactive and expedient in the management of short term
sickness with effective liaison between staff, their
representatives and Trust management.
The Trust will be alert to emerging infectious disease pathogens,
ensuring that opportunities to promote and take-up vaccination
programmes are provided to the workforce.
Furthermore, abstractions from frontline operations to other
duties will be managed in line with the Resource Escalation
Action Plan, though also reviewed in terms of the benefits such
abstractions provide over the challenges which they create,
where staff abstractions bring about a greater advantage to
achieving the aim of this framework then consideration should
be given to how best to maintain said benefits.
Benefit:
Robust staff sickness management and control of abstractions
allows the Trust to utilise its work force in the most productive
and effective way thus reducing the spiral effect of work force
fatigue and brining about better financial control.
We will achieve this by:

Ensuring all short term staff sickness receive contact from their
line manager on the first day of sickness with follow up contacts
in line with Trust Policy.

Ensuring all short term staff sickness is referred to the
Occupational Health & Wellbeing Team.

Ensuring that Health Board area Management Teams review on
a weekly basis the levels of sickness within each Locality.

Working with Public Health Wales in order to identify trends in
infectious diseases and take steps to implement measures to
protect our workforce by promoting access to vaccination clinics
or other similar strategies.

Ensuring abstractions from core operations are reviewed by the
Health Board area Management Teams and actions taken in line
with the respective escalation level or shortfalls.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure to provide robust sickness
management
1
4
4
13
Residual
risk
score if objective
is achieved
2
Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Principle 9.
Objective:
To provide robust strategic, tactical and operational
leadership
Description: It is critical that operational and tactical planning and response is
based on sound strategic direction. The Trust therefore provides
24/7 strategic leadership which is accessible within the
organisation and to our external partners thus allowing an ability
to escalate concerns / pressures or bring about a co-ordinated
top-down approach to emerging challenges.
Furthermore, the Trust will provide robust 24/7 Tactical and
Operational leadership with appropriate managers trained to
fulfil these roles, who are known and have developed local
relationships with their respective health board colleagues and
thus able to work collaboratively in resolution of escalating
demands.
Benefit:
Clear communicated strategic direction provides un-ambiguous
tactical parameters within which the Trust can operate, as well
as providing our health and social care partners clear direction
in terms of what support can be provided or would be required
by the Trust in meeting the presenting demands, which leads to
providing more effective services across the whole of the health
economy.
We will achieve this by:

Ensuring 24/7 continuity in on call management at Gold, Silver
and Bronze levels with relevant communications pathways
shared with key partners including health boards.

Anticipating the impact of external events such as severe
weather and taking action to enhance our on-call arrangements
through activating Gold, Silver, Business Continuity, Logistics or
Communications Cells.

Continuing to access or deliver Gold, Silver and Bronze
commander training.

If the Trust enters escalation Level 4 or Level 5 (Business
Continuity), the Trust will consider initiating the Regional
Performance Co-ordination Cell (RPCC). The function of the
RPCC is to deliver robust performance management to ensure
the effective and efficient delivery of frontline services. In
collaboration with operational managers, CCC and frontline staff
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
to deliver improved job cycle efficiencies, effective resourcing
and improved ‘real time’ communication.
Risk Assessment:
Hazard
Failure
to
leadership
provide
robust
Likelihood
Impact
Total Score
2
4
8
Residual
risk
score if objective
is achieved
3
Principle 10.
Objective:
To anticipate and react to external influences or events
which may have an impact on organisational service
delivery
Description: Anticipating where external influences may bring about service
delivery pressure allows for proactive and pre-emptive
preparation. The Trust will therefore use open and closed
sources of information to “horizon scan” and inform our resource
plans and Status Deployment Plans, which we will share with
our partners in order that our plans are developed in a coordinated and mutually supportive way.
Benefit:
Pre-emptive preparation allows the Trust to anticipate
challenges which may affect the normal service delivery model
and therefore create specific arrangements which maintain
patient safety and effectiveness of our response ensure our staff
safety and utilisation of specialist deployable assets.
We will achieve this by:

Working with partner agencies to identify or source information
which could cause undue pressure on WAST resources or
require a response greater than that available through normal
core rostering.

Developing specific operational or tactical plans to communicate
our intentions and provide a basis on which to manage the
response, which in themselves will be developed in partnership
with other responders such as the police, fire service, health
boards, local authorities or voluntary agencies.

Ensure that core staffing is increased to attempt to match
anticipated demand.
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure to anticipate external
events which may have an impact
on service delivery
3
4
12
Residual
risk
score if objective
is achieved
6
Principle 11.
Objective:
To maximise the utilisation of Community First Responders
(CFRs).
Description: Community First Responders provide a valued and important
role supporting frontline services to respond to incoming 999
calls in the community. The utilisation of CFRs provides the
most expedient and appropriate response to patients in distress
within the framework of our clinical response model allowing a
targeted deployment of Emergency Medical Services resources.
During anticipated or actual periods of high demand the Trust
will also seek to utilise the support of its valued partnerships with
co-responders.
Benefit:
Early intervention from trained and equipped responders brings
a much enhanced patient outcome with reduced morbidity and
mortality, better long term prognosis and ultimately reduced
burden on the financial resources of the wider NHS.
We will achieve this by:




Actively contacting first responder teams on a daily basis in
order to achieve greatest availability.
Continue to recruit and establish additional CFR schemes.
Ensuring where possible the Clinical Contact Centres staff a
dedicated CFR desk to manage and co-ordinate CFR activity.
Continue to roll out and utilise Public Access De-fib Sites
(PADS)
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure to achieve stretcher
performance
targets
for
Community First Responders
4
3
12
16
Residual
risk
score if objective
is achieved
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Principle 12.
Objective:
To ensure access to specialist response assets.
Description: The winter period bring about challenging environmental
conditions which can and often exceed the capabilities of normal
road based ambulance vehicles. As a result in recent years the
Trust has invested in its vehicle infrastructure in order to be self
sufficient with such a capability. Priority will be given to ensuring
effective and maximum utilisation of these resources during
environmentally challenging conditions. Furthermore, even
though the Trust has an enhanced capability it recognises that
under extreme conditions its own capacity may be exceeded
and therefore mutual supportive opportunities will be sought with
partners.
Benefit:
As a peripatetic clinical organisation the Trust is highly
dependent on its ability to get a response to a patient’s side,
therefore these assets bring about direct patient benefit, staff
safety through the provision of vehicles capable of travelling in
snow or flood as well as organisational resilience in regards to
being able to provide critical workforce transport to and from
their place of work.
We have achieved this by:

Providing 16 * operational Land Rover Discoveries and 81
Honda CRVs (4*4) rapid response vehicles across the Trust.

Fitting our frontline fleet (Emergency Ambulance’s, Rapid
Response Vehicle’s & Patient Care Services vehicles) with
specialist “Cold Weather” tyres designed to ensure maximum
traction in snow or icy conditions.

During periods of prolonged severe weather (i.e. snow) the Trust
will consider the utilisation of regional ‘silver cells’ to support the
robust and safe management / co-ordination of frontline staff
and resources.

To maximise, where available third sector providers (voluntary,
private and other organisations) to support the Trust with
specialist assets (e.g. 4*4 support to transport staff into work /
home).
Risk Assessment:
Hazard
Likelihood
Impact
17
Total Score
Residual
risk
score if objective
is achieved
Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Failure to identify
response assets
specialist
2
4
8
6
Principle 13.
Objective:
To be proportionate in allocation of resources which are
underpinned by sound interpretation and appreciation of
data and cognisant of intelligence sources.
Description: To pay cognisance to demand data in order to inform effective,
resources supply which demonstrates best value for money and
ability to match supply with anticipated demand.
Benefit:
Anticipating demand based on qualitative empirical data,
matched with known peaks in activity, such as New Years Eve
will ensure that the operational resources available to the Trust
are sufficient to meet anticipated demand, therefore, providing
the best patient centred response, equity in matching the activity
across all available resources and proportionate utilisation of
Trust financial resources.
We will achieve this by:

Informatics has updated the predictive demand tool which is
used by Heads of Service to determine resource requirements.

Continue to develop, implement and introduce demand led
intelligent rosters for our core operational workforce.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure to use data to inform
resource base
2
4
8
Residual
risk
score if objective
is achieved
4
Principle 14.
Objective:
To have business disruption and emergency preparedness
arrangements which reflect anticipated challenges
throughout the winter period.
Description: Clear, documented and communicated plans relating to severe
weather events or consequences which they may bring about
are critical in terms of providing direction and leadership during
events that may challenge the ability of the Trust to react to
escalating emergencies. Therefore, the Trust will review its
arrangements ensuring they reflect the latest guidance and are
able to provide a systematic approach to the situation, these
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Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
plans will include as a minimum – fuel disruption, severe
weather, flooding and any mutual aid provided by our partners.
Furthermore, the Trust proactively manages its fleet in order to
minimise lost productivity hours and availability of operational
resources.
Benefit:
Recent winter periods have seen significant challenges brought
about through severe weather events, such as the snow in
2012/13. Underpinning the Trusts ability to maintain our external
response capacity through effective business continuity planning
is critical to ensuring that we are able to maintain an effective
patient response capacity and staff are safe in performing the
duties we ask of them.
Minimising episodes where operational hours are lost due to
vehicle down time ensures that operational staff availability is
being used to the best of their potential thus enhancing our
ability to react to patient needs.
We have achieved this by:

Ensuring operational plans relating to severe weather events,
flooding and fuel disruption have been reviewed.

General plans relating to the wider Trust response to a major
incident is under review in order that it can draw on mutual aid
from across the UK ambulance services.

Commencing a review of our pandemic Influenza Plan in line
with recently published WG guidance.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure to develop and or
implement business disruption
plans
2
4
8
Residual
risk
score if objective
is achieved
4
Principle 15.
Objective:
To ensure staff are supported in performing their duties and
the expectations of the Trust are clearly communicated.
Description: Staff absenteeism during the winter period brings about
challenges in terms of our capacity to match resource availability
with demand; therefore it is imperative that the Trust is clear in
setting out its expectations in regards to attendance but equally
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critical in terms of supporting staff in their return to work. The
Trust will therefore utilise its HR Business Partners in order to
be timely, accurate and consistent in providing advice and
guidance to staff during periods of absenteeism.
Benefit:
Clearly communicated supportive guidance relating to staff
absenteeism ensures that confusion relating to attendance at
work during periods of severe weather does not result in
shortfalls in available resources thus enabling the Trust to meet
the anticipated demands and a consistent approach is taken
across the Trust.
We will achieve this by:

Issuing direct communications to staff when anticipated events
determine the need.

Continue to communicate regularly with our workforce to ensure
they are fully aware of Trust issues, improvement initiatives and
directives to deliver services efficiently and effectively.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure
to
provide
clear
communications to staff resulting
in shortfalls in resources
2
4
8
Residual
risk
score if objective
is achieved
3
Principle 16.
Objective:
To provide suitable facilities from which to deliver effective
services that are capable of supporting staff needs.
Description: The winter period brings many challenges to the operational
estate, where high winds, significant rain or snow and extreme
temperatures may cause elements of the estate or utilities which
underpin the estate to fail. It is therefore critical that the
preparedness of our estate is checked and any remedial works
undertaken in anticipation of failure which may result in the need
to relocate our operational serves. Furthermore, preparation
regarding continuity of access and egress from our estate is vital
during periods of extreme weather therefore arrangements to
maintain access / egress will be developed.
Benefit:
The resilience of our estate aims to provide continuity in the way
in which we deliver operational services, takes account of the
welfare needs of our staff as well as protecting our capital
investment.
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We will achieve this by:

Continue to undertake reviews of our estate to identify and
rectify any issues with local facilities ensuring they are
conducive to a safe working environment.

Continue to review and develop safe and effective social
deployment points.
Risk Assessment:
Hazard
Likelihood
Impact
Total Score
Failure to maintain operational
service delivery from our estate
3
3
9
Residual
risk
score if objective
is achieved
6
Principle 17.
Objective:
To ensure strategies within NHS-DW, where appropriate,
are cognisant and coordinated with those of ambulance
EMS operations.
Description: Support provided by NHS-DW in regards to alternative
dispositions and the management of lower acuity activity allows
for better resource utilisation and the most appropriate patient
response. Therefore, the Trust will ensure resilience in the way
in which it delivers NHS-DW services and where necessary
escalate theses to match anticipated challenges with demand.
Benefit:
Intervention by NHS-DW clinical staff with patients whose
clinical presentation would not routinely warrant the response
from an emergency ambulance or the attendance at an
emergency department greatly reduces the demand on these
services, thereby providing a better patient experience and a
greater capacity to deliver services to those with higher clinical
needs.
We will achieve this by:

Ensuring NHS-DW staffing reflects anticipated demand allowing
capacity to take Green 1 & 3 calls or when the escalation level
warrants appropriate Red 2 calls.

Remote monitoring of the RI stack by NHSDW where the
services are not co-located.
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
Redeploying NHSDW nurses to the WAST Clinical Contact
Centres in order to support the management of the Health
Professional and Green stacks.
Hazard
Likelihood
Impact
Total Score
Failure to ensure coordination
between EMS and NHSDW
3
4
12
Residual
risk
score if objective
is achieved
6
Performance Measures
In order to assess the effectiveness of each Objective the Trust has identified
the following performance metrics as the preferred measures. These metrics
will be identified in each Health Board area Winter Delivery plan where they
will reflect the local performance measure.
Principle Objectives
Number
1
Performance Metric
To manage resource pressures Cat A8 Performance
through effective application of the
Monitor
complaints
WAST Escalation Plan
compliments / DATIX
/
2
To maintain compliance with the Cat A8 Performance, Red
“Clinical Response Model”
to Green 1 disposition,
Green 3 alternative modes
of transport
3
To maximize all opportunities to
access
alternative
pathways
providing the “Right Service in the
Right Place at the Right Time”.
4
To provide resource outputs that Projected UHP vs. Actual
reflect anticipated demand
UHP
5
Seek to achieve or exceed Cat A8 Performance and
compliance
with
Status
Plan CCC SPM Compliance
Management
and
Status
Monitor
complaints
/
Deployment Planning
compliments
6
To provide intelligence led patient Cat A8 Performance and
focused responses
Response Model
22
% Utilisation of Alternative
Care
Pathways
and
percentage of on-scene
resolution & referral
Welsh Ambulance Services NHS Trust
Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
7
To provide an effective coordinated N/A
resource utilisation plan on a daily
basis
8
To be proactive in sickness absence WAST Sickness Rate and
and
workforce
abstractions daily UHP Abstraction data
management
9
To provide robust strategic, tactical Cat A8 Performance and
and operational leadership
monitoring through the
daily conference calls
10
To anticipate and react to external Cat A8 Performance and
influences or events which may monitoring through the
have an impact on organisational daily conference calls
service delivery
11
To
maximise
on
Community
First
contribution
12
To ensure access to
response assets
13
To be proportionate in allocation of Cat A8 Performance and
resources which is underpinned by monitoring through the
sound
interpretation
and daily conference calls
appreciation of data and cognisent
of intelligence sources
14
To have business disruption and
emergency
preparedness
arrangements
which
reflect
anticipated challenges throughout
the winter period.
voluntary % CFR contribution to CAT
Responder A performance Nationally &
HB area
specialist Cat A8 Performance
UHP
Lost Production hours
Hospital
Handover
Turnaround delays
/
15
To ensure staff are supported in WAST Sickness Rate
performing their duties and the
expectations of the Trust are clearly and monitoring through the
daily conference calls
communicated.
16
To provide suitable facilities from N/A
which to deliver effective services
that are capable of supporting staff
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needs.
17
To ensure strategies within NHS- Number of calls passed to /
DW,
where
appropriate,
are resolved by NHSDW
cognisant and coordinated with
those
of
ambulance
EMS
operations.
Specific Arrangements relating to Christmas and New Years

Christmas and New Year rosters will be finalised no later than 4 weeks
in advance with the aim of offering flexible rostering to those who wish
to take up this option.

Rosters will reflect anticipated demand and be uplifted in core resource
type with planned increases in EMS, RRV, UCS, CCC, NHSDW and
PCS which match.

Non-essentiall activity will be scaled back during this period in order to
release frontline staff and mangers back to operations in order to
supplement
operational
resource
availability.
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Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru
Appendix
WAST, Social Services & Health Boards Joint Winter Plans
The following joint plans have been developed in collaboration between the
Welsh Ambulance Service NHS Trust, Social Services & Health Boards.
AWAITING APPROVED
INCLUSION
LOCAL
HEALTH
Abertawe Bro Morgannwg University Health Board
Aneurin Bevan Health Board
Betsi Cadwaladr Health Board
Cardiff & Vale University Health Board
Cwm Taf Health Board
Hywel Dda Health Board
Powys Teaching Health Board
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BOARD
PLANS
FOR