Public Board Meeting July 2015 Item 5a THIS PAPER IS FOR DISCUSSION

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Gerard Stone
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1 NOT PROTECTIVELY MARKED Public Board Meeting July 2015 Item 5a THIS PAPER IS FOR DISCUSSION TOWARDS 2020 :TAKING CARE TO THE PATIENT Lead Director Author Key points Action required Timing Pauline Howie, Chief Executive Pat O Connor, Director of Care Quality & Strategic This paper provides a summary of the achievements in delivering the Board s Strategy Towards 2020: Taking in quarter one 2015/16. Good progress has been made including: Scoping out of the full transformation programme recognising the complexity and interdependencies; Progression of the implementation of the National Out of Hospital Cardiac Arrest strategy; Enhancement of triage and response protocols from other agencies including GPs, hospital transfers and Police; Further development of our hear treat and refer framework, implementing Manchester Triage System for clinical advisors and developing clinical queue to prioritise lower acuity calls more effectively; Modelling of workforce requirements and review of roles and scope of practice; Completion of initial 2 day Delivering Frontline Leaders and Managers (DFLM) course and development of Personal Plans (PDPs) for team leaders and managers to build capacity and capability; Pilot of Vocational Qualification (VQ) model for technicians in North of Scotland to be evaluated in partnership; Commenced implementation of communications hub across fleet as part of mobile telehealth programme. The Board is asked to discuss progress with the 2020 Strategy. This report is produced bi-monthly for information and assurance to the Board regarding progress with the 2020 Strategy and the implementation of key programmes of work supporting the delivery of the quality improvement objectives within our annual Corporate Plan. Doc: a Towards 2020 Taking Page 1 Author: Director of Care Quality & Strategic

2 Contribution to the 2020 vision for Health and Social Care Benefit to Patients Equality and Diversity This programme of work has been mapped to the Scottish Government 2020 Vision. This report aims to identify the primary national priority areas that align to the individual strands of strategy development and improvement programmes. This integrated programme of development and improvement work is designed to support Scottish Ambulance Service to deliver on the key quality ambitions within Scottish Government s 2020 Vision and our internal Strategic Framework Towards 2020: Taking Care to The Patient, which are to deliver safe, person-centred and effective care for patients, first time, every time. This report summarises progress across a number of workstreams and programmes. Each individual programme is required to undertake Equality Impact Assessments at appropriate stages throughout the life of the programme. There are no equality and diversity issues to highlight from this report. In terms of the overall approach to equality and diversity, key findings and recommendations from the various Equality Impact Assessment work undertaken throughout the implementation of Towards 2020: Taking are regularly reviewed and utilised to inform our Equality Outcomes Framework. Doc: a Towards 2020 Taking Page 2 Author: Director of Care Quality & Strategic

3 NOT PROTECTIVELY MARKED SCOTTISH AMBULANCE SERVICE BOARD TOWARDS 2020 TAKING CARE TO THE PATIENT PAT O CONNOR, DIRECTOR OF CARE QUALITY & STRATEGIC DEVELOPMENT SECTION 1: PURPOSE The purpose of this report is to provide an overview of progress since the last reporting period against the various workstreams to deliver the 2020 Strategy. SECTION 2: RECOMMENDATIONS The Board is asked to discuss progress with the 2020 Strategy. SECTION 3: BACKGROUND Towards 2020: Taking was launched in February Since then, we have mapped our current work and established a framework for delivering the strategy, to ensure the Corporate Plan / Local Delivery Plan for 2015/16 is also fully aligned. Over the past 6 months, our focus has been to review current arrangements, build and shape our infrastructure and initial work in this, the first year of the strategy. We will build on this going forward to co-design with patients, staff, carers and partners more detailed plans for a whole systems approach to deliver our 5 year plan. Our detailed implementation plans will ensure the Board and the Executive Directors have clarity on the aims, goals, milestones and measurable patient and staff outcomes as we progress. It is important to note that during this first quarter of 2015/16, the Executive Team has also been in transition with two new Executive Directors joining the Service recently. In the next quarter the Executive Team in collaboration and individually will present further detail on the whole systems approach for change at scale. SECTION 4: DISCUSSION This first year 2015/16 of our strategy implementation, will build on the foundations delivered within our Working Together for Better Patient Care Strategy. We will now move at pace to test, implement and scale up many of the good practices developed to date. Our new 2020 Strategy work streams are aligned in three key themes: service Doc: a Towards 2020 Taking Page 3 Author: Director of Care Quality & Strategic

transformation; developing our future workforce and enabling technology. We fully recognise the complexity and interdependency between them.

Through our whole systems approach we intend to continue to engage with our teams, patients, carers and partner organisations to co-design, coproduce and implement new and improved ways of working.

The driver diagram below summarises our high level framework for delivery.

project management work, but will view each workstream as key elements of a complex, organisational interdependent whole systems change programme over the coming five years.

services Build community resilience Increase use of technology Scale up success Reduce variation Care Governance Framework Clinical Teams driving Improvement in emergency, unscheduled and scheduled

4 transformation; developing our future workforce and enabling technology. We fully recognise the complexity and interdependency between them. This Strategy will require significant organisational change over the next 5 years throughout the Service. Through our whole systems approach we intend to continue to engage with our teams, patients, carers and partner organisations to co-design, coproduce and implement new and improved ways of working. Our engagement plans are designed to ensure that everyone who has ownership feels connected to our goals to improve the quality and experience of our patients. The driver diagram below summarises our high level framework for delivery. The Board should note that, whilst the 2020 Steering Group will ensure the implementation, measurement and achievement of the 2020 Strategy, we do not intend to use the narrow focus of individual project management work, but will view each workstream as key elements of a complex, organisational interdependent whole systems change programme over the coming five years. Taking Care to the Patient Improved access, care quality and outcomes by December 2020 Workforce development E health Service transformation Staff profile with enhanced skills Flexible and responsive services Build community resilience Increase use of technology Scale up success Reduce variation Care Governance Framework Clinical Teams driving Improvement in emergency, unscheduled and scheduled care for new care pathways, co designed using patient experience and feedback Build capability to execute change at scale using improvement methods Data driving improvement CLINICAL / OPERATIONAL TRANSFORMATION This area of work is focussed on the transition from our current operational model, largely driven by timeliness of response, to our new clinically driven operational model aimed at ensuring the appropriate skilled response to patients to improve outcomes. The transition from our current state to that future model is enormously complex, affecting every area of our operation and hugely dependent upon the development of our future workforce and an infrastructure of pathways, technology and support that goes beyond our organisational boundaries into the wider health and social care environment. Doc: a Towards 2020 Taking Page 4 Author: Director of Care Quality & Strategic

5 The Board is aware of the scale of the transition the Service is aiming for in respect of increased hear and treat, increased see, treat and refer and a reduction in avoidable attendances and subsequent admissions to hospital and the impact this will have on the shape of our future workforce in terms of skills and roles at a high level. Under this theme, there are 4 key strands of work to progress: A forum for robust testing of new ideas and innovation, ensuring evidence is clear and the Service effectively tests and embeds change at scale aligned to the strategy; Enhancing our response to emergency care, focussing improvement on genuinely time critical patients, including cardiac arrest, major trauma and stroke and our prehospital medical response to major incidents; Enhancing the decision support infrastructure for Ambulance Control Centre ( ACC) staff and crews to triage more effectively, make the right decisions for patients and easily access information, pathways and clinical professional support to enable that; Managing the complex transition from our current model to our one ambulance service model fully integrated into the wider health and social care system. Much of the work to date has been in scoping out this workstream, with a focus specifically on developing and testing improvements to the triage process, not least in enhancing the triage process in respect of GPs, Police and hospitals. Additionally, significant progress has been made in terms of the Service s response to cardiac arrest with continued improvement in Return of Spontaneous Circulation (ROSC) rates achieved as a result. Progress to Date Key achievements in quarter 1 include: Implementation of Manchester Triage Tool for clinical advisors in ACC providing additional decision-support. The development of the clinical queue for clinical advisors to prioritise lower acuity calls for clinical advisors has also been progressed, reviewing clinical codes to determine which calls are suitable for immediate transfer to NHS 24 and which could be dealt with by a clinical advisor as hear and treat without subsequent dispatch of an ambulance; Successful launch of the Out Of Hospital Cardiac Arrest Strategy with a key role for the Service and continuing roll out of 3RU model for cardiac arrest across to West Central Division with demonstrable improvement in Return of Spontaneous Circulation (ROSC) rates throughout the year to date; Pilot in East Ambulance Control Centre of a dedicated urgent desk to manage urgent resources more effectively and improve the triage process with GPs requesting urgent ambulance transfers. Early indications are positive evidencing the assumptions within the new clinical model that much of this work is appropriate for Patient Transport Service (PTS) resources but also, that a focus on the triage process can ensure higher acuity patients are responded to more appropriately and timeously. This work will be extended into quarter 2 with a view to extending across all Divisions; Progress towards implementation in 2016 of major trauma network for Scotland, including successful completion of trauma triage tool, scoping with regions the Doc: a Towards 2020 Taking Page 5 Author: Director of Care Quality & Strategic

6 requirements for the trauma desk in Ambulance Control Centres which will be critical to the successful tasking and co-ordinating of Scottish Ambulance Service response across the network, and work with regional groups to develop protocols and pathways; Work to review care pathways for stroke across Scotland with a view to developing a shared pathway for the effective care of stroke patients reaching definitive care as timeously as possible; Pilot with Police Scotland to enhance the triage process for Police calls, with direct discussion with police officers on scene; Work with NHS Forth Valley to develop protocols for requesting inter-hospital transfers to better triage need and manage resources more effectively. DEVELOPING OUR FUTURE WORKFORCE This workstream will be critical in delivering the Service s 2020 Strategy, developing a flexible, modern workforce to operate at the full scope of its practice, supported to make better decisions for patients and deliver the highest quality of care. It is recognised that this scale of transition will go beyond 2020, but significant progress will be made within the next five years of the strategy to support clinical and operational transformation and the development of our one ambulance service model, develop and embed new roles and working practices, strengthen our leadership capacity and capability and ensure our education model is effective. A detailed transition plan within each Division and Ambulance Control Centre will be developed over the coming weeks, recognising the importance of ownership operationally to effect the scale of transition required. Progress to Date Key achievements in quarter 1 include: Completion of initial workforce modelling for 2020 to safely and effectively meet the core response requirements of the new clinical model, notably the level of specialist paramedics required to deliver increased see and treat rates and reduce avoidable A&E attendances; Progress to review the scope of practice for specialist paramedics, recognising the operational variance within the current cohort of specialists; Pilot of a Vocational Qualification (VQ) model in the North Division for technicians. This approach is helping to address recruitment challenges for remote areas, decentralising delivery of training for new staff and will be evaluated in partnership to determine whether or not this qualification route could be rolled out more widely for Technicians and Ambulance Care Assistants (ACAs); Completion of the first 2 day programme for Team Leaders and Area Service Managers as part of the Delivering our Frontline Leaders and Managers Programme. The two days were extremely well received by those attending, with each manager identifying their Personal Plan to be delivered through a series of Continuous Professional (CPD) sessions throughout 2015/16. Delivering Frontline Leaders and Managers (DFLM) has now been brought under the wider Future Workforce Programme; Implementation of Global Rostering System (GRS) into Ambulance Control Centres to support more effective workforce planning. This system allows Ambulance Doc: a Towards 2020 Taking Page 6 Author: Director of Care Quality & Strategic

7 E-HEALTH Control Centres to see the capacity of resources against planned on a real time basis across the Service and more proactively address any capacity gaps. Technology will also be a key enabler to effectively delivering the 2020 Strategy and this workstream is primarily focussed on two key strands: Enhancing the mobile telehealth infrastructure across the Service fleet, replacing the current electronic patient record, and developing capacity for remote diagnostic capability, sharing and accessing of information, and improving decision-support for crews; Replacement of the current Airwave communications platform once the current contract comes to an end. Progress to Date Key achievements in quarter 1 include: Completion of the tender for hardware and award of contract. The implementation plan has also been finalised and implementation of new communications hub across the fleet will be progressed in Additionally, a new tablet version of the Electronic Patient Report Form (e-prf) will be rolled out to staff. Commenced scoping of next generation of patient record including early discussions with potential suppliers. The tender process for phase two is due for completion by December 2015 and the requirements gathering stage is well underway, led by a consultant paramedic aligned to the programme. Progress procurement process for emergency service mobile communications engaging with Scottish Government, Police Scotland and the Scottish Fire and Rescue Service. SECTION 5: CONSULTATION This paper has been produced for the Board with input from members of the Executive Team and workstream leads. Doc: a Towards 2020 Taking Page 7 Author: Director of Care Quality & Strategic

SCOTTISH AMBULANCE SERVICE LOCAL DELIVERY PLAN

SCOTTISH AMBULANCE SERVICE LOCAL DELIVERY PLAN SCOTTISH AMBULANCE SERVICE 2014-15 LOCAL DELIVERY PLAN Scottish Ambulance Service National Headquarters Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB 14 March 2014 1 List of Contents Section 1: