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Health Scrutiny
Accountability SessionThursday 26 January 2012
Anthony C Marsh
SBStJ FASI MBA MScWest Midlands Ambulance Service NHS Trust
• Established in July 2006 merging with Staffordshire in October 2007
• Over 532,000 emergency patient journeys annually
• 5.36 million population
• Over 5,000 square miles, 80% rural
• Approaching 3000 999 calls per day
• £200 million budget
• Existing fleet of over 850 vehicles
• 4,000 Staff
• 4 Air Ambulance Helicopters
Firmographics
Trust Vision
VisionDelivering the right patient care, in the right place, at the right time,
through a skilled and committed workforce, in partnership
with local health economies
Strategic Objectives
Achieve Quality
and Excellence
Accurately
assess patient
need and
direct resources
appropriately
Establish market
position
as an
Emergency
Healthcare
Provider
Work in
Partnership
Service Delivery Objectives
Deliver Service
ImprovementIncrease Efficiency
Develop our
Workforce
Transform our
Technology
Infrastructure
Values
•World Class Service
•Patient Centred
•Dignity and Respect for All
•Skilled Workforce
•Teamwork
•Effective Communication
Transformational Business Strategy
• Retain the best elements of an
operational Ambulance Service
• Emergency Planning
• Major incident Response
• Rapid Response to incidents
• Flexible and Adaptable ways of
working
• Implement the benefits of an Integrated
Healthcare Provider
• Community Paramedics
• High volume of Healthcare Professionals
• Higher volumes of referral to alternative
pathways
• Clinical Supervision and Mentoring
• Delivery of a High Performing Ambulance Service
• Top Quartile in Response Times
• Top Quartile in Clinical Outcomes
• Cost effective delivery of service
• Highly regarded by patients, public and
Stakeholders
Developing a Service embedded in the Community
Transforming from a Traditional Ambulance Service to
an Integrated Healthcare Provider
Regional Performance 2010/11
Cat A8 Cat A 19min Cat B19 5 Second Answer
West Midlands 76.8% 98.0% 95.0% 98.1%
South Western 76.9% 96.1% 95.6% 81.6%
South Central 77.5% 95.3% 91.4% 84.3%
South East Coast 76.0% 97.7% 94.3% 89.7%
London 75.1% 99.0% 87.2% 90.1%
Great Western 74.3% 95.1% 91.7% 94.9%
East of England 74.6% 95.6% 93.1% 86.3%
North East 75.8% 98.5% 93.5% 98.1%
Yorkshire 73.7% 97.4% 93.7% 94.9%
North West 73.6% 95.6% 87.0% 97.6%
East Midlands 72.4% 93.5% 88.3% 88.1%
• WMAS, The only Ambulance Service to achieve all operational
performance indicators
NEW Operational Performance Indicators
TARGET Q1 Q2 Q3 Q4TD YTD
CAT A8 75.0% 77.5% 77.3% 75.8% 79.1% 76.8%
CAT A19 95.0% 98.1% 98.0% 98.0% 98.2% 98.1%
GREEN 2 95.0% 98.5% 98.0% 97.4% 98.6% 97.9%
GREEN 4 95.0% 98.7% 97.2% 99.7% 99.6% 98.4%
5 Second
Answer95.0% 98.6% 93.1% 94.9 % 96.6% 95.7%
APRIL – JANUARY 2011
Clinical Performance Indicators
2011 / 2012
National
MeanPosition
STEMI Pats to Hosp (150 mins) 87.5% 6th
STEMI Care Bundle 71.7% 1st
Stroke Pats to Hosp (60 mins) 65.7% 4th
Stroke Care Bundle 92.7% 6th
ROSC 23.8% 4th
Cardiac Arrest – Patient Discharged 6.6% 3rd
Care Quality Commission
Quality and Risk Profile
Jan-11 Feb-11 Mar-11 May-11 Jun-11 Jul-11 Sep-11 Oct-11 Nov-11
HIGH RED
LOW RED
HIGH AMBER 1
LOW AMBER
HIGH NEUTRAL 1 3 1 3 3 3 3 2 1
LOW NEUTRAL 4 3 5 4 4 4 5 5 5
HIGH GREEN 1 1 1 1 1 1
LOW GREEN 1 1 2 1 1 1 2 2 3
National Awards
• Health Business Awards Finalist 2011
• HSJ Healthcare Organisation of the Year 2011 Finalist
• Emergency Services Award Ambulance Innovation 2011
Bariatric Ambulance
• Emergency Services Award Ambulance Technology 2011
Performance Cell
• ASI NHS Ambulance Service of the Year 2011
• ASI Technician of the Year
• ASI Control Staff Award
• ASI Innovations Award
• ASI Special Incident Award
• ASI President’s Award
• Substantial improvements in staff survey results
Membership Governors
Jan 2012 Plan + 2 years Members
Council
Public 7,937 7,500 10,000 15
Staff 4,000+ 4,000+ 4,000+ 5
Appointed na 9
Total 13,937 11,500 14,000 29
Will Elect
• Greater accountability through increased involvement of public and
staff
• More effective provider of healthcare services
By planning and looking forward for the development of our services
What will be Different
Governors
Foundation Trust & Patient Engagement
The Members Council consists of 29 Governors
Staff have 5 Elected Governors
Emergency and
Urgent Operational
staff (2)
Emergency
Operations Centre
Staff (1)
Non Emergency
Operational Staff (1)
Support Staff (1)
Public have 15 Elected Governors
West Mercia (3) Birmingham (3) Black Country (3) Staffordshire (3) Coventry and
Warwickshire (3)
There are also 9 Appointed Governors (1 each of the following)
South Staffs &
Shropshire
Healthcare NHS
Foundation Trust
Commissioning
Primary Care Trust
Malvern Hills District
Council
Birmingham City
Council
Coventry University
Community First
Responders
University Hospital
Birmingham NHS
Foundation Trust
St John Ambulance West Midlands Fire
& Rescue Service
Building for the Future
• Improving leadership, both clinically and managerially, so that
organisation structure, culture and style match new models of
care
• Improving the consistency and quality of care provision
• Improving efficiency and effectiveness
• Supporting performance improvement
• Developing the workforce
o Advanced Paramedic
o Electronic Care System
NHS Pathways & Directory of Services
Engagement with WM Stakeholders
Commissioners and Providers, over 500 presentations
4500 LIVE Entries on the CMS DOS
Full range of alternate care
services available to Call Assessors and Paramedics
NHS Pathways – Directory of Services
Handover Delays
Cohorting Hours Cases
2010/11 2726 3468
2011 to date 2608 3467
Total 5347 6959
Delays >30 minutes
Time Period
(mins)
2008/9
(%)
2009/10
(%)
2010/11
(%)
2011 to date
(%)
30-45 15.8 20.6 22.1 26.1
45-60 2.8 3.8 4.3 4.8
60+ 1.2 1.7 2.1 1.9
Stafford Hospital Temporary Overnight Closure of
A&E
• Work in partnership to develop a safe alternative model
• Introduced an integrated transfer protocol
• No complaints or risks identified during the period
• Trust’s performance maintained
• Since 1 December conveyance has been arranged for an
average of15 patients per night – a total of 883 patients