Emergency & Urgent Care Ambulance Service Haringey CCG: 30 th March 2017

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1 Emergency & Urgent Care Ambulance Service Haringey CCG: 30 th March 2017 Performance and Demand Management Andrew Grimshaw Interim CEO Peter Rhodes Assistant Director of Operations London Ambulance Service NHS Trust 1

2 Background & challenges The challenge: Managing a large volume of incidents, 1.1m significant increase in demand The duration of each incident being quite short and variable Having tight response times to achieve, for 0.5m incident arrive at 75% within 8 minutes Pan London How is this achieved? Through a balance of; Predicting demand patterns; Mobilising capacity to match demand; Estimating job cycle time (mobilisation of vehicle to green up at hospital); Assessment of the Multiple Attendance Ratio (MAR), some incidents require more than one vehicle; Maintaining a utilisation level that allows variation in the volume, distribution and duration of demand to be managed; Maintaining a pan-london response model. London Ambulance Service NHS Trust 2

3 2016/17 Plan Defined a model for 2016/17 which; We agreed with LAS Commissioners demand, assuming 2.36% growth. Defined patterns that were even across London, with an assumption of 2% demand management from September. Defined a Job Cycle Time (JCT) and Multiple Attendance Ration (MAR) with some improvement from October. Calculated an establishment and recruitment plan to employ the associated staff. This model didn t; Secure 75% A8 performance for 2016/ % for year, with an exit run rate of 71.2%. Didn t address utilisation - this would only improve once trajectory was met. Meaning variation in one of the key metrics (demand, capacity or JCT/MAR) would result in a movement in the trajectory. London Ambulance Service NHS Trust 3

4 North Central London context A8 performance against trajectory for the North Central London was hit last week (NC Actual: 71.10% - NC Trajectory: 68.70%). Performance in March (to 30/3/17): London Ambulance Service NHS Trust 4

5 Operating Context - Haringey Operate from legacy estate Tottenham (St Anne s), Bounds Green, Friern Barnet. No specialist centres in Boroughs of Haringey, Enfield or Barnet. HASU (UCH Camden), MTC (RLH), HAC (RFH Camden). Acute Trusts with long ambulance handover delays (data for 2017). London Ambulance Service NHS Trust 5

6 Action Plan in Place for Haringey Redeployment of Training Station and Private Ambulances into Sector. Deployment of Motorcycle to Tottenham (Fire Brigade dependent). Extra response car at Bounds Green 24/7. Redistribution of response cars across Sector to displace Northwards. Work towards a tethering arrangement for certain response cars (inc JRU). Increase the deployment of Tactical Response Unit cars into South of Sector. Move Sector staffing to 100% (achieved by end Q1). Work with CCG to increase pathway coverage (lower conveyance = lower JCT). Further integration with 111/IUC hub for advice and discharge. Continue to work with Acute Trusts to reduce ambulance handovers across Sector. Work with CCG/blue light collaboration colleagues re. estate. London Ambulance Service NHS Trust 6

7 Trustwide what have we been doing? CQC re-inspection, undertook a comprehensive inspection of the Service on 7,8,& 9 February 2017 Quality Improvement Plan, identified workstreams: - Making the LAS a great place to work (eg Retention Band 6, Advert to Action recruitment, Bullying & Harassment awareness training / speak up - Achieving good governance (eg Risk Management, Improving Incident Reporting) - Improving patient experience (eg Bariatric) - Improving environment & resources (eg Fleet prep & Make Ready) - Taking pride and responsibility (eg Medicine Management) London Ambulance Service NHS Trust 7

8 Challenges & opportunities Pressures: 2016/17 demand on our service and the wider healthcare system. 2017/18-19 growth. Marauding Terrorist Fire Arms Attack (MTFA), resilience and capability in our capital. Workforce and retention (Band 6 for paramedics). Opportunities: Demand Management (111, HCPs, Frequent Callers, Met DG). Job Cycle Time (JCT) > need for pathways and decreased handover times. Ambulance Response Programme (ARP), aim to improve response time to critically ill patients. IM&T investment for our staff, collaboration with health & social care systems. Integrated Urgent Care model (111/OoH). Care Pathways, consistent and unified pan London. London Ambulance Service NHS Trust 8

9 Questions London Ambulance Service NHS Trust 9

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