WELSH AMBULANCE SERVICES NHS TRUST NATIONAL CLINICAL CONTACT CENTRE STRATEGY

Transcription

1 WELSH AMBULANCE SERVICES NHS TRUST NATIONAL CLINICAL CONTACT CENTRE STRATEGY VERSION 1.8 FINAL Clinical Contact Centre Strategy V 1.8 Final Page 1 of 64

2 DOCUMENT CONTROL SHEET The source of the document will be found in the following location: U:\PROJECT FOLDERS\EMS STRAND\OPSP002 RESTRUCTURING THE DELIVERY OF OPERATIONAL SERVICES (DISTRIBUTION) Document Version History: Version Number Date Author Summary of changes Version GM / DB /GB Skelton Document Commenced Version GB /DB Structure and sub headings agreed Version GM / DB /GB Commenced Populating Sections Version GB Update all sections Version GB First complete draft for circulation Version GB Updated following comments received from core group Version GB Updated following migration to VPH and minor changes to structure Version GB Updated following comments from DJM Version GB Updated following comments from SJ / SP / AE / HD / LH Version GB Updated following comments from GM Version GB Updated following comments from Clinical Directorate NHSDW Version GB Updated following meeting with Alison Kedward Approvals This document requires the following approvals: Name Title Date Version Grant Gordon Sara Jones Steve Pryor Deputy Director of Ambulance Services Director of Unscheduled Care and Clinical Governance Director of Ambulance Services Controls Steering Group 30/12/2008 Version 1.3 Executive Management Group (EMG) Risk and Modernisation Committee 20/05/2009 Version 1.7a Trust Board 15/07/2009 Version 1.8 Final National Clinical Contact Centre Strategy V 1.8 Page 2 of 64

3 Distribution This document has been distributed to: Name Title Date Version Grant Gordon Deputy Director of Operations Version 1.1 Debbie Bateman Programme Manger (Controls) Version 1.1 Gillian Pleming Duty Shift Manager North Version 1.1 Chris Preston NHSD Wales Version 1.1 Simon Reynolds Senior Programme Manager Version 1.1 Gwilym Morgan OPSP002 Lead Version 1.1 Core Group Core Group Version 1.1 Control Group Newly formed Control Group Version 1.3 Risk and Modernisation Committee 20/05/200 Version 1.7a Trust Board 15/07/200 Version 1.8 Final National Clinical Contact Centre Strategy V 1.8 Page 3 of 64

4 CONTENTS Document Control Sheet Introduction/Overview Vision Provide a universal and comprehensive service with equal access for all, free at the point of use, based on clinical need: Work continuously to improve access, quality and safety: Treat every patient with dignity and respect: Commit to equality and non discrimination: Better Value, Better Care Respect the confidentiality of individual patients and provide open access to information about services Support and value staff: Work in partnership with others to ensure a seamless service for patients: Stakeholder Analysis Stakeholder Analysis Strategic Drivers National Policy Drivers Modernisiing Unscheduled Care (DECS) NHS Wales Primary and Community Strategic Delivery Programme Designed for Life Making the Connections Delivering Beyond Boundaries Welsh Audit Office Review Taking Healthcare to the Patient Fulfilled Lives, Supportive Communities Improving Social Services in Wales High Impact Changes and Response Time Algorthyms National Tri Services Control National Clinical Contact Centre Strategy V 1.8 Page 4 of 64

5 4.2 Local Policy Local Delivery Plan TIme to Make a Difference Programme The Welsh Ambulance Service Clinical Vision Existing Benchmarking Strategic Objectives Performance Governance ~ Patient and Responder Safety Timely Appropriate Response Value for Money Maximising benefits of General WAST Expenditure Links to Other Internal Strategies Future Vision the National Clinical Contact Centre for the Future Overview of Where do we want to be National Building Infrastructure and Occupancy Regional Management Team Support Demand Management Resilience and Business Continuity Telephony Architecture ICT Infrastructure Handling 999 Calls Differently ~ Clinical Traige Call Flows and NHS PAthways NHS Pathways Available Clinical Support Future Call Flow Process Complementary Management Structure to Support New RoleS Response to Call Ratios 999 Calls Staffing StructureS and Responsibilities Regular Audits Leads National Clinical Contact Centre Strategy V 1.8 Page 5 of 64

6 7.0 Workforce Culture Workforce Plan Education and Development Core Competencies Staff Wellbeing System Architecture Virtual Computer Aided Dispatch Telephony Infrastructure Cummunication Plan High Level plan Contact Information Glossary Appendix 1 Current Estate Position Appendx 2 Current Control Infrastructure Pcs controls Non emergency transport (net) Centres NHS Direct Wales Appendix 3 Demand EMS / PCS / NHSD Wales EMS Demand PCS Current Demand and Performance NHSD Wales Current Demand and Performance Appendix 4 Workforce Analysis ~ EMS / PCS / NHSD Wales EMS Control Establishment PCS Establishment NHSDW Establishment Appendix 5 Quality Standards for Each Organisation EMS Controls NHSD Wales PCS National Clinical Contact Centre Strategy V 1.8 Page 6 of 64

7 1.0 INTRODUCTION/OVERVIEW This strategy has been written to provide a clear direction of travel for the modernisation and integration of the Trusts Ambulance Control Centres and NHS Direct Wales. It builds on the recommendation 17.a of the Welsh Audit Office review (2006) of the Welsh Ambulance Service NHS Trust (WAST). In support of our vision and delivery of this strategy the trust committed to providing services that are: o o o o o o o o o o o Accessible to all through varying means of contact Provide multilingual services Improving Patient Outcomes Patient Focused Improve staff working arrangements and environments Timely Safe and Efficient Clinically Appropriate and Effective Effectively governed Accessible and Responsive Delivered in the Right Environment The Welsh Ambulance Service management is acutely aware of the significant contributions that our current control centres make, but organisationally we need to ensure our services are aligned to the strategic modernisation of health services across Wales. We are heavily committed to our obligations under the Delivering Emergency Care Services strategy and see our control centres as being pivotal in fulfilling this. Our current control centres need to be developed into Clinical Contact Centres. These new centres need to be holistically developed to provide an individual, appropriate and patient focused service to all callers. This Strategy was written following a large multidisciplinary workshop held in Newtown on the 18 th of June For this strategy to be successful it will require significant support from the Welsh Assembly Government and Health Commission Wales. Following approval of the Strategy, a Strategic Plan will be developed showing the movement of travel towards the future state. Indicative costs can then be fed into the strategic outline case to ensure financial support is available for the modernisation programme. National Clinical Contact Centre Strategy V 1.8 Page 7 of 64

8 It is envisaged following approval of the strategy that the following elements shown in the diagram below need to be completed. National Clinical Contact Centre Strategy V 1.8 Page 8 of 64

9 2.0 VISION The vision for the Trusts Clinical Contact Centres is to facilitate the delivery of world class health care through the engagement of a professional, highly motivated, self regulating workforce supported by leading edge technology. Through the Clinical Contact Centres the Trust will seek to deliver increased patient satisfaction; improved patient outcomes and enhance workforce satisfaction through increased empowerment and autonomy for staff and managers. The Trust, through its Clinical Contact Centres, will apply the following principles in taking forward the delivery of the vision for the public, patients and staff and will: 2.1 PROVIDE A UNIVERSAL AND COMPREHENSIVE SERVICE WITH EQUAL ACCESS FOR ALL, FREE AT THE POINT OF USE, BASED ON CLINICAL NEED: The Clinical Contact Centres will exist to serve the public. This means that the views and preferences of service users and carers should shape service design and ensure that services offered should suit their convenience rather than that of the organisation; 2.2 WORK CONTINUOUSLY TO IMPROVE ACCESS, QUALITY AND SAFETY: The Trust will work continuously to make the services delivered by the Clinical Contact Centres easier to access, the care provided ever safer, and to ensure that mistakes are learned from and reduced. The quality of health services and patient satisfaction needs to be high for all who use the Clinical Contact Centres and always improving; 2.3 TREAT EVERY PATIENT WITH DIGNITY AND RESPECT: Everyone, whether or not they can make their views known, deserves to be treated with dignity and respect. The principles of dignity, equality, respect, fairness and autonomy are fundamental. This is never more so than when people are ill and at their most vulnerable. The NHS should, at all times, maintain the dignity and respect of individual service users; 2.4 COMMIT TO EQUALITY AND NON DISCRIMINATION: The society the NHS serves is ever more diverse, with differences between individuals in respect of age, gender, disability, sexual orientation, race, language, religion, and national, ethnic or social origins. The services offered by the Clinical Contact Centres will need to be appropriate to the needs of different communities; 2.5 BETTER VALUE, BETTER CARE The NHS is funded by the taxpayer with an expectation to deliver improved value and care. The Clinical Contact Centres will strive to improve the value for money it delivers, to set an example by the sustainable use of the resources it consumes and contribute to the sustainability of local communities; National Clinical Contact Centre Strategy V 1.8 Page 9 of 64

10 2.6 RESPECT THE CONFIDENTIALITY OF INDIVIDUAL PATIENTS AND PROVIDE OPEN ACCESS TO INFORMATION ABOUT SERVICES The Clinical Contact Centres will protect the personal details which individual service users share in order to access appropriate treatment and care. However, as a public service, the NHS must ensure that those to whom it is accountable have a clear picture of the services it provides; 2.7 SUPPORT AND VALUE STAFF: The staff of the Clinical Contact Centres, both those who deal directly with patients and those who provide support services away from the front line, are its most precious resource. Their expertise and experience needs to be used to the full for the benefit of service users, and they also need to be recognised and rewarded through best employment practices; 2.8 WORK IN PARTNERSHIP WITH OTHERS TO ENSURE A SEAMLESS SERVICE FOR PATIENTS: The role of the Clinical Contact Centre frequently spans organisational boundaries. The delivery of holistic care to individual users may also draw on services provided by different organisations. Both the commissioning and delivery of services must be undertaken in partnership with the public, users, carers, local authorities, independent and third sector organisations. It is essential that WAST remains fully aligned to developments across Wales with regard to the modernisation of unscheduled care. Ambulance Controls, NHS Direct Wales and, where commissioned, out of hours providers will be fully integrated within three Regionally Based Clinical Contact Centre facilities; one in the North, one in Central and West and the other in the South East with the aim of providing organisational synergy, economies of scale, best value and seamless health care for patients. The leadership and direction of the Clinical Contact Centres will be through the Operations Directorate under the stewardship of the Deputy Chief Executive, and supported fully by the Clinical, and ICT / Estates Directors. The nature of the services provided will be; Easily accessed Consistent Safe Quick Seamlessly integrated High quality Value for money The Clinical Contact Centres will coordinate and respond mobile health care resources, provide telephone triage, advice, and facilitate an online health care resource. The services provided will provide access to; o o o o o o Nurse Telephone triage, health information or advice Online health information, resources and advice Out of Hours call handling where commissioned Emergency Ambulance services Non emergency transportation planning and control Dental Help Line National Clinical Contact Centre Strategy V 1.8 Page 10 of 64

11 A patient, relative, carer, health care professional or member of the public telephoning NHS Direct Wales or seeking assistance from the ambulance service or OOH, where commissioned, will be answered within the Clinical Contact Centre within the Region from which they are calling whenever possible. The Clinical Contact Centre will however be virtual in nature so that at peak times through making use of leading edge technology the whole system capacity can be utilised and the same consistent high quality service provided from any of the three Regional centres. The staff who answer calls within the Clinical Contact Centre will be multi skilled, registering and signposting callers to the most appropriate provider (nurse, ambulance, OOH, PCS) for their condition or enquiry. This staff group will have the same core competences and will be recruited, selected and trained together to fulfil a variety of call taking duties. National Clinical Contact Centre Strategy V 1.8 Page 11 of 64

12 3.0 STAKEHOLDER ANALYSIS On the 18 th of June 2008 a large multidisciplinary team produced a stakeholder analysis that determined who the internal and external stakeholders are, their current interest and influence was also mapped STAKEHOLDER ANALYSIS University Higher Education NICE DOH Utilities Health and Safety CCA LRF Local Council Authority WAG / Acute / Trusts / Unions / HCW Trust Board / CHC / LHB s /Finance Training R&D / Technology Providers Health Informatics / Internal Estates / BT PCS / NET Centres / Staff / ARRP HOWIS / CAD Provider / USC NHS Trusts / Central Gov Internal Directorates / Business Continuity NHSDW / Hosp Trusts / Hosp Clinics GP S Political Parties / Execs / Public AM s / PM s / Non Execs Police Fire Cummunity Health Councils DDA / Equality & Diversity / BSP Suppliers Social Services External PCT s / HPC/ HR / GP OOH s Welsh Lang Board / Public Health Other Amb services / Mental Health First Responders / Risk Management Media / Clinical Gov / AMPDS Patient Focus Groups Influence (Low / Medium / High) Airports Fleet Providers Clinical Waste Amb Service Network Occupational Health Road Safety Forums Schools Entertainment / sports industry Environmental Agency Mountain Rescue Highway Agency Language Line NOSS Prison Services WRVS Coastguard RAF Complaints & Lit Sea Port Air Amb Income Generation HCS PPI Involvement Private Health Providers MOD Patients / families Welsh Risk Pool Hospices St Johns / Voluntary Services Prof Health Interest (Low / Medium / High) In order for this Strategy to be successful WAST must ensure that Stakeholders are fully engaged and a stakeholder management strategy will be developed separately. National Clinical Contact Centre Strategy V 1.8 Page 12 of 64

13 4.0 STRATEGIC DRIVERS WAST is committed to ensuring that its future Clinical Contact Centres are fit for purpose and that they provide an appropriate, safe and timely response to the people of Wales. The services should be easily accessed and tangibly improve both the patient experience and clinical outcome. WAST s strategic vision dovetails into a number of existing nationals strategies which are detailed below. 4.1 NATIONAL POLICY DRIVERS MODERNISIING UNSCHEDULED CARE (DECS) Modernising Unscheduled Care has been identified by the Welsh Assembly Government as a priority for delivering improved healthcare to the people of Wales. It is aimed at people who need access to health and social care that is not planned, and has a clear goal to make the service easier to use by helping people understand which service can best provide for their needs. Unscheduled care is provided through a range of community and primary care services of which the ambulance service is a key component. The Ambulance Service will play a key role as an enabler to support the modernisation of unscheduled care. The configuration of Unscheduled Care services will vary from area to area depending on the needs of the local population. The aim is to create the right mix of skills and facilities to ensure that patients are assessed by the professional who is most appropriately placed to deliver the care they need. All service provision will be reviewed with new service models being developed to meet unmet health needs, with other services being realigned to deliver the most appropriate care. The National Clinical Contact Centre Strategy therefore, will assist WAST in delivering it s obligation to modernise Unscheduled Care. The following Unscheduled Care principles 1 will underpin the future direction of travel. Treat the sickest person first, no matter how they enter the system; Deliver evidence based care within an agreed clinical model integrated with other service providers; Minimum time to definitive diagnosis, decision and initiation of treatment; Avoid passing the baton of care more than is necessary; Maximise the use of available resources (staff, technology and estate); Provide local care where possible, with full engagement of other service providers; Integrate and co ordinate service delivery through the use of care co ordination systems NHS WALES PRIMARY AND COMMUNITY STRATEGIC DELIVERY PROGRAMME Since the recent mergers of the Local Health Boards the development of a Primary and Community Services Strategic Delivery Programme is currently being led by Dr Chris Jones CBE, the focus of the Strategic Delivery Programme is to describe an integrated model of care as the basis of the vision for the new NHS in Wales. This Strategic Delivery Programme will be fully supported by this Clinical Contact Centre Strategy as it will create great stakeholder involvement, breakdown barriers, and steer patients safely to community based services where appropriate. 1 A Guide to Good Practice: Unscheduled and Emergency Care Services (National Leadership and Innovation Agency for Healthcare, 2008) National Clinical Contact Centre Strategy V 1.8 Page 13 of 64

14 4.1.3 DESIGNED FOR LIFE Designed for Life set the Vision in 2005 for the provision of health and social services in Wales until 2015, which includes the provision of unscheduled care services of a consistent response and of high quality, regardless of where, when and how the public or patients contact the service. It aims to ensure that pre designed pathways are in place to enable the right treatment to be provided, in the most appropriate place, from the right person, as quickly as possible, 24 hours a day. It also includes the sharing of patient information across the system, an emphasis on prevention and health promotion and a reduction in the number of people who require admission to hospital. Designed for Life similarly to DECS talks about patients following pre defined pathways, and a need for a consistent high quality response for the people of Wales. Transforming our current control centres into Clinical Contact Centres will allow WAST to develop a central clinical hub that can determine the best course of treatment for a patient rather than sending an emergency response inappropriately. It is also possible due to the imminent arrival of the Airwave and mobile data technology that primary care staff in the community could be mobilised to referrals direct from the clinical hub MAKING THE CONNECTIONS DELIVERING BEYOND BOUNDARIES Making the Connections Delivering Beyond Boundaries sets out to transform public services in Wales. This will mean significant change in the way public services work, built around the needs of the citizens. It will be focussed on meeting people s needs first time regardless of who provides the service, and is much more ambitious in driving up performance. WAST sees the significant benefits that can be achieved by working more closely with emergency service colleagues, and NHS partners in achieving common goals, advancements in referral pathways and directories of service will support this strategy. The opening of Vantage Point House in October 2008 has enabled greater partnership working as NHSDW and GPOOH s will be co located with EMS and PCS in the first Clinical Contact Centre of this kind WELSH AUDIT OFFICE REVIEW In July 2006 the National Assembly for Wales invited the Auditor General for Wales to lead an inquiry into the Ambulance Service in Wales. The inquiry was to review the effectiveness of performance standards, staffing issues, financial and resource pressures and consider the implications for the future. The final report published in December 2006 concluded that there were longstanding and severe problems throughout the service, but that they could be resolved over time provided that various internal and external challenges were dealt with. The report summarised twenty eight recommendations that could impact on both LHB s and Acute Trusts. The Trust Board s Modernisation Plan (Time to Make a Difference) was released in January 2007 set out the direction of travel to address the key weaknesses that had been identified in the WAO Report. The trust s modernisation plan recognised the need to ensure that we as an organisation are able to meet the needs of the public by sending the most appropriate resource to a patient in a timely and safe manner. The success of this Strategy will undoubtedly assist greatly in improving performance and patient experience in a measurable and sustainable way, and will close out action 17a in the WAO recommendations TAKING HEALTHCARE TO THE PATIENT Taking Healthcare to the Patient authored by Peter Bradley in 2005 outlines a clear strategic vision for the future of all UK ambulance services. It describes services that provide both high quality call handling and clinical advice (hear and treat) and safe effective mobile healthcare (see and treat). In achieving this vision, the four key challenges of Leadership, Education, Patient Involvement and Partnership Working, must be embraced to ensure that the service looks, feels, delivers and behaves differently in the future. Strengthening our Clinical Contact Centres both strategically and operational will allow WAST and its patients to benefit from some of the key strategic aims laid out in Taking Healthcare to the patient. National Clinical Contact Centre Strategy V 1.8 Page 14 of 64

15 4.1.7 FULFILLED LIVES, SUPPORTIVE COMMUNITIES IMPROVING SOCIAL SERVICES IN WALES This 10 year strategy for social services echo s the principles set out in Making the Connections Delivering Beyond Boundaries, of which key reforms will include the establishment of Local Service Boards, Local Service Agreements and improving the way in which public bodies engage with the people they serve. WAST will work with all other partners to deliver a service that is joined up flexible and efficient, to consistently high standards and in partnership with service users HIGH IMPACT CHANGES AND RESPONSE TIME ALGORTHYMS This document had been produced for ambulance trusts and key stakeholders involved in the commissioning and performance management to act as a guide, and bring together high impact changes and algorithms to bring about a real and sustained improvement in performance and patient care. The improvement philosophy underpinning the concept of High Impact Changes starts from the principle that ambulance service operations need to be designed not just to avoid performance failure, but also to enable continuous improvement across the whole organisation Some of the changes are stand alone in terms of delivery; others have clear dependencies with each other and require planned implementation through a robust project management process. In developing this document, we have considered the whole call management cycle and have worked to ensure that the changes are complementary and improve the whole system rather than just individual areas. The document also lists identified areas of good practice within ambulance trusts and highlights a number of Department of Health publications which organizations may find helpful, many of these have been incorporated already into the benchmarking that has been conducted by a specialist project group within WAST NATIONAL TRI SERVICES CONTROL The Trust is committed to exploring the concept of joint emergency services control centres with blue light partners optimising the potential for achieving economies of scale and maximising opportunities for synergy. This strategy will therefore be flexible and adaptable in response to the changing environment. National Clinical Contact Centre Strategy V 1.8 Page 15 of 64

16 4.2 LOCAL POLICY LOCAL DELIVERY PLAN The Local Delivery Plan (LDP) for Unscheduled Care has been developed in a collaborative approach with health care partners via the Local Health Board Unscheduled Care Project Boards. Participation in these Project Boards has ensured that the Ambulance Trust s plans are fully integrated with the wider provision of unscheduled care services in each of the health economies. The key aims of the LDP, as required by the Welsh Assembly Government are: Address the delivery of the national targets for 2009/2010 and the wider policy requirements to improve unscheduled services; Provide a comprehensive and clear vision of how the Ambulance Trust s contribution to unscheduled care services will be improved during the two year period; Be aligned to the High Level Aims for unscheduled care set out in the Delivering Emergency Care Services (DECS) strategy and the Annual Operating Framework 2009/2010 which are; o o o o o Managing Demand more effectively; Improving Ambulance Response & Handover times; Improve A&E waiting times; and Improve patient flow and discharge planning. Improve Patient experience (added by the Ambulance Service) Be comprehensive and community based, with all organisations being responsible for the delivery of one plan as opposed to several singular plans; Demonstrate consideration of the workforce required to deliver the planned services in line with WHC (2008) 050; and Enable the organisation to tangibly demonstrate service improvement. National Clinical Contact Centre Strategy V 1.8 Page 16 of 64

17 4.2.2 TIME TO MAKE A DIFFERENCE PROGRAMME The `Time to make a Difference (TTMD) Strategic Plan, January 2007, sets out how the Welsh Ambulance Service NHS Trust intends to transform Ambulance Services in Wales over the next 5 years. The role of the paramedic is planned to be enhanced in order to provide the capability to perform a greater range of clinical procedures. Underpinning this vision is the requirement to provide front line crews with enhanced information systems that can be accessed from the operational ambulance resource. The modernisation programme TTMD clearly identifies the need to implement modern, robust, fully functional mobile data terminal equipment in all service vehicles, in order to improve patient care, crew safety, operational, and clinical performance. The plan has two key, integrated elements. Firstly, the Trust will concentrate on getting the basics right in terms of strategy, people, processes and systems. Secondly, in the longer term, there will be a fundamental process of change. Central too many of the themes within TTMD is the requirement to get the right people in the right place at the right time, and key to meeting this requirement is the need to invest and develop our current control rooms into Clinical Contact Centres THE WELSH AMBULANCE SERVICE CLINICAL VISION The WAST clinical Vision implemented via the Clinical Directorate, in collaboration with all, places users and providers at the centre of pre hospital care. It supports the investment made within WAST and NHS Wales in leadership development and the need to sustain this and grow new future clinical leaders. In developing clinical leadership at all levels across the organisation we aim to safeguard the quality and safety of our patient services and ensure WAST remains responsive and accountable EXISTING BENCHMARKING As part of the existing controls projects run under the auspices of the Time to Make a Difference Programme there has been a significant benchmarking exercise. This benchmarking has examined working practices, staffing levels, staffing structures and technology, in other words the core components of the current control rooms. The benchmarking team identified elements of best and poor practice in each control room and visited five English Ambulance Trusts as a comparator, these were Northeast, East Anglia, West, South Western, West Midlands and Greater Manchester. The Benchmarking Report, (which contains one hundred recommendations for change) was formally approved on the 7 th May 2008 at a workshop led by the Deputy CEO Mike Cassidy. These recommendations have been split into two distinct areas standardisation and modernisation. The standardisation elements are being implemented across Wales and in the South East Region prior to the move into Vantage Point House. The modernisation elements will be continued in April 2009 following a period of bedding in to the new control environment. National Clinical Contact Centre Strategy V 1.8 Page 17 of 64

18 4.2.5 STANDARDISATION The Standardisation element of the benchmarking recommendations concentrates on aligning systems, codings, current technology, best working practices and call flow processes. This element involves thirty four of the one hundred recommendations and those that apply to the South East Region are required to be implemented prior to the move to Vantage Point House. Any remaining elements for the North and Central and West Controls will be addressed during the bedding in period for Vantage Point House. The standardisation element means that by October 2008 all Controls across Wales will operate and function in the same way which will allow for greater interoperability between regions and will also be a key enabler for a move to a virtual computer aided dispatch system (CAD) MODERNISATION The modernisation element of the benchmarking is secondary to the standardisation and contains the remaining sixty six recommendations, some of which are longer term objectives. A large part of these recommendations refer to the Department of Health s High impact changes and response time algorithms for NHS Ambulance Trusts April In undertaking the modernisation elements it is likely that there will be financial implications which will require business cases to determine business justification and affordability. An example of some of the modernisation elements will mean: Implementation of Status Plan Management Implementation of individual and collective performance management framework for Controls Implementation of the CAD upgrade National Control Structure Staff Training and development Virtual telephony system National Clinical Contact Centre Strategy V 1.8 Page 18 of 64

19 5.0 STRATEGIC OBJECTIVES 5.1 PERFORMANCE With the nature of the service that we provide there is a significant emphasis on the attainment of performance targets. As it is recognized that the control rooms are the hub for co ordinating the EMS & PCS services, it is acknowledged that their effective management and streamlining is critical to the achievement of the stringent targets that we are set. To ensure that we address this, this strategy aims to deliver the following: Establish a flexible structure that is able to adapt with the continually evolving health structure, enabling us to meeting the patient needs in a timely effective manner and maintaining a synergy between performance and patient safety/needs. Ensure that a robust performance management framework is integrated into the culture, structure and processes of the control room. 5.2 GOVERNANCE ~ PATIENT AND RESPONDER SAFETY With the increased emphasis on integration with other health care and blue light services, patient safety is key factor for consideration. There are four main components of patient safety that this strategy will address, these are: To address any governance issues relating to the sharing of sensitive patient information between individual health care providers. To establish a control structure that safeguards high standards of clinical care for patients and creates an environment in which clinical excellence will flourish. To establish effective clinical governance procedures and support for operational crews utilising telemedicine were a clinician is on hand to offer advice where appropriate. To establish and maintain a culture of clinical & non clinical professional accountability where staff are empowered to deliver a best in class service through the implementation of continuous professional development and performance management. 5.3 TIMELY APPROPRIATE RESPONSE As was outlined in Section 3 (Strategic Drivers) of this strategy there is a strong emphasis within Wales about ensuring that patient receive the right care at the right time. To support this concept this strategy aims to ensure that it delivers the following: The transformation of our current control centres into Clinical Contact Centres will allow WAST and other health care partners to develop a central clinical hub that can assist in determining the best treatment pathway rather than sending an emergency response inappropriately. This Strategy requires all other partners to collaborate and make community based services accessible and available for us by the Ambulance Service. An integrated control room structure that utilizes state of the art technology and industry best practice focused on meeting people s needs first time. National Clinical Contact Centre Strategy V 1.8 Page 19 of 64

20 5.4 VALUE FOR MONEY The primary object of documenting the trust s vision for Control Rooms in this strategy is to ensure investment decisions are strategically based any will continue to support the needs of the patient, health care community and public purse as a whole. Therefore in this area this strategy aims to delivery the following 2 things: To ensure that any investment is related to the achievement of long term strategy benefits in line with Trust and the wider health care community strategies (e.g. Modernising Unscheduled Care ) To effectively exploit any new technology and processes any to maximize efficiently saving whilst still meeting the patient and health care community needs. 5.5 MAXIMISING BENEFITS OF GENERAL WAST EXPENDITURE As we have mentioned previously the control room is the hub for successfully coordinating the effective delivery of our PCS, EMS and unscheduled care services. It is therefore the intention of this strategy to ensure the following: The final control room structures, processes and technology will enable the maximisation of benefits realisation of any future investment within the trust or unscheduled care community. Thus ensuring that the service demonstrates value for money with enhanced care for patients. 5.6 LINKS TO OTHER INTERNAL STRATEGIES Estates Strategy Fleet Strategy USC Strategy (Clinical Model) PCS Delivery Model Document Nursing Strategy National Clinical Contact Centre Strategy V 1.8 Page 20 of 64

21 6.0 FUTURE VISION THE NATIONAL CLINICAL CONTACT CENTRE FOR THE FUTURE 6.1 OVERVIEW OF WHERE DO WE WANT TO BE This strategy has been designed in such a way that is has described WAST s current position, what gaps exist within the current, and it is this part of the Strategy that paints our future vision of where we want to be. For ease of reading this section is laid out to reflect the core component parts of a functional efficient Contact Centre environment. 6.2 NATIONAL BUILDING INFRASTRUCTURE AND OCCUPANCY It has been very clear that whilst developing this strategy the integration of NHSD Wales is an extremely important factor in our future development of unscheduled care. The present situation is that of a disparate estate with call centre functions being carried out at different locations. The future state must therefore be the commissioning of three bespoke region centres that are designed to include the co location of, ambulance service, NHSD Wales and any other GP out of hours providers, similarly to the blueprint that Vantage Point House has produced. This approach is absolutely essential for WAST to meet its obligation under the DECS Strategy. It must be recognised that to achieve this aim, a robust planning and engagement process should be maintain with the Welsh Assembly Government and our commissioners. Each build must be modern future proofed and have significant room for expansion particularly if Wales were to adopt the English Call to Connect Standards. Currently this alone would not be viable due to the chronic shortage of space in our controls. 6.3 REGIONAL MANAGEMENT TEAM SUPPORT For the Clinical Contact Centres to receive the maximum benefit of senior managerial support it is essential that the regional management teams are collocated within these new builds. This managerial support can be effectively utilised in the event of a major / serious incident being declared. 6.4 DEMAND MANAGEMENT It is essential that each of the future Clinical Contact Centre have all activities baselined to ensure a match of resource versus demand against all disciplines within the contact centre. Each contact centre should have the ability to sophistically measure this alignment and implement changes to resources when required. In the first instance regional resilience must be assured, but this can be further strengthened by technological advancements when a virtual environment has been achieved. Once true virtualisation of services is achieved there will need to be an overarching monitoring of National Contact Centre Resources. National Clinical Contact Centre Strategy V 1.8 Page 21 of 64

22 6.5 RESILIENCE AND BUSINESS CONTINUITY It is imperative that each of the 3 Regional Clinical Contact Centres is fully resilient in all areas. This should include Electrical Generator Support Uninterrupted Power Supply Duplex Servers Emergency Lighting / Heating Backup Computer Aided Dispatch System Secure systems and premises No single points of failure Each Regional Clinical Contact Centre should be designed in such a way that it can effortlessly take over any deployment or call taking function of another centre instantly in the event of a business critical failure. Each Regional Contact Centre should have a resilient Mobile Command and Control Function capable of managing a major incident remotely from the Clinical Contact Centre. This mobile command vehicle should have full IT integration into our CAD systems and be able to effectively communicate with other Emergency Authorities. In the event of a significant outage of one of the Clinical Contact Centres, call taking and deployment functions should transfer instantaneously to the other centres. This would clearly not be sustainable, but in the short term would allow the region affected time to implement business continuity plans. Each Regional Clinical Contact Centre should have a mobile command and control vehicle capable of acting as a hub to facilitate a medium term solution. The mobile command unit should have the functionality to run both telephony and CAD services into a temporary structure so that a command and control function can be re established regionally. In addition each Regional Clinical Contact Centre should have a Strategic Command Room for managing major incidents. This room should be well equipped with the following. Phones Faxes Video Conferencing Voice Recording (room based) Access to CAD Systems Mapping Wall Mounted Displays A Suitable News White Boards Maps Additional space should be identified at all contact centres that can be utilised by external partner agencies such as Public Health etc. In addition to the above resilience each region should have provision of a fallback or dark site to be utilised in the event of a clinical contact centre being compromised for a significant length of time. This site should only be used in the event of a Regional Clinical Contact Centre being compromised for a prolonged period of time, possibly as a result of a structural problem, fire damage etc. National Clinical Contact Centre Strategy V 1.8 Page 22 of 64

23 Setup up Mobile Control Unit to return functionality Prepare Dark Site for Longer term occupancy Telephony Only Transfer Calls to other CCC s Issues not resolved CAD Only Split Deployment between the two other CCC s Fault find And Repair Full Systems or Building Comprimise Split Call taking to one CCC and deployment to the other Sustainable solution, matters resolved Clinical Contact Centre Strategy V 1.8 Final Page 23 of 64

24 6.6 TELEPHONY ARCHITECTURE The Telephony Architecture needs to overcome a number of key challenges as due to the co location of NHSD Wales the new structure would have a number of call streams coming into the centre. The vision in this strategy would be that NHSD would be a non emergency medical number for Wales in an attempt to reduce 999 activity and stream demand more effectively. Whatever the telephony solution it is essential that all Regional Clinical Contact Centres have integrated approach to telephony. The presenting calls whether these are emergency or non emergency should go to the next available appropriate operator in any of the Clinical Contact Centres. This would be extremely useful if one of the regions was involved in managing a major incident as the call taking flow could be managed by the other two centres. Best practice would dictate that the call taking function should not be co located with the dispatch function and all contact centres layouts should reflect this. 6.7 ICT INFRASTRUCTURE The future vision for the ICT Infrastructure is the need to move to a virtual systems. Following the benchmarking report significant work has been undertaken to pave the way for a virtual ambulance CAD by standardising current system codes and parameters. This strategy does not support the view of one central application, but is does recommend that every region will have its own server based application that feeds a central database. The reason for this is that in this case a regional application adds to resilience in the event of a failure. This approach would make essential upgrades more manageable. Currently we have different applications for EMS, PCS, and NHSD Wales, all these systems in principle should be virtualised, and any opportunity to developed merged solutions in the future should be explored. WAST must ensure that it remains vigilant with regard to software developments such as NHS Pathways, and that new products entering the market are closely followed, evaluated and implemented where appropriate. 6.8 HANDLING 999 CALLS DIFFERENTLY ~ CLINICAL TRAIGE Currently the Welsh Ambulance Service is licensed to use Advanced Medical Priority Based Dispatch (AMPDS) to prioritise its presenting 999 calls. This system is wholly dependant upon the caller s ability to answer key questions relating to the patients perceived condition. The system prioritises those calls where Priority Symptoms are identified as being the most urgent i.e. Immediately Life Threatening. AMPDS is an assured and proven process of prioritising 999 calls, however it doesn t allow the call taker much discretion to breakaway from the rigid questioning regime. Presently to effective triage calls requires additional software, training and development which must become the norm for all call takers. Clinical Contact Centre Strategy V 1.8 Final Page 24 of 64

25 A description of the categories of 999 calls can be summed up as follows: Call Category Purple Red Amber Green Description A subset of the RED call. Purple or Echo calls are the highest priority of calls. Emergency Calls Prioritised as being immediately life threatening. Emergency Calls Prioritised as serious but not immediately life threatening. Emergency Calls Prioritised as being neither immediately life threatening nor serious As already highlighted in this strategy WAST has piloted Clinical Desks into its existing control function. These desks have used NHSD Wales nurses to intervene in certain low acuity 999 calls. This has allowed for more in depth telephone triage using proven software to support a clinician in reaching a safe disposition for the patient concerned. The future state will maximise the clinical triage expertise of NHS Direct to be integrated across all call boundaries, and for a far higher rate of 999 calls to be offered alternative outcome i.e. safely downgraded with care being discharged appropriately. The ambulance service will remain significantly challenged by the fact that it has to react quickly to mobilise a response if the call is deemed to be immediately life threatening It is essential that WAST remains aware of changes to the marketplace with regard to clinical support software and that all new products are evaluated against WAST s requirement, NHS pathways being a prime example. It will be essential to procure systems or develop processes that can easily identify a life threatening call, but a system flexible enough to triage non immediately life threatening calls so that resources could be stood down. Once a suitable 999 call is identified this is when the greater clinical expertise from NHSD Wales should be used to gain a greater understanding of the patients presenting condition. Each Regional Contact Centre should have a robust Clinical Area that has highly trained clinically qualified call takers that will manage the call through to its conclusion. National Clinical Contact Centre Strategy V 1.8 Page 25 of 64

26 6.9 CALL FLOWS AND NHS PATHWAYS NHS PATHWAYS WAST has recently been made aware that NHS Pathways software has now been approved for the use in UK ambulances services. NHS pathways offers alternative services to callers who do not need an ambulance response. This move means that ambulance services can now choose to train 999 operators to use the system, which allows them to make immediate referrals to local services that may be more appropriate. NHS Pathways has been piloted successfully in the North East, where it has been used for two years and has handled more than 1m calls. NHS Pathways has additionally been assessed and approved by the Emergency Call Prioritisation Advisory Group, an independent committee chaired by Peter Bradley, the DH s national ambulance advisor and chief executive of the London Ambulance Service. NHS Pathways has been shown to help call handlers make a more accurate assessment of calls that need an urgent ambulance response. Conversely, a survey of patients in the North East who dialled 999 but did not need an ambulance found that 93% were still happy with the response they received. WAST must ensure that exiting new developments in the market place such as NHS Pathways are fully evaluated and considered as potential essential modernisation away from the disparate systems used today AVAILABLE CLINICAL SUPPORT As part of the multidisciplinary team approach within the Clinical Contact Centres it is essential that at any time call handlers, allocators, and managers have unhindered access to an experienced clinician that can support and advise on difficult calls. This approach will add to clinical safety, increase user confidence, and leave all staff feeling supported in the workplace National Clinical Contact Centre Strategy V 1.8 Page 26 of 64

27 6.9.3 FUTURE CALL FLOW PROCESS This is the proposed call flow process for the National Clinical Contact Centre National Clinical Contact Centre Strategy V 1.8 Page 27 of 64

28 6.9.4 COMPLEMENTARY MANAGEMENT STRUCTURE TO SUPPORT NEW ROLES Previous versions of the National Clinical Contact Centre Strategy have suggested a proposed future structure for the Clinical Contact Centre. This structure has now been superseded by the current management restructuring process and will be determined upon the outcome of that process. Clinical Contact Centre Strategy V 1.8 Final Page 28 of 64

29 6.9.5 RESPONSE TO CALL RATIOS 999 CALLS This document has already detailed how the Welsh Ambulance Service is experiencing as all ambulance services are with year on year rises in demand. Historically the Ambulance Service is a reactive service and currently the call to response ratio is very high. It is essential that sending an emergency resource to an incident should only happen when it is clear that the acuity of the patient s condition warrants such a response STAFFING STRUCTURES AND RESPONSIBILITIES Due to the integration of NHSD Wales and Ambulance Service Controls much work will need to be done to harmonise roles. NHSD Wales will bring with them much expertise in clinically accessing a wide variety of calls. The ambulance service recognises this expertise and acknowledges the fact that our current reactive deployment is based on a prioritisation and not on telephone triage. Much will be gained by utilising elements of best practice from specialist areas, NHSD Wales, and Ambulance Control Skills. To progress staffing structures transparently it will be necessary for an in depth review of demand, current establishments and future roles to be completed. It is essential therefore that this process is completed with the buy in of Human Resources and Staffside. Although it is clear that some economies of scale will exist by fully integrating NHSD Wales and Ambulance Service controls, there is a significant requirement for additional and exciting new roles required for this strategy to meet its objectives REGULAR AUDITS Audits should be carried out twice yearly, with re audits if necessary to close out any non compliances. Some of the key areas that should be covered are as follows. Compliance against KPI s Implementation of recommendations from clinical incidents and complaints Adherence to existing Standard Operating Procedures Procedural knowledge to enable management of serious incidents Examination of Qualifications and Evidence of continuous professional development LEADS The Deputy CEO has overall responsibility for the direction and success of this strategy, with support from the Clinical Director and their respective teams. The Utilisation Managers are each responsible for their own Control, and report directly to their Regional Director. Where projects are required to deliver an output, subject to business case approval there will be a dedicated project manager assigned to the projects, with the Programme Manager for Controls monitoring progress against the overall TTMD Modernisation Programme. Clinical Contact Centre Strategy V 1.8 Final Page 29 of 64

30 7.0 WORKFORCE The Trust must ensure that it s most important asset, its staff are used effectively as possible. As well as ensuring that there is a dynamic workforce plan in place there, must be a electronic resource product that can examine a national picture at any one time, and plan accordingly. This may include the movement of functions between the Contact Centres at times of predicted high demand, special events, sickness, and system outages. Welsh language provision must always be factored into this process. In addition the Clinical Contact Centre must evolve the concept of multidisciplinary team working. This concept will see the breaking down of existing or historic silos, and lead to a level of greater integration, culture and performance. 7.1 CULTURE The Clinical Contact Centre teams need to recognize their pivotal and specialized role in supporting the wider organization to meet its targets. By striving towards standards of excellence in achieving KPIs and developing systems to provide care pathways the Contact Centres should develop an identity separate but complementary to the EMS and PCS transport facilities. The culture within the Contact Centres needs to be strong but supportive leadership that encourages, supports, motivates, and empowers its staff. All Contact Centres should develop their staff to the highest possible standards of service. 7.2 WORKFORCE PLAN The Trust will develop a workforce plan for its Clinical Contact Centres. The plan will ensure that minimum staffing levels by grade are achieved to ensure that each Contact Centre is closely aligned to its call demand profile, and that appropriately trained and skilled call takers are available when needed. This will require significant training and development across all disciplines to achieve a multi skilled workforce, combined with comprehensive demand profiling to ensure a best fit of local resources. The Trusts Workforce Plan will include the requirements of the modernisation of the Clinical Contact Centre. The vision will include integrated recruitment, selection and education of the workforce. 7.3 EDUCATION AND DEVELOPMENT It is extremely important that WAST ensures that its National Clinical Contact Centre Staff have the opportunity to develop throughout their service. It is clear that the ambulance service needs to reduce its call to response ratio as many callers do not require an emergency ambulance response. This could be achieved at source by increasing the skill of the relevant call takers to allow an alternative disposition to be found that does not rely on an ambulance or RRV emergency response. A key driver to this could be the development of NHS Pathways software within Wales. The development of management skills within the teams should closely reflect roles as either operational or staff managers. Every staff member within the clinical contact centre should have a clearly identified line management structure for the support of personal and professional development. The Trust must ensure that its induction packages and career paths are clear and supportive. All staff should have regular standardised one to one s and each member of staff should have a personal development plan. The Knowledge and Skills framework should be fully adopted to support and reward staff development. National Clinical Contact Centre Strategy V 1.8 Page 30 of 64

31 WAST should continue to engage with the National Call Handling Curriculum which can develop staff to Higher Education levels. A particular area for development is that of the management function within the Contact Centre, and it will be a pre requisite that all managers undertake a formal management qualification, either a general qualification or a specific Contact Centre Course. All staff employed after 2004 should have attained the NVQ Contact Centre Professionals (ranging levels 1 to 4 depending on role). Those staff who have a post registration career framework must be adequately supported in meeting their individual requirements to maintain effective registration. 7.4 CORE COMPETENCIES The Ambulance Review Forum which is lead by Peter Bradley, has commenced a review of the National Competencies that are relevant for Emergency, Urgent and Scheduled Care staff that provide teleadvice to the public. Skills for Health have been contributing to this work in identifying any gaps and the development of new competencies where necessary. This work is ongoing with involvement from key stakeholders, and the individual competencies are still in draft format, rather than a complete National Competency Framework being available. The Trust will continue to link in with Skills for Health, to obtain updates on progress on this important development element for our Clinical Contact Centre staff. 7.5 STAFF WELLBEING The Contact Centres should provide all staff with the best possible facilities in which to conduct their work, the contact centres should be fully compliant with contact centre standards laid down by the Health and Safety Executive. Any new clinical contact centre that has a proposed life span up to 10 years should have a minimum of 33%, and a maximum of 50% room for future expansion. This would be particularly relevant if Wales is to adopt the Call to Connect Standards in the future. It is also extremely important that staff are placed within a team structure, and as such each team can be self sufficient in providing, mentorship, leadership and training. This will improve support to the individual, and increase accountability throughout our contact centres. There is a need to ensure that each contact centre has a quiet room that staff can go to after having taking a distressing call from the public. More importantly all managers including trainers should be trained to provide the most appropriate support, and to recognise early signs of work related stress and act accordingly. Individual staff should be educated to understand how the nature of their work can affect them, and how they can best deal with these situations as they occur. Every member of staff working in a clinical contact centre should have unhindered access to a full range of occupational health services including counselling. WAST must be compliant to the European Working Time Directive and it essential that each centre has electronic rostering capability. To spread workload more evenly rotas should be reflective upon the demands placed upon the service. National Clinical Contact Centre Strategy V 1.8 Page 31 of 64

32 8.0 SYSTEM ARCHITECTURE Welsh Ambulance Services NHS Trust The Trust must ensure that it moves to a resilient virtual computer aided dispatch system. Each Contact Centre should be able to take over the full or part functionality of another Contact Centre in the event of an incident occurring that comprises business continuity. 8.1 VIRTUAL COMPUTER AIDED DISPATCH It is essential that each Clinical Contact Centre has the best possible software applications to support its staff in the following key areas. Fast Prioritisation of 999 calls Supported Deployment ensuring the fastest and most appropriate resource is sent Clinically supportive software to effectively Triage Calls safely Electronic Incident Transfer to pass calls to other providers 8.2 TELEPHONY INFRASTRUCTURE The Trust must ensure that its telephony infrastructure is designed in such away that all contact centres are able to effortlessly answer any presenting call. Each Contact Centre should have a separate call taking area that does not antagonise the deployment of resources. A member of the public calling a contact centre should always get the next available call handler regardless of that call handlers location. National Clinical Contact Centre Strategy V 1.8 Page 32 of 64

33 9.0 CUMMUNICATION PLAN Welsh Ambulance Services NHS Trust The Trust has a full time communications department that will assist in ensuring that information contained within this Strategy is effectively communicated to all key stakeholders. National Clinical Contact Centre Strategy V 1.8 Page 33 of 64

34 10.0 HIGH LEVEL PLAN High Level Task Year 08/09 Year 09/10 Year 10/11 Year 11/12 Year 12/13 Year 14/15 Year 15/16 Year 16/17 Year 18/19 Year 20/21 National Clinical Contact Centre Strategy Stakeholder Management Strategy OPSP002 Benchmarking against other ambulance services OPSP002 Recommendation report 100 recommendations OPSP002 Implement standardise recommendations SE region ESTP008 VPH merge 2 SE control rooms, add NHSDW, GPOOH, EMS & PCS OPSP002 Standardise all regions with 34 recommendations by October 08 ESTP008 VPH bed in new Clinical Contact Centre Business Case for modernisation of Controls and implementation of N & CW Clinical Contact Centres April 09 Begin implementation of modernisation recommendations in SE Clinical Contact Centre Clinical Contact Centre Strategy V 1.8 Final Page 34 of 64

35 High Level Task Year 08/09 Year 09/10 Year 10/11 Year 11/12 Year 12/13 Year 14/15 Year 15/16 Year 16/17 Year 18/19 Year 20/21 PCS move into Carmarthen Control Centre (non essential staff move out to other locations) April 09 Begin implementation of some modernisation recommendations into N & CW existing Control Centres New Project Virtual CAD System New Project Status Plan Management Planning & design of North Region Clinical Contact Centre fully modernised with NHSDW from Bangor New Project North Region Clinical Contact Centre fully modernised with NHSDW from Bangor Planning & design of CW Region Clinical Contact Centre fully modernised with NHSDW from Swansea New Project CW Region Clinical Contact Centre fully modernised with NHSDW from Swansea National Clinical Contact Centre Strategy V 1.8 Page 35 of 64

36 11.0 CONTACT INFORMATION Mr Alan Murray Chief Executive Officer Welsh Ambulance Services Headquarters Upper Denbigh Road St Asaph Denbighshire LL17 0RS Clinical Contact Centre Strategy V 1.8 Final Page 36 of 64

37 12.0 GLOSSARY 999 Call Emergency Call AM Assembly Member AMPDS Advanced Medical Priority Dispatch System ARRP Ambulance Radio Replacement Project AS1 Document Reference for an emergency call AS2 Document reference for an Urgent Admission AS3 Document Reference for a Routine Patient Journey ASST Assistant BSP Business Support Partnership BT British Telecom C3 Version of EMS CAD CAD Computer Aided Dispatch Cat A An Immediately Life Threatening Emergency Call Cat B A Serious but not Immediately Life Threatening Call Cat C An Emergency Call that is neither life threatening nor serious CCA Civil Contingencies Act CCC Clinical Contact Centre CEO Chief Executive Officer CHC Community Health Council CPD Continuous Professional Development DDA Disability Discrimination Act DECS Delivering Emergency Care Strategy DFL Designed for Life DOH Department of Health EMS Emergency Medical Service GP OOH General Practitioners Out of Hours GP General Practitioner HCS Health Courier Service HCW Health Commission Wales HDS High Dependency Service HOWIS Health of Wales Information Server HPC Health Proffesions Council HR Human Resources ICT Information Communications Technology KPI Key Performance Indicator LHB Local Health Board LRF Local Resilience Forum MOD Ministry of Defence NET Centre Non Emergency Transport Centre NHS National Health Service NHSDW CAS NHS Direct Wales Clinical Assessment System NHSDW NHS Direct Wales NICE National Institute of Clinical Excellence Non Exec Non Executive Director NOSS National Occupational Standards for the Inspection of Public Services Skills for Justice One to One Meeting on a one to one basis OOH Out Of Hours OPSP002 Operations Project 002 PCS Patient Care Services PPI Patient & Public Involvement Pre Alert Electronic Early Notification of an incident on CAD R&D Research & Development RAF Royal Airforce RTA Road Traffic Accident SMS Short Message Service TTMD Time to Make a Difference Modernisation Programme National Clinical Contact Centre Strategy V 1.8 Final Page 37 of 64

38 URG USC WAG WAO WAST WRVS Urgent Unscheduled Case Welsh Assembly Government Welsh Audit Office Welsh Ambulance Services NHS Trust Womens Royal Voluntary Service National Clinical Contact Centre Strategy V 1.8 Final Page 38 of 64

39 APPENDIX 1 CURRENT ESTATE POSITION The Welsh Ambulance Service and NHSDW merged with NHSD Wales on 1 st April The Trust has the following disparate Control / Contact Centre estate infrastructure. Region Service Provision Location Owned / Leased North Region Emergency Medical Services Patient Care Services Net Centre Bryn Tirion, Llanfairfechan, N Wales Leased Central & West Region South East Region Income Generation District Nurses Midwives Public Health Board Oncall Local Health Board Oncall NHSDW Contact Centre Bangor Building Owned but not the land Emergency Medical Services Patient Care Services Net Centre Carmarthen Cefn Coed Hospital, Cockett, Swansea Leased NHSDW Contact Centre Swansea Leased Patient Care Services Proposed for move to CW Leased Control Llangynor, Carmarthen Patient Care Services Community Alarms Withybush Hospital, Pembrokeshire Leased Emergency Medical Vantage Point House Leased Services from October 2008 Patient Care Services NHSDW Bed Management GPOOH s The North control room is dated, lacking expansion potential and will require replacement in the near future. It will accrue significant repair costs relating to the estate, heating, drainage, water, gas, and electrical systems. In addition to the issues listed above the north control room situated at LLanfairfechan has significant dependencies from the neighbouring hospital site with regard to heating services. Also, as the need for technology has increased this site has a significant limitation with regard to its power supply, so much so that it has been identified as a catastrophic risk for the Trust with a risk rating of 25. Carmarthen Control is situated at the Dyfed Powys Police Headquarters where they share certain facilities. It is at capacity and any expansion plans would have to be agreed jointly with the landlord concerned. Currently there are ongoing proposals to relocate PCS from Cefn Coed in Swansea, into Carmarthen Control, subject to the relocation of some of the current residents who are non control essential personnel. National Clinical Contact Centre Strategy V 1.8 Final Page 39 of 64

40 The Southeast Clinical Contact Centre at Cwmbran (Vantage Point House) became fully operational in December 2008, this building is in stark contrast to the other centres, being a fully modernised building which brings together core service provision and cements relationships between ambulance service control, NHSD Wales and GP OOH s. Vantage Point House is a blueprint for the future of Clinical Contact Centres across Wales. NHSDW have three Contact Centres, located in Bangor, Swansea and Vantage Point House. All three of these centres are relatively new and modern buildings that are fit for their current operational role. However non of these sites have significant room for expansion. National Clinical Contact Centre Strategy V 1.8 Final Page 40 of 64

41 APPENDX 2 CURRENT CONTROL INFRASTRUCTURE EMS CONTROLS The Welsh Ambulance Service s Emergency Control rooms currently deal with in excess of 350,000 incidents per year. These calls include life 999 calls (AS1), Doctors Urgent admissions (AS2), and bookings for routine ambulance transport (AS3). It operates its command and control function from three main sites, one in the North, Central West and Southeast Region. All Emergency Medical Service Contact Centres operate round the clock 365 days a year. They are responsible for the effective utilisation of ambulance resources. These resources include emergency ambulances, Solo Rapid Response Vehicles, Community First Responders, Co responders and High Dependency Vehicles. Pre April 1998 there were five ambulance trusts throughout Wales, with eight control rooms that were rationalised down to four by The merger with NHSDW in April 2007 has increased this to seven Control rooms / Call Centres across Wales. It is this legacy that has left wide variations between technology, systems, structures and working practices that are in the process of being standardised today by the OPS 2 project group. In addition to the general resource utilisation the control centres also have responsibility for coordinating large scale incidents, liaising with other emergency services, and other UCS healthcare providers Each Contact Centre operates a computer aided dispatch system (CAD). These systems currently run the same software application provided by MIS Emergency Solutions LTD. Currently each control room runs its own CAD system, and there is no ability for electronic incident transfer between the controls which does not provide any resilience in the event of a critical system failure. This is also not conducive to the management of cross boundary incidents between Regions. To meet its obligations under the Welsh Language Act 2 A fully bilingual service is provided in North Control by ensuring that there is a Welsh speaker available on every shift. Central and West are able to partially achieve this requirement, with South East being unable to achieve it due to the lack of Welsh speaking staff. When Central & West and South East Regions are unable to provide a Welsh speaker the calls can be translated by accessing a language line service or from gaining assistance from another control room where a Welsh speaker was available. Provision of the virtual telephony and CAD system will enable this service to be provided seamlessly. Performance Management frameworks for Control in Wales are currently being designed and implemented but are at a very early stage. It is essential that these structures and processes are developed consistently across all regions to reflect the roles of the individual staff concern. On a day to day basis operational performance is monitored by the Shift Managers on duty in conjunction with their Allocators. Operational performance is reported upon regularly throughout the day to operational and senior managers within each region. It is also reviewed historically for lessons learned and trend analysis at Level 1, 2 and 3 performance meetings. 2 Duty of notified public bodies to prepare schemes (1) Every public body to which a notice is given under section 7 below and which (a) provides services to the public in Wales, or (b) exercises statutory functions in relation to the provision by other public bodies of services to the public in Wales, shall prepare a scheme specifying the measures which it proposes to take, for the purpose mentioned in subsection (2) below, as to the use of the Welsh language in connection with the provision of those services, or of such of them as are specified in the notice. (2) The purpose referred to in subsection (1) above is that of giving effect, so far as is both appropriate in the circumstances and reasonably practicable, to the principle that in the conduct of public business and the administration of justice in Wales the English and Welsh languages should be treated on a basis of equality. (3) In preparing a scheme under this Part of this Act a public body shall have regard to any guidelines issued by the Board under section 9 below. National Clinical Contact Centre Strategy V 1.8 Final Page 41 of 64

42 Interfaces into the independent health record currently do not exist however this area will need developing when the service commissions a mobile data capability. Any development in this area will be carried out in conjunction with Informing Healthcare (IHC). All Regions have an Advanced Medical Priority Based Dispatch System (AMPDS) Facilitator and Auditor that audit 3% of all emergency calls. All Controls in Wales have been accredited with the Centre of Excellence award for achieving compliance with the Academy guidelines. There are only approximately 60 Controls worldwide that have achieved this standard. Wales is the only Country that has achieved it. There are four regionalised analogue radio systems that have limited connectivity and are inflexible to the needs of a modern ambulance service. These systems are not reliable; coverage is poor with only approximately 46% of the Welsh land mass having a service. The ARRP Project in ongoing and Airwaves will provide excellent coverage down to hand portable level on all A and B class roads and centres of population throughout Wales. It is totally flexible and not restricted to regional or functional boundaries. It is a key driver in achieving a virtual CAD and will provide resilience in the event of a control failure. ARRP also adds a dimension interoperability with other emergency service colleagues which is an essential element of managing a major incident. National Clinical Contact Centre Strategy V 1.8 Final Page 42 of 64

43 EMS HIGH LEVEL MANAGEMENT STRUCTURE The Management Structure for each Control is shown below. The Regional Directors are responsible for the Control/s within their region. National Clinical Contact Centre Strategy V 1.8 Final Page 43 of 64

44 OPERATIONAL EMS MANAGEMENT STRUCTURE ~ LOWER LEVEL The staffing structure within each EMS control has recently been standardised across Wales as part of the OPSP002 benchmarking exercise. This has enabled dedicated roles and responsibilities to be functional in each Control, in readiness for such time that a virtual control is in operation which will allow for interoperability between regions. The roles that are included within the standardised staffing structure are as follows; *Please note that AMPDS Facilitators and Auditors sit within the Clinical Directorate National Clinical Contact Centre Strategy V 1.8 Final Page 44 of 64

45 EMS CLINICAL DESKS WAST has been running Clinical Desks as a pilot within its ambulance control rooms. This pilot has involved NHSD Wales nurses being co located within the ambulance control. Once a 999 call has been prioritised as a CAT C (Nurses able to deal with 83 of the 92 sub codes for Cat C Calls) call which is neither life threatening nor serious it can be handed over to a nurse for further telephone triage. To ensure maximum safety for callers certain other circumstances were excluded, such as out of area calls, paediatrics, and 3 rd and 4 th party calls to name a few. The flowchart below shows the process National Clinical Contact Centre Strategy V 1.8 Final Page 45 of 64

46 The performance of the Clinical Desk has been audited and the reported results are tabled below (Aug / Oct 2008). No. of category C calls Total % Category C calls passed to the clinical desk % Calls resolved by Nurse no ambulance response/ transport required * % Calls returned for emergency ambulance (EA) 999 response 87 16% Calls downgraded to urgent (AS2) response % Other (e.g. ambulances arriving on scene & patients refusing triage) 74 14% Calls excluded due to risk assessment (e.g. public place) 8 1% Of the calls passed for Nurse triage (n = 541), 39% resulted in no ambulance response/transports to hospital. When calculated against the number of calls that were eligible for transfer to the Nurses in the 2 month period, this encouragingly equates to 3.5 ambulances being stopped per day. Further improvement is supported by previous evidence 3 that identified that where low priority 999 calls are resolved by the Nurse, the ambulance job cycle time (receipt of call to handover at hospital) is reduced by 37 minutes. For PDSA cycle 2 this equates to 7, 807 minutes (or 130 hours) saved of ambulance job cycle time (releasing emergency ambulance resources to respond to immediately life threatening calls). 3 Turner J, Snooks H, Youren A, et al,. (2006) The cost and benefits of managing some low priority 999 ambulance calls by NHS Direct nurse advisers. Report for the National Co ordinating Centre for NHS Service Delivery and Organisation. National Clinical Contact Centre Strategy V 1.8 Final Page 46 of 64

47 EMS CURRENT CALLFLOW PROCESS Currently, the call flow process within each control room operates in a similar way with some slight variations. The Call taker processes the call through the AMPDS system and Pre Alert. The call is then passed to the Allocator to dispatch a resource, and it is also viewed by the Incident Support Desk for the possibility of deploying an alternative responder. The Assistant Allocator provides assistance in messaging the hospital, fire police etc. See call flow process diagram below EMS CONTROL TRAINING Historically, Control training has been provided within each region with little or no coordination across the Trust from a national perspective. More recently, this has now moved to be coordinated by the National Ambulance Training College in Swansea with a dedicated Control Training Coordinator. Training courses are established on an as and when basis and are not pre planned from a National perspective, which would allow for financial benefits to be achieved through economies of scale. National Clinical Contact Centre Strategy V 1.8 Final Page 47 of 64

48 PCS CONTROLS The Patient Care Service undertakes approximately 1.3 million non urgent patient journeys each year utilising a wide range of staffing and vehicle combinations. PCS currently does not have a national contract but does have 12 individual service level agreements that sit with acute trusts and local health boards. PCS transport a wide range of patients with specialist needs; these include renal, mental health, oncology and hospice patients to name but a few. To accommodate a diverse patient base PCS have a wide range of vehicles to transport patients, these range from doubly crewed ambulances to volunteer car drivers. PCS produces an income of 16 million pounds per annum and operates predominantly on a Monday to Friday 0800hrs to 1800hrs basis. PCS control and planning functions are currently operated from 22 locations across Wales. These locations vary in size and ownership, some being hospital based liaison offices, others being based in ambulance stations. Out of the 22 sites there are only four recognisable central control points of note. The PCS control function in the north and southeast is co located with the EMS control with Cefn Coed being an outlier. There is also a PCS function in operation from Withybush Hospital in Pembrokeshire. The PCS legacy systems for the Southeast Region have been centralised at Vantage Point House and the Central and West region based at Cefn Coed are anticipated to move to the Central and West Control in Carmarthen. Similarly to EMS, PCS controls are outdated and lack space for expansion. The process of planning and controlling within the Regions is fragmented with numerous variations of models operating in each of the regions and also even variations within the regions, which lack cohesion and structure. These varying models have little or no procedures and as a result planners are led by tradition. Currently there is no connectivity with the EMS CAD system which would allow for bookings that are received by EMS Control to be electronically transferred to the PCS function. Therefore this can result in an EMS resource undertaking transport unnecessarily that could be managed by PCS. There are number of PCS projects currently underway to modernise PCS. The implementation of the cleric computer aided dispatch system will assist in standardising working practices and improve the way PCS crews receive their work on a daily basis. National Clinical Contact Centre Strategy V 1.8 Final Page 48 of 64

49 PCS STRUCTURE NON EMERGENCY TRANSPORT (NET) CENTRES There are two Non Emergency Transport (NET) centres, one located in North Control in Llanfairfechan and the other located in Central and West Region at Cefn Coed Hospital. The operation of the South East NET centre is independent of the Ambulance Service and calls are managed by Rhondda Cynon Taff Local Health Board, and then passed on to the Ambulance Service to provide the transport. The NET centres operate by the application of an all Wales Eligibility Criteria to ensure that transport is only provided to the patients and escorts that really need it. Patients who do not qualify for transport are signposted to alternative transport providers. The single database of patient registration across Wales will allow for the equitable provision of service, and provide consistency and utilisation of patient information. NET CENTRE STRUCTURE National Clinical Contact Centre Strategy V 1.8 Final Page 49 of 64

50 NHS DIRECT WALES On the 1 st of April 2007 NHS Direct Wales became part of the Welsh Ambulance Service NHS Trust. NHS Direct Wales provides a 24 hour confidential health advice and information service, signposting the people of Wales to the most appropriate level of healthcare for their needs. Nurses and call handlers provide 24 hour telephone triage via the helpline. Following a detailed clinical assessment using Clinical Assessment Software (CAS) callers are provided with advice as to which service they need to access to meet their clinical need, or where appropriate they are advised as to how to care for themselves at home and manage their symptoms. The Health Information service delivers Information Therapy which is dispensed using information prescriptions via the 0845 service and P1/NHSDW Website. Information Therapy includes: descriptions of conditions and treatment options; self management information; access to community based and online resources such as self help and wellbeing support groups. Health Information advisors provide front line support via the telephone and online for service users. They provide advice and information to support users to make sound decisions regarding their own healthcare and to navigate the complex health care system effectively by appropriate signposting to services and groups. The NHS Direct Wales website is promoted as the consumer health information portal for Wales (Portal one). The website is accessible for the public and health professionals and holds a variety of diverse resources including a bilingual A Z health encyclopaedia; health service directories and an online information prescription service. NHSDW provides 24 hour health information and advice service for the deaf community by the use of text phone (Minicom), with plans to develop SMS and fax contact for deaf callers in the future. A bilingual English/Welsh service is provided with all other languages provided via links to Language Line. NHSDW has electronic links via the Adastra system to immediately transfer and share data with the partnered out of hours services. NHSDW patient records can be flagged to denote safe haven patients or resuscitation status to ensure safe and appropriate care delivery. NHSD Wales operates from three call centres Bangor, Swansea and Gwent, and a Headquarters building in Swansea. All properties are leased with the exception of Bangor where the building is owned but not the land. In comparison to the ambulance service controls NHSD sites are far more modern with no building being less than seven years old. However like ambulance service sites NHSD sites are also restricted as far as expansion is concerned with only six seats spare across Wales. All NHSD Wales sites have uninterrupted power supply (UPS) installed, generator support and off site data warehouse functionality for clinical data. NHSD Wales has the ability to identify previous contacts from patients and manually flag them if appropriate, but has no electronic data transfer to the current ambulance service controls. NHSD Wales does have a link to other healthcare providers by utilising adastra. NHS Direct is operationally managed by an operational nurse and Call Handler Coordinator on each shift who monitor the clinical safety of all callers to the organization and regulate call flow to meet KPI requirements. The service is managed as a virtual unit and the operational nurse and Call handler Coordinator can be based in any of the three sites. The Operational Nurse provides initial management of any adverse incident or complaints. Out of hours a senior manager is on call for higher level clinical, operational and major incident support. A minimum of 1 call per call taker is randomly reviewed for quality and performance management purposes. Results of call audits are used to inform training and individual performance management. All reviews are held on a central database to highlight trends and themes. A panel meets monthly to audit the quality of the reviews. NHSD Wales has recently been engaged in providing information and advice to the public with regard to the recent swine flu pandemic. National Clinical Contact Centre Strategy V 1.8 Final Page 50 of 64

51 Local Health Board No of Calls Region No of Calls Swansea LHB 1261 Gwynedd LHB 761 Angelsey LHB 525 Rhondda Cynon Taf LHB 346 Cardiff LHB 319 Caerphilly LHB 246 Neath Port Talbot LHB 229 Bridgend LHB 221 Newport LHB 196 LHB Not Known 184 Non-Wales LHB 161 Carmarthenshire LHB 144 Conwy LHB 127 Torfaen LHB 121 Vale of Glamorgan LHB 110 Flintshire LHB 102 Monmouthshire LHB 96 Wrexham LHB 93 Pembrokeshire LHB 80 Powys LHB 67 Merthyr Tydfil LHB 62 Blaenau Gwent LHB 61 Denbighshire LHB 61 Ceredigion LHB 42 Total 5615 NHSD Wales currently escalate a relatively small percentage of their calls to attract an ambulance response. As there is no electronic link currently this is normally completed by the means of an additional call. The table on the left shows the number of calls transferred during 2007 by local health board area. The table below shows the number of calls equated to ambulance regions. Region No of Calls Southeast 1557 Central and West 2044 North Region 1669 All Wales 5270 OOA 345 National Clinical Contact Centre Strategy V 1.8 Final Page 51 of 64

52 CURRENT NHSD WALES STRUCTURE NHSD Wales are currently reviewing their own structure and how they dovetail into the ambulances services current structure, for this reason this documents includes the current and a proposed short term structure. Clinical Contact Centre Strategy V 1.8 Final Page 52 of 64

53 PROPOSED TRANSITIONAL STRUCTURE National Clinical Contact Centre Strategy V 1.8 Final Page 53 of 64

54 APPENDIX 3 DEMAND EMS / PCS / NHSD WALES EMS DEMAND WAST serves a population of 2.9 million across 20,640 sq kilometres and incorporates both urban and rural communities. The Trust employs 2,576 people of whom 76% are operational: 1,310 on emergency duties; and 693 on non emergency ambulance and Health Courier Services. In common with all Ambulance Trusts, the demand for 999 services is increasing year on year. This is particularly so in Wales where demand is growing faster than in England. Activity levels suggest there is no evidence of this trend changing. As is the case for many public services, the geographical and demographical profile of Wales provides its own challenges. In the sparsely populated areas, Emergency Medical Service activity is low, but because of the geography it is necessary to maintain levels of cover which would not otherwise be justified. In addition to this WAST experiences seasonal uplifts in its activity relating to transient population increases due to tourism. However, above all of these is the continuing trend of increased public expectation for service provision. Like many other areas of the public service sector, the quality and availability of emergency ambulance services has risen but not in line with the pace of improvement or demand expected by the population served. This and the other factors mentioned above all contribute to the growth in demand for the Trust s services. Clinical Contact Centre Strategy V 1.8 Final Page 54 of 64

55 Figure 1 : Graph Showing Number of Calls Figure 2 : Graph Showing Number of incidents The Trust has seen growth in the number of incidents consistently over the past four years. Control TOTAL AS1 As2 As3 Carmarthen 132, ,768 19,475 5,385 Church Village 42,807 36,467 4,791 1,549 Mamhilad 99,984 81,547 15,804 2,633 Llanfairfechan 108,576 87,503 16,699 4,374 Vantage Point 83,260 69,327 11,688 2,245 Total 467, ,612 68,457 16,186 %Total 82% 15% 3% Figure 3 : Emergency, Urgent and Routine Calls for 2008 /09 Clinical Contact Centre Strategy V 1.8 Final Page 55 of 64