Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 1

Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 1

Contents Welcome from the Chair and Chief Executive 3 The Welsh Ambulance Service at a Glance Who We Are and What We Do 6 Our Year in Review: The Highlights 9 How Our Services are Planned and Delivered 11 A Clinically-Led Service 13 Emergency and Urgent Care Services 23 Giving People More Choice 27 Non-Emergency Patient Transport Services 29 Our Volunteers 32 Emergency Preparedness 35 Research and Innovation 38 Our People and Places 39 A Place for Everyone 45 Sharing Expertise Overseas: Wales for Africa 47 Our Places 49 Our Fleet 51 Quality at the Heart of What We Do 53 An Open Culture 55 Working Across Boundaries 58 The Emergency Medical Retrieval Service (EMRTS) and Wales Air Ambulance Charity 61 Good Governance: Managing Ourselves Effectively and Efficiently 63 The Year Ahead 2017/18 66 Declarations of Interest 68 Report of the Director of Finance, Patsy Roseblade 70 Salary and Pension Entitlements of Senior Managers 87 Sustainability Report 93 Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 2

Welcome from the Chair and Chief Executive Welcome to our 2016/17 Annual Report, which we hope is an interesting read and gives you a flavour of what s been happening at the Welsh Ambulance Service over the last year. In many ways, 2016/17 has been a remarkable year. While no year is ever without its challenges, this has been a year of real improvement and progress, one which has marked the maturing of our organisation and which signals the start of another new chapter in the Welsh Ambulance Service story. This statement is not one designed to be self-congratulatory or indulgent. Nobody is more acutely aware of some of our continued challenges than we are, but it would be wrong of us not to celebrate the significant strides we have made, both in terms of the performance and quality of our services and in the corporate health of our organisation. We started 2016/17 in a more positive position, despite having had a challenging winter period, and with a determination to make sure that we consolidated the gains we have been making consistently over the last couple of years. As well as exceeding our performance target of attending 65% of immediately life-threatening calls within eight minutes for every month in the year, we ve also achieved some other landmarks which we hope will give us very strong foundations for the future, recognising that quality is very much at the heart of everything we do. In December 2016, Welsh Government confirmed a 4.48m investment in a new Computer Aided Dispatch (CAD) system. The CAD is at the heart of our operational effectiveness and you can read more about how the new system will help us deliver better on page 19. In September 2016, the Trust saw its status under the NHS Wales Escalation and Intervention Arrangements deescalated by the Welsh Government from enhanced monitoring to routine arrangements. Together with the Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 3

approval by Welsh Government of our Integrated Medium Term Plan (IMTP), this development is significant in representing a positive shift in confidence in the organisation and reflects our increasing capacity to deliver. You can read more about the many positive things that have happened over the year in this Annual Report. We also reflect on some of our longer term challenges and opportunities which will form part of our ambitious agenda for 2017/18 and beyond. The focus of our work now is to make a fundamentally different and innovative contribution to the wider NHS system in Wales, particularly in primary and community care and to optimise the skills and abilities of our workforce to deliver the best possible care to our patients. We have started some of this work, much of which you can read about in this document, but there is lots more we can and want to do. We will be working with our partners throughout the coming year to agree and implement some new and different ways of working to deliver great care to the people of Wales. We can t deliver anything without people with the compassion to care and the commitment to deliver; we are blessed to have so many working with us here at the Welsh Ambulance Service. Our staff do an amazing job every day. Whether working on the frontline in our emergency or non-emergency teams, in our Clinical Contact Centres, in NHS Direct Wales (NHSDW) or the new 111 service, in corporate teams or as volunteers working in their own communities, their aim is to make life better for the people of Wales. We also work closely with our NHS and emergency service partners. Together, we are all bigger and better than the sum of our parts, working to care for some of our society s most vulnerable people when they most need support. There are lots of ways you can join us on our journey. You can find out more by keeping up with developments on Twitter @welshambulance, finding us on Facebook, checking out our website or emailing us at transformation.amb@wales.nhs.uk You are also very welcome to come to one of our regular Board meetings, which are open to everyone and are held across Wales. On Board days, we spend the afternoon listening to our staff, patients, stakeholders and Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 4

anyone who wants to come along. There s an opportunity to chat openly with our Board members and to pose any questions you might have. You can find out more here or keep an eye on social media for events near you. In the meantime, stay in touch and we hope you enjoy reading this year s Annual Report. Best regards, Tracy Myhill Chief Executive Mick Giannasi Chair Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 5

The Welsh Ambulance Service at a Glance Who We Are and What We Do The Welsh Ambulance Service was established in 1998, with NHS Direct Wales becoming part of the Trust in April 2007. We provide a service to some three million people across Wales that s an area of almost 8,000 square miles. Our services are focused in three areas unscheduled care, planned non-emergency transport and telephone and online advice. Our unscheduled care services (emergency and urgent care) provide support to patients with illnesses that are immediately life-threatening through to minor injuries. Our planned non-emergency transport services help thousands of patients each year to get to their hospital and medical appointments. NHSDW and the pathfinder 111 service, which was newly introduced in some parts of Wales in 2016 (see page 28 for details), provides telephone and online advice to patients who feel unwell, helping to signpost patients to, or arrange, the most appropriate care for them. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 6

Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 7

Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 8

Our Year in Review: The Highlights 2016/17 has been an important year for us. Our clinical model, which had been piloted since 2015, was confirmed on a permanent basis by Cabinet Secretary for Health, Wellbeing and Sport, Vaughan Gething; Welsh Government confirmed funding for our new Computer Aided Dispatch system, which will significantly improve the way we manage our calls, and our Integrated Medium Term Plan, which sets out what we are going to do over the next three years, was approved. We continued our journey to becoming our best by very successfully holding the first in our new style annual Staff Awards, where more than 200 staff were recognised for their contribution to the organisation. This might have been because of long or distinguished service, or by doing something above and beyond in their day-to-day role to make a difference to our patients. As the host organisation for the new pathfinder 111 service, which brings together the services of NHSDW with local GP out-of-hours services, in October we helped launch 111 successfully in the Abertawe Bro Morgannwg Health Board area covering Swansea, Bridgend, Neath and Port Talbot, making it easier for local people to find the help they need, when they need it. Successfully launched the new 111 service in the Abertawe Bro Morgannwg Health Board area. Our performance against our eight-minute target for calls, where the patient is in a life-threatening condition, exceeded the 65% target for every month of the year, meaning that we are getting to more of the sickest people in our communities more quickly than ever. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 9

We won two NHS Wales Awards for our work with frequent callers, working with Cardiff and Vale University Health Board and a range of other agencies, to reduce the demand on emergency services from those people who call us repeatedly. This important work scooped the Working Seamlessly Across Organisations and the Outstanding Contribution to Prudent Healthcare awards. We recognised more than 200 staff for their contribution at the first of our new style annual Staff Awards ceremony. We worked with thousands of primary and secondary school children across Wales, teaching them the basics of CPR through our Shoctober and Restart a Heart initiatives. We also held a fantastically successful event celebrating our work with members of the community with a learning disability. We managed all this within our budget in 2016/17, ending the year with a very small surplus of some 44,000. Read on to find out more about all of these and more. Follow the hyperlinks you see highlighted throughout this document to get further detail. Our work with frequent callers won two NHS Wales Awards with Cardiff and Vale University Health Board. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 10

How Our Services are Planned and Delivered Emergency ambulance services are commissioned on a collaborative basis by the seven Local Health Boards through the Emergency Ambulance Services Committee (EASC) and the Chief Ambulance Services Commissioner (CASC), acting on their behalf. The Commissioning & Quality Delivery Framework for emergency ambulance services is the document which sets out what is expected of us. We have developed, in collaboration with our commissioners, five-step pathways for both our emergency and nonemergency services. They focus on ensuring real improvements in our services for our patients. Figure 1: Five-Step Emergency Ambulance Care Pathway Designed with permission using the CAREMORE 5 steps. Copyright, 2017 WAST The focus of the pathway is to ensure that patients are able to choose the right service for them (Step1), that there is more advice for patients when they call (Step 2), that more patients can be treated at scene or referred to Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 11

other services if that would be more appropriate for them (Steps 3 and 4) and we take to hospital only those patients who absolutely need to go there (Step 5). The Non-Emergency Patient Transport Service (NEPTS) Five-Step Model also shows what is expected of us and will be the mainstay of how our performance is measured by our commissioners from 2017/18. Figure 2: NEPTS Five Step Model You can read more about the ambulance care pathways, what they mean and how they work in our Performance Analysis. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 12

A Clinically-Led Service The Welsh Ambulance Service is committed to being a clinically-led, high quality service that provides the best possible care for patients. 2016/17 has been the first full year that our Clinical Response Model, which began as a pilot in October 2015, has been in operation. During that time, our performance has improved markedly, with the service meeting its target of reaching a minimum of 65% of life-threatening calls within eight minutes every month since the new model launched. The development and implementation of the Clinical Response Model was the first step in the transition from a time-based target to one which focused on clinical outcome. Following an independent review commissioned by EASC to gauge the effectiveness of the model, Cabinet Secretary for Health, Wellbeing and Sport, Vaughan Gething, announced in February 2017 that the model would be implemented on a permanent basis. Simply put, the aim of the model is to focus on the quality of care for patients and the outcome achieved, while maintaining an eight-minute response target for those patients with an immediately life-threatening condition, for whom time is of the essence. This includes patients in cardiac or respiratory arrest, for example. The new model has three types of call Red, Amber and Green. Red calls are immediately life-threatening calls someone is in imminent danger of death, such as a cardiac arrest. There is compelling clinical evidence to show an immediate emergency response will make a difference to a person s outcome. The eight-minute target has been retained for this group, with a target of 65% of calls receiving an eight-minute response Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 13

Amber calls refer to those patients with conditions that may need treatment and care at the scene and fast transport to a healthcare facility, if appropriate. Patients are prioritised on the basis of clinical need and patients receive a fast, blue light response. There are no time-based target for amber calls; instead a range of clinical outcome indicators (the Ambulance Quality Indicators) have been introduced to measure the quality, safety and timeliness of care being delivered, alongside patient experience information, which is published every quarter Green calls are non-serious calls, which can often be managed by other health services, including by providing healthcare advice or through self-care. This category also includes many calls from healthcare professionals While there remains work to be done, it is clear that the Welsh Ambulance Service has led the way on a UK and global basis in focusing its response model on those patients in most critical need of care. Our challenge now is to work on improving our performance for the many patients who are seriously unwell but not in a life threatening condition. These are patients who fall mainly into our amber category of calls. You can read more about the clinical model in our Performance Analysis. MEASURING QUALITY: AMBULANCE QUALITY INDICATORS For the overwhelming majority of patients, time is not the best indicator of clinical outcome. It is doing the right thing, delivering the right care and, if necessary, taking the patient to the right healthcare facility that have the most bearing on how well a patient recovers from their illness or injury. Last year, as part of the collaborative commissioning arrangements, we worked closely with our commissioning partners on the development, implementation and publication of Ambulance Quality Indicators (AQIs). These indicators provide information on the quality of care we give to patients and the outcomes achieved. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 14

2016/17 has been the first full year of AQI implementation and, while the process continues to mature, allowing us to scrutinise and review what they are telling us, the AQIs are already providing a wealth of information which will inform our future development. The AQIs are published quarterly and you can find them here. We have also begun to use patient stories to illustrate the Ambulance Quality Indicators, and our performance data more generally, bringing the statistics to life. You can find some examples of these stories here. OURPERFORMANCE IN SUMMARY Our performance in 2016/17 was significantly improved on recent years. The impact of the new clinical model, together with better planning, particularly over the challenging winter period, meant that we reached or exceeded our 65% performance target for the most serious Red calls across Wales in every month of the year. This was against the backdrop of increasing demand for our services, with emergency ambulance service incident demand increasing by 1.9% over the period April 2016 to March 2017. Our total number of verified incidents (i.e. calls we attended rather than calls we received) was 463,018, up from 454,356 in 2015/16. Performance for Red (life-threatening) calls is shown in the table. Figure 3: Percentage of RED Incidents Responded to Within Eight Minutes Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 15

Below, you can find a summary of our performance, which is linked to the five steps of the Ambulance Care Pathway. You can find more detail about our performance in our full Performance Analysis. Step 1: Help Me Choose Helping people to choose the right service for them is an important part of our work. NHSDW and the pathfinder 111 service, which was launched in the Abertawe Bro Morgannwg Health Board area in October 2016, are integral to our work in this area, supporting patients with telephone and online advice. 111 brings together the NHSDW and local GP out-of-hours services. Between April 2016 and March 2017, NHSDW dealt with 301,640 calls and there were 3,262,978 hits on its website. During the busy winter period, we actively promoted the symptom checker element of the NHSDW website, which provides advice and guidance on a range of ailments. Raising people s awareness of this service was designed to help patients make better decisions about the type of care they needed. This proved popular, with the symptom checkers being the most visited NHSDW website pages over the winter. The most popular searches were stomach pain, generally unwell and colds and flu. Since the 111 pathfinder service went live in the Abertawe Bro Morgannwg University Health Board area (October 2016), more than 60,000 calls have been answered by the service (as at end March 2017). Frequent Callers Another key aspect of supporting people to make the right healthcare choice is our work with frequent callers. Frequent callers account for between four and five per cent of our 999 call volume each month. Frequent callers are defined as anyone making more than five 999 calls in any month. Frequent callers are often vulnerable and may have mental health needs, so we work with our partners to actively manage this type of caller. Each month, a cohort of frequent callers is identified and we then work with them over a four-month period. Substantial reductions have been seen in the calls from our frequent callers when we work collaboratively with Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 16

other agencies to put in place the support they really need, rather than using the 999 service as a fix for other problems which are not a medical emergency. The focus moving forward is on how this approach can be expanded across Wales and further developed to include frequent caller organisations, for example, nursing homes and hostels, where some work is already underway. You can read more about this in our Performance Analysis. Step 2: Answer My Call We received nearly half a million calls in 2016/17 (486,085), with the number of calls ranging between 38,000 and 45,000 999 calls per month as outlined in the graph below. We also provide Hear and Treat services through our Clinical Desk, which is staffed by nurses and paramedics and provides additional clinical triage and advice to callers where appropriate. During the winter of 2016/17, we invested further resources in this service, with the support of Welsh Government, to provide more patients with clinical advice over the telephone. While this uplift in funding was temporary, it has been confirmed as permanent in 2017/18, which will allow us to help more people in this way and avoid sending ambulances to patients unnecessarily in future. The next graph overleaf shows the percentage and number of calls ended following hear and treat advice, freeing up more ambulances and crews to go to those patients in greatest need. 46,000 44,000 42,000 40,000 38,000 36,000 34,000 999 Call Volume Figure 4: 999 Call Volume Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 17

Figure 5: Hear and Treat Performance of Clinical Desk Supporting Our Partners Another development in 2016/17 was our work with colleagues in the police, particularly in embedding clinicians in police control centres during periods where we knew we were going to be busy, for example during the Six Nations rugby tournament. Working with South Wales Police, this initiative has proved very successful, providing clinical advice to police officers on scene to decide the best course of action for a patient and resulting in fewer ambulances being deployed and freeing up police time. The pilot with South Wales Police will now be made permanent and a similar scheme will be introduced with other police forces in 2017/18. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 18

Investing in Technology We were delighted to receive 4.48m from Welsh Government this year to fund our new Computer Aided Dispatch (CAD) system, which will help improve our response times further. The CAD is the system that our Clinical Contact Centre staff use to assess and prioritise 999 calls, as well as dispatch resources, and it is critical to the management of our Emergency Medical Service. The new system will mean we can fully realise the benefits of the new clinical response model. We anticipate the new system will go live in autumn 2017. Step 3: Come to See Me The Welsh Government target for Red incidents responded to within eight minutes is 65%. Throughout 2016/17 this target was achieved, with performance being above 70% for every month of the year. RED calls are those where the patient is in an immediately life-threatening condition, for example when a patient s heart has stopped or they have stopped breathing. These calls, thankfully, make up a relatively small percentage of our call volume. For example, between January and March 2017, Red incidents represented 6.6% of the incidents we dealt with. Figure 6: Red Incident 8 Minute Performance Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 19

The majority of our calls fall into the Amber category, where patients are seriously ill or injured but their condition is not life-threatening. Figure 7 shows the median response time for Amber incidents in 2016/17. The median is the mid-point or value in a set of numbers. Figure 7: Amber Incidents Median Response Performance You can read more about the way calls are categorised and our performance in our Performance Analysis. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 20

Step 4: Give Me Treatment Treatment given by ambulance clinicians before a patient reaches hospital is major factor in their chance of survival and recovery. Our clinicians use packages of care, assessment and treatment known as care bundles for certain conditions. A key part of the new Clinical Response Model was the introduction of a set of clinical indicators. Performance on seven of these measures are formally reported by the Emergency Ambulance Services Committee through the Ambulance Quality Indicators(AQIs). Throughout 2016/17, more than 90% of stroke patients were documented as receiving an appropriate stroke care bundle 81% of older people who had fallen and had a suspected fracture of hip/femur were documented as having received pain relief 65.8 of acute coronary syndrome patients were documented as receiving the appropriate STEMI (STelevation myocardial infarction) care bundle Step 5: Take Me to Hospital While our staff treat many patients safely and effectively at scene, there are clearly times when we have to take the patient to a hospital for the right care and treatment. We took fewer patients into hospital in winter 2016/17 than the previous year, despite demand for our services going up. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 21

NHS Wales guidance states that the handover of care of patients from an ambulance crew to hospital staff should be within 15 minutes. This is important, as taking more than 15 minutes means that the patient has to stay on the ambulance, which is often not appropriate for them given their condition. It also means that the ambulance is not available to respond to other calls in the community. Figure 8: Patients Conveyed to Hospital As a result of better planning and closer working between us and our partners, including Local Health Boards, there was a reduction in lost hours as a result of handover delays at hospitals. Nevertheless, lost hours, as a result of handover delays, remain a significant issue for us with 7,137 hours being lost in the peak month of January 2017, which equates to 595 shifts or 19 shifts per day during that month. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 22

Emergency and Urgent Care Services We worked hard once again in 2016/17 to deliver improvements to our emergency and urgent care services. Recognising that demand is likely to rise year on year, we are looking innovatively at the ways in which our staff can make the best possible contribution to the wider healthcare system in Wales and to the care of patients, using the full breadth of their skills. While this will become a significant focus for us in 2017/18, working closely with groups of GP practices (primary care clusters) across Wales, we have made some significant strides this year in the way we manage our patients and we have introduced some award-winning initiatives to manage patients better in the community, rather than taking them to hospital, if there is a better and clinically appropriate alternative. Community Paramedicine By working closely with GPs and looking for collective solutions to shared challenges, we have identified a number of innovative ways of bringing the skills and experience of paramedics and GPs together to support better care for patients. One model which was tested this year was that of the community paramedic, based on two trials, one in Aberdare and one in the Western Vale of Glamorgan. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 23

Dependent on area, paramedics undertake a number of different roles, for example, working with primary care practices and the GP out-ofhours service, as well as undertaking home visits and attending 999 calls that come in to the ambulance service. In the Cwm Taf University Health Board area, Advanced Paramedic Practitioners are working as part of a multidisciplinary team in a GP practice. In the Cardiff and Vale University Health Board area, a community paramedic works from a rapid response car and works with local GP practices in the Western Vale of Glamorgan to assess suitable patients on behalf of a GP. In the Hywel Dda University Health Board area, the Trust has also been working to provide additional clinical support to GP practices and the out-of-hours service. These new models of joint working are producing positive results, reducing the number of patients being admitted to hospital in these geographical areas. Given the benefits of community paramedicine that we have seen so far, our intention in 2017/18 is to begin to extend the model, for example in the Powys Health Board area, with a community based paramedic working with the clinical team at Llandrindod Wells Hospital. Further evaluation is planned to measure the effectiveness of this joint working. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 24

Helping People Who Have Fallen We know that lots of the calls we receive are about people who have fallen, many of them frail and elderly. Sometimes the patient is uninjured and needs help to get up. At other times, the patient has hurt themselves and needs treatment, whether at home or, in the case of more serious injuries, at hospital. We are working hard to recognise the needs of elderly people and to improve how we manage people who have fallen. In 2016/17, we had three different dedicated trials running in partnership with Aneurin Bevan University Health Board, Cardiff Telecare and North Wales Fire and Rescue Service. All of these were aimed at ensuring that patients who have fallen receive the most appropriate, timely assessment and onward referral. There are also 10 dedicated Community First Responder falls response teams. One example of these new initiatives is the Falls Response Service (FaRS) team based in the Aneurin Bevan Health Board, where a paramedic and a member of the health board s Community Response Team (CRT) operate from specialist vehicles to respond to people who have fallen. Team vehicles are equipped to manage the clinical needs of a patient who has fallen and provide specialist equipment to assist moving and handling the patient safely while on the ground. Patients also receive an appropriate medical examination, followed by an in depth social assessment and evaluation, which has resulted in many people being able to stay at home without the need to be taken to hospital. A new ISTUMBLE Toolkit has been developed for use in care homes when someone has had a fall. It is designed to provide a checklist to help when calling for assistance and to help decide if it is necessary to call 999. The falls Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 25

assessment tool has been adopted by Abertawe Bro Morgannwg University Health Board, Aneurin Bevan Health Board, Cwm Taf Health Board and pilot homes in the Cardiff and Vale area. The tool has also been endorsed by Care Forum Wales and Care and Social Services Inspectorate Wales. In the Cardiff and Vale area, we have placed 25 lifting devices in nursing and residential homes for use by staff when patients fall. In one home, we have reduced falls-related 999 calls by 62% over six months, meaning faster and more appropriate help for patients who have fallen. We have now set up a Falls Strategic Oversight Group, which will examine the results of these initiatives to develop an organisation-wide approach to responding to people who have fallen. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 26

Giving People More Choice Our ambition is to ensure that our patients have the best possible clinical advice and care. We know that patients are not always sure about where to get help when they feel unwell, which means they sometimes call 999 when it isn t a real emergency. This year, as well as our NHS Direct Wales service, which provides telephone and web-based support and guidance for patients, we launched the pathfinder phase of the 111 service, which brings together the NHSDW and GP out-ofhours services. You can find out more about both services below. NHS Direct Wales NHSDW is a health advice and information service available 24 hours a day, every day. You can call NHSDW on 0845 46 47 if you are feeling unwell and are unsure what to do, or you can find out more on a wide range of conditions, treatments and local health services via the NHS Direct Wales website. There were 301,640 calls to NHSDW in 2016/17 and 3,262,978 visits to its website. Both of these figures were down on the 2015/16 figures and, while volumes might have been affected by the introduction of the 111 service in some parts of Wales, we will continue to work hard to promote the service during 2017/18. The most common reason for people to ring NHSDW is to ask about dental problems but, during the winter period, we have also actively developed and Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 27

promoted the NHSDW symptom checker to help people understand better what might be wrong with them. You can read more about NHSDW in our Performance Analysis. 111 The new 111 pathfinder service was launched in the Abertawe Bro Morgannwg University Health Board area in October 2016.111 is a new, completely free way to contact the NHS from landlines and mobiles and brings together NHS Direct Wales and the GP out-of-hours service. In June 2015, the Welsh Ambulance Service was appointed by Welsh Government as the host organisation for the pilot and evaluation phase of the 111 pathfinder service, which aims to improve the delivery of urgent primary care by providing a single point of access to help patients get help when they need it, as well as improving access to health information and advice. In addition to providing clinical advice and guidance to patients, local paramedics and other clinical staff at the Welsh Ambulance Service also have access to the clinical teams at 111 for more specialist advice and guidance if they need it when they are attending a patient in the community. Since the 111 pathfinder service went live in October 2016, more than 60,000 calls have been taken (as at end March 2017). The service has been positively received by patients and health professionals and will be rolled out to Carmarthenshire and other parts of Wales in 2017/18. You can read more about 111 and what it does in our Performance Analysis. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 28

Non-Emergency Patient Transport Services Our Non-Emergency Patient Transport Services (known as NEPTS) take patients to planned appointments and treatment. NEPTS also plays a vital role in the smooth running of the NHS by taking patients who have been discharged from hospital home, or to other places of care. During the course of the year, NEPTS undertook 797,410 journeys. This was a reduction of 2.3% in comparison with the previous year and continues a trend that has been seen over recent years. 2016/17 was a very important year for NEPTS. After the approval of the NEPTS business case by Welsh Government in January 2016, the service has been on a journey of improvement, implementing the business case recommendations. Our key achievements this year include: NEPTS Enhanced Service In September 2016, we introduced the NEPTS Enhanced Service for renal dialysis patients and patients attending oncology treatment. The aim of the enhanced service was to ensure these vulnerable patients arrive and depart within 30 minutes of their treatment time starting and finishing. There are increased clinical risks if renal dialysis patients regularly have reduced treatment times because of the late arrival of transport and it is important that all patients are collected and taken home promptly following the end of treatment. With the introduction of the enhanced service in September 2016, the number of renal patients receiving reduced treatment regularly (i.e. three episodes in a four week period) has reduced from an average of seven patients per month to zero. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 29

Dedicated NEPTS Leadership To ensure that we stay focused on our non-emergency service and that improvements are implemented and sustained, we have put in place a dedicated NEPTS leadership team. The leadership team now includes 29 Operational Team Leaders and six Non-Operational Team Leaders, who together support a NEPTS team of some 600 members of staff. This structure allows our team to focus on the nonemergency service yet retain valuable links with our Emergency Medical Service colleagues. Community Transport Partnerships During 2016/17 we developed our partnerships with non-nhs community transport providers across Wales. These services play a valuable role in providing access for people living in rural communities and, by working in partnership with these organisations, we are able to provide a valuable income stream that they can use to support their other important work in the community. Community transport organisations and voluntary ambulance services conveyed 48,679 patient journeys on behalf of NEPTS, equating to 6% of all our patient journeys in in 2016/17. In 2015/16 they undertook 19,350, which equated to 2.5% Discharge Services During the year, NEPTS continued to play an important role in supporting the Welsh NHS through the discharge of patients from hospitals across Wales. During 2016/17, NEPTS undertook 54,127discharges, an increase of 3% over the previous year. This increase is despite an overall reduction in NEPTS journeys in 2016/17, which demonstrates the increasing importance of the service supporting patient flow within our hospitals. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 30

Working with our Commissioners We have worked closely with our future commissioners throughout 2016/17 on the development of a five-step non-emergency transport service care pathway, mirroring that already in place for our emergency ambulance service. The diagram below shows the five steps in the NEPTS pathway, which will form the basis of the way in which these services are commissioned and their quality evaluated from 2017/18. We are proud of the progress our NEPTS service has made during the year and recognise that we need to do even more during 2017/18 to improve further the service we provide to our patients. Through our dedicated staff, and working closely with our partners, we are confident that the achievements made in 2016/17 can be continued into next year. You can read more about how we did in our Performance Analysis. Figure 9: Five-Step NEPTS Pathway Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 31

Our Volunteers We very much value the contribution that our many volunteers make to the Welsh Ambulance Service, whether that s as a volunteer car driver or as a Community First Responder. Many of our patients benefit from the skills and contribution of our volunteers and we are very grateful to the many people across Wales who give up their time to support us and our patients. Investing in our volunteers, whether that be in training, in equipment or in recognising their contribution, is high on our list of priorities and we remain committed to building on these relationships further in the coming years. Volunteer Car Service Our Volunteer Car Service (VCS) is an important and highly valued part of our NEPTS team. The service provides a comfortable, reliable and caring way to travel long distances across the rural areas of Wales, especially for those patients travelling for life sustaining treatments like kidney dialysis or radiotherapy, for example. Training for our VCS drivers includes first aid, safeguarding, health and safety and conflict resolution; volunteer drivers must re-qualify annually. Volunteer cars are also checked on a regular basis to ensure they continue to maintain the high standards we expect. During 2016/17, our volunteers undertook around 200,000 journeys, which was a reduction of 20% over 2015/16. Attracting volunteers is a challenge most organisations Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 32

face and NEPTS is no exception. We are constantly looking for volunteer drivers to help provide this valuable service to our patients and we would be delighted to hear from anyone interested in supporting us. Expenses are covered at a rate of 39p per mile and volunteers receive training and support, as well as a great deal of personal satisfaction from knowing they are making a real difference to the lives of some of our most vulnerable patients. If you are interested in joining our VCS, please telephone us on 01633 626262 or e-mail us at enquiries.acs@wales.nhs.uk Community First Responders Community First Responders (CFRs) are volunteers who give their time freely to help care for people and save lives in their community. They are everyday people who are trained to deal with a wide range of potentially life threatening conditions or, sometimes, simply to provide reassurance until the arrival of an ambulance. Supported by our first responder departments across Wales, in 2016-17 our CFRs responded to an incredible 12,736 emergency calls, arriving first on scene almost 80% of the time. We currently have 275 teams, comprising 1,561 CFRs who are all volunteers and who commit many hours to their role, not only in their availability to respond to calls, but also in training, development and support to their communities. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 33

We have worked closely with our first responders to roll out a new smartphone-type, handheld communications device that uses Terrafix software to allow the CFR to officially book on duty, be automatically allocated to appropriate calls, be directed to the call using the built in satellite navigation and provide direct communication to the newly introduced CFR desks in each of our three Clinical Contact Centres. 2016/17 has also seen some substantial changes in the training and development of our CFRs with the introduction of a clear scope of practice, new training qualification, new equipment such as the igel supraglottic airway device, pitcrew CPR techniques and tourniquets. These developments all contribute to improved clinical outcomes for our patients. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 34

Emergency Preparedness The Welsh Ambulance Service is a Category One Responder under the Civil Contingencies Act 2004 (CCA), the UK Government s Counter Terrorism Strategy (CONTEST) and the Security and Counterterrorism Act (2015). We have to ensure that our statutory obligations and duties are met in relation to this role and that other legislative and guidance documents relating to security and emergency preparedness, from both the UK and Welsh Governments, are addressed as part of our core business. We have a Major Incident Plan, which is regularly reviewed and takes full account of the requirements of the Civil Contingencies Act (2004), Welsh Government Emergency Planning Core Guidance to NHS Wales and relevant best practice guidance. The Resilience and Specialist Operations department comprises resilience managers responsible for specific health board areas across Wales, as well as the Hazardous Area Response Team (HART), the Special Operations Response Team (SORT) and an Event Planning Manager. The resilience managers work closely with key partners in delivering against statutory (Civil Contingencies Act 2004) and non-statutory guidance in relation to emergency preparedness, resilience and response (EPRR). Resilience managers engage through the Local Resilience Forums (LRFs), which are coterminous with the four Welsh police forces. The department is also engaged in national fora to support the area of operations from Resilience/EPRR, HART and SORT. We are also engaged in the UK Contest Board, the UK counter terrorism strategy. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 35

Under the Civil Contingencies Act 2004 (CCA), Category One Responders are subject to the following full set of legal civil protection duties: Risk assessment Emergency planning Business continuity planning Warning and informing Information sharing and Co-operation The HART team forms the central plank of what would be the organisation s response to any major incident, physical incident or weather-related event (including, in the current political climate, the organisation s response to any acts of terrorism) and employs 28 paramedics and 14 Emergency Medical Technicians, supported by management and administration staff. Our Resilience and Specialist Operations department continues to work closely with multi agency partners both in Wales and the wider UK. The last year has focussed heavily on refreshing and improving our business continuity arrangements, as well as a large tier one counter terrorism response and recovery exercise and planning for the Champions League Cup Final in June 2017. In addition, HART and SORT teams have continued to build and develop internal relationships and multiagency links to develop our capabilities and enhance our performance. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 36

The SORT team has also undertaken partner agency training in line with government requirements to provide a robust response to the public in the event of a terrorist attack. You can read more about our role as a Civil Contingencies Act Category One Responder in our Annual Governance Statement. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 37

Research and Innovation The Welsh Ambulance Service has a long track record in research and development (R&D). In recent years, we ve invested more in our research capacity and are now at the forefront of pre-hospital research, working on a range of significant research projects and continuing to attract further interest as our reputation grows. Working with a range of local, national and international partners, we have developed and attracted a comprehensive portfolio of research studies. With support from Health and Care Research Wales (HCRW), we have strategically aligned financial investments to resource and support the safe delivery of research in the Welsh Ambulance Service. We also promote the principle that R&D is a core role of healthcare organisations in delivering safe and effective care. We currently have 11 research projects underway and further details are showcased in our 2016/2017 Research and Innovation Annual Report, which you can read here. 'To build a culture where research can flourish, influencing practice for patient benefit' Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 38

Our People and Places As an ambulance service, we are all about our people. We cannot deliver high quality care, or continue to improve our service, without the support of everyone who works for us. We employ almost 3,000 people, clinical and non-clinical. You can see the make-up of our workforce in the table below. Additional Clinical Services Administrative & Clerical 2% 0% 0% 4% Category 2016/17 Additional Clinical Services 1,357 Allied Health Professionals Estates & Ancilliary Medical & Dental 33% 45% Administrative & Clerical 479 Allied Health Professionals 985 Estates & Ancillary 48 Medical & Dental 2 Nursing & Midwifery Nursing and Midwifery 114 Professional, Scientific & Technical 16% Professional, Scientific and Technical 0 Total 2,985 Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 39

Our staff numbers have increased this year from 2,840 in 2015/16 to 2,985 in 2016/17. We have also made sure that the way we categorise our staff reflects the job that they do, which is why we have re-categorised our call handlers from administrative and clerical to additional clinical services. One of our major pieces of work in 2016/17 was the commissioning of a demand and capacity review, which looked at the type of staffing and skills we will need over the coming years to meet the projected demand on our services in the future. This review is now complete and we are using its findings to inform our recruitment and staff training and development plans for the future. One of our priorities is to make sure we are an employer of choice, where colleagues are valued, and treated, as individuals. Our gender balance is approximately 40:60 female to male and our senior manager balance in 2016/17 was very similar. You can read more about our plans to achieve a more diverse workforce and our progress so far in our Treating People Fairly plan and in our 2016/17 Treating People Fairly Annual Reportor find out more later in this report. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 40

Staying Well We recognise that working in our service can be stressful and, with an ageing workforce, taking care of our staff is really important. The health and wellbeing of our colleagues is crucial for us in delivering and maintaining safe, high quality healthcare. We know that, by looking after our colleagues and encouraging colleagues to look after themselves and each other, this will benefit our patients and communities across Wales. To help us do this, we continue to build upon the development of our shared vision, purpose and behaviours through living and sharing these, to create a culture where everyone is valued and supported. The nature of our work means that we face challenging situations every day and we are continuously working to ensure we have the right interventions and support in place to support both the physical and emotional health and wellbeing of our colleagues. In September, the Trust signed the Time to Change Wales organisational pledge to reduce mental health stigma in the workplace and developed an action plan so that we can actively improve knowledge and understanding about mental illness and, most importantly of all, get people talking about mental health. This will continue to grow in 2017/18, with an additional exciting partnership with Mind Cymru. September was also the month for the launch of our Wellbeing Advocates - a network of colleagues who want to find out more about health and wellbeing and promote health and wellbeing in the Welsh Ambulance Service. We currently have more than 110 advocates and we are excited to be planning CPD events around mental health, and other health issues, in 2017/18. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 41

The NHS Staff Survey 2016 provided us with an opportunity to find out what colleagues thought about working in our organisation. The results from the survey demonstrated an increase in engagement from 43% to 53% based on the 2013 figure, showing that we are going in the right direction, but still have improvements to make. Our Staff Survey Workshop in March has led to the development of priorities to improve on the 2016 results and teams across the organisation have been meeting to share feedback and ideas for moving forward. We will now be holding more regular surveys on a smaller scale to ensure we keep in regular contact with colleagues and provide an opportunity to feedback. We were fortunate to receive funding towards developing Trauma Focused Peer Support (TRiM) in the Welsh Ambulance Service in 2016/17 and will have our first practitioners ready to support their colleagues by the end of October 2017. We continue to develop a range of interventions to support colleague health and wellbeing, which has included posters and bulletins highlighting how to identify signs of stress, advice on musculo-skeletal problems, encouraging movement through the introduction of sit/stand desks and developing bespoke development sessions for teams including stress awareness, behaviours and leadership. We have continued to support healthy living with the Cycle to Work Scheme, where all colleagues are able to sign up to obtain bicycles and safety equipment while saving income tax and national insurance. This has been a success again in 2016/17. As we move forward into 2017/18, we are linking in with the Mind Blue Light Programme to find out what interventions and support are available for our colleagues and their families. We are excited at the prospect of identifying training, building stronger networks with our blue light partners and being able to access the wealth of resources developing across Wales. The top reasons for absence are musculoskeletal problems and anxiety/stress/ depression and other psychiatric illnesses. We continue to performance manage absence robustly, and support line managers and staff in the form of sickness audit toolkits, local sickness action plans, signposting and resources and access to support through the Employee Assistance Programme. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 42

In 2017/18 we are keen to work with staff to improve our uptake of the flu vaccination, which rose slightly this year to 31% but fell well short of the Welsh Government target for flu vaccination for frontline staff of 50%. We know there are a number of practical and other barriers to staff being vaccinated and planning for our 2017/18 flu campaign will start early in the year. Developing our People We know that investing in training and development contributes to the wellbeing of our staff, something which underpins our Being Our Best ethos. 2016-17 (Number) 2015-16 (Number) Days lost (long term) 53,593.42 52,265.05 Days lost (short term) 20,339.59 20,063.65 Total days lost 73,933.00 72,328.70 Total staff years 2982.19 2845.40 Average working days lost 1548.12 1586.88 Total staff employed in period (headcount) Total staff employed in period with no absence (headcount) 3166 3009 842 979 Percentage staff with no sick leave 28.00% 31.87% Figure 10: Sickness Absence Data We place emphasis on leadership at all levels of the organisation and agreed a significant investment in our Team Leading Programme in 2016/17, which went live early in 2017/18 and will help us embed our behaviours and develop the talent of many of our leaders across the organisation. We also place importance on individual conversations with colleagues and an investment of time in their development. We are making steady progress in improving the percentage of staff who receive an annual Performance and Development Review (PADR). In 2016/17, 69.34% of eligible employees had a PADR between 1 April 2016 and 31March 2017, an increase on the previous year s figure of 50.58%. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 43

Other 2016/17 achievements include: Development of accredited, regulated Level 3 Award and Certificate for NEPTS and UCS Induction programmes Delivery of the Level 4 Associate Ambulance Practitioner programme Further development of the bespoke EMT Conversion programme, to enable local delivery in conjunction with Swansea University colleagues Successful External Quality Assurance of Future Quals programmes Development of two WAST Driving Instructors via the Future Quals National Principal Assessor programme, to enable development of additional tutors in-house Procurement and introduction of our immersive learning environment, which provides a more real-life way of training colleagues Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 44

A Place for Everyone At the Welsh Ambulance Service, we value equality and diversity and are working hard to make us a more diverse and inclusive organisation, regardless of background, belief, gender or ethnicity and one which reflects more closely the communities we serve. Equality and Diversity Our Equality and Human Rights Strategy (2016-20) is called Treating People Fairly. It explains what we intend to do to build on the progress we have made over the last four years. Our aim is that we create an environment where, regardless of background or circumstances, each patient is provided with a high quality service to meet their needs and every colleague achieves their full potential. Our aim, at the heart of all of our plans, is to move from treating people how we want to treat them to treating people how they want to be treated. Treating People Fairly is significant as it links how we will play our part in delivering the Equality, Welsh Language, Well-being of Future Generations and Social Services and Well-being Acts. The most important part of delivering Treating People Fairly is helping every colleague to recognise, understand and value difference in everyone by ensuring that no-one is excluded. One of our achievements this year was the re-launch of our Lesbian, Gay, Bisexual and Trans+ (LGBT+) staff network, which offers our staff, volunteers and their allies the opportunity to work together in creating better relationships between our organisation and local LGBT+ communities. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 45

Through the network, we are working to eliminate LGBT+ discrimination, promoting equality of opportunity for all employees and volunteers in the Welsh Ambulance Service. You can read more about our progress in our Treating People Fairly Annual Report. More Than Just Words: Our Commitment to the Welsh Language As an all-wales service, we recognise the important role that the Welsh language plays for our patients and staff. Supporting our Welsh-speaking staff and patients in feeling comfortable to use their preferred language on a dayto-day basis is central to our commitment to being a culturally inclusive organisation. We remain committed to the Welsh Government s More Than Just Words strategy which places being able to use your own language as an integral part of care. Under the Welsh Language (Wales) Measure 2011, standards will gradually replace the existing system of Welsh language schemes provided under the Welsh Language Act 1993. We will continue to implement our Welsh Language Scheme in accordance with legislation until the new Welsh language standards for the health sector come into existence, working closely with the Welsh Language Commissioner to ensure we meet our obligations to staff and patients. In 2016/17: 3094 (96%) of the Trust s workforce had self-assessed their Welsh language skills 13 (0.4%) of Trust staff received Welsh language lessons to entry level 346 out of 397 (87%) of the organisation s new staff (i.e. new since 1 April 2016) received Welsh language awareness training. You can read more about our work in this area by reading our More Than Just Words Annual Report. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 46

Sharing Expertise Overseas: Wales for Africa The Welsh Ambulance Service has been supporting the charity Partnerships Overseas Networking Trust (PONT) since 2009, working with the Ugandan community of Mbale to tackle poverty and improve access to basic health care. We have supported the scheme throughout 2016/17 and it continues to go from strength to strength. Sharing expertise and knowledge, our staff have been instrumental in the development of a motorbike ambulance service in Mbale, which has poor roads and infrastructure and with which bikes can cope better than four-wheeled vehicles. The service, which operates on a 24/7 basis, has now completed more than 24,200 journeys since its launch in December 2010. It operates through a network of volunteer Village Health Teams, whose workers make an initial triage of patients and call for the ambulance if they feel it is appropriate. Approximately 65% of patients transported are maternity or obstetric related, the remainder being made up of children and adults with other illnesses and injuries. WAST staff are planning their next visit in mid-2018 to carry out further training with the Village Health Teams and also to carry out monitoring and evaluation work. With the support of WAST, the Pennies from Heaven scheme has now been launched. This is a simple fundraising scheme to support Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 47

the work of the charity; it allows the contributor to donate the odd pennies from their pay to the charity each month. More details are available on our website, on the dedicated website for the project http://pont-mbale.org.uk/main/ and on Facebook and Twitter. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 48

Our Places The Welsh Ambulance Service occupies 109 buildings. Of these, 50 are freehold, 39 leasehold and a further 20 are subject to a Memorandum of Terms of Occupation (MOTO) agreement. Some locations have more than one principal use, such as Vantage Point House in Cwmbran, which is both an administrative centre and a Clinical Contact Centre. Trust buildings are categorised as follows: Category of Building Number Ambulance Stations 74 Control Centres 5 Fleet Workshops 4 Office / Administration Centres 7 Social Deployment Points 10 Reporting Stations 10 ARC/MRD Hart 3 Closed Buildings 0 The total (gross internal) floor area of buildings occupied by the Welsh Ambulance Service is 41,362m 2. This year, we have also developed an Estates Strategy, which sets out our vision for our estate in the longer term. Our objectives for the future include: Providing the right quality of premises that will result in an estate portfolio which is safe, appropriate and flexible, meeting all statutory obligations. Current backlog maintenance will be largely eliminated and there Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 49

will be a planned preventative maintenance regime to ensure properties are maintained to appropriate standards Providing the right type of premises in the right location to allow for the effective and efficient control, management and deployment of resources, including exploration of partnership opportunities with local partners Developing and rationalising the operational estate on a hub (Ambulance Resource Centre / Make Ready Depot) and spoke (Reporting Station / Social Deployment Point) basis Developing the non-operational estate to include three Clinical Contact Centres and regional administrative centres with the potential to include training facilities and Implementing locally adapted solutions to support the concept of washing and stocking, delivering cost effective operational services and minimising the risk of cross infection. The Estates Strategy offers the possibility of a radical estates transformation programme which also supports the fleet function, in particular, to implement a make ready approach to effective vehicle washing and stocking on a hub and spoke basis. The make ready approach provides a purpose built facility with colleagues whose primary responsibility is to ensure our vehicles are both clean and appropriately stocked. This enables frontline colleagues to concentrate on service delivery, as well as reducing infection risks. The hub and spoke model is essentially a strategically located Ambulance Resource Centre (ARC) and a series of social deployment points (SDPs), ensuring a timely response to incidents. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 50

Our Fleet With continued support from Welsh Government, we have been able to continue to upgrade the fleet. A total of 101 new vehicles have been replaced during 2016-17, representing an investment of 10m. The investment allowed us to buy: 35 new emergency ambulances all of which conform to the latest Euro6 emissions standards 52 non-emergency patient transport service vehicles, two of which are plug-in hybrids that reduce emissions and increase fuel efficiencies. All of them conform to Euro 6 standards. 14 specialist vehicles, including vehicles capable of carrying equipment needed to support serious / major incidents as well as ones to provide a mobile vehicle cleaning service to the Trust One vehicle to facilitate a co-responder scheme with the police 13 Rapid Response Vehicles, which are the same as our current model but with a more eco-friendly and smaller, more efficient diesel engine. This engine, although smaller in size, is still able to provide the right levels of performance required from an emergency vehicle. We continue to update our fleet to the latest specification vehicles, helping to improve our fuel efficiencies and reduce emissions. The investment also provides our patients with a better experience and allows our staff to Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 51

deliver the best possible care. There are currently more than 700 vehicles in the fleet, covering an area of more than 8,000 square miles across Wales. The fleet department s newest workshop at Wrexham, built in collaboration with North Wales Fire and Rescue Service, went live in April 2016. It has a state-of-the-art five vehicle bay workshop. Four of the bays are fitted with vehicle lifts and the fifth bay has brake testing and headlight alignment facilities. The building also accommodates the fleet administration team, providing them with much improved facilities and space. There are three other workshops within the fleet department; these are located in Bangor (North Wales), Blackweir (South Wales) and Blackwood (South Wales). All of the workshops have an apprentice, all of whom are now in the last year of a three-year training programme. The fleet workshops have continued to support the Health Courier Service arm of the NHS Wales Shared Service Partnership in maintaining their fleet of more than 80 vehicles across Wales. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 52

Quality at the Heart of What We Do The Welsh Ambulance Service is committed to being a quality-driven organisation. This means that quality underpins everything we do. Every year, we publish an Annual Quality Statement, which tells you more about what we are doing to bring our quality agenda to life across the organisation. This year, we have continued our drive for improvement on the quality front, with good progress made in a number of areas. For example, we know that providing care and support to patients with dementia, and their families, is an increasing part of our role. We ve supported our staff to improve their knowledge and understanding of the condition, with many colleagues attending dementia awareness sessions through the Dementia Friends initiative, while some have become Dementia Friends Champions. We re hoping to be awarded Dementia Friendly Organisation status in 2017/18. We consulted widely on our draft Mental Health Improvement Plan during 2016/17. The plan sets out our approach to providing care for people who find themselves in mental health crisis or who have poor mental health and need our support. We also recognise that the mental well-being of our staff is really important and this is reflected in our plan and referred to elsewhere in this document. We also worked closely with younger people in 2016/17 on a number of exciting initiatives, including the successful Restart a Heart and Shoctober campaigns, which saw thousands of secondary and primary school children across Wales taught the basics of CPR, a life skill which we believe everyone should have. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 53

We will be continuing these projects in 2017/18, as well as developing and agreeing our Promises to Children and Young People, reflecting the success of Promises to Older People, which have been recognised as an example of best practice by the Older People s Commissioner for Wales. We use the key principles of the Welsh Government s Health and Care Standards as the basis for our quality agenda. These are: Staying healthy Providing safe care Delivering effective care Treating people with dignity and providing dignified care Providing timely care Treating people as individuals Staff and resources You can read more about what we are doing under each of these headings to improve the quality of the services we provide in our Annual Quality Statement. As set out earlier in this document, our clinical response model also has a set of Ambulance Quality Indicators (AQIs), which are monitored monthly and published quarterly. In addition, we have developed a number of internal quality ambitions and outcome measures, which you can read more about in our Integrated Medium Term Plan. You can read more about quality governance and the way in which our Board receives assurance about our quality agenda in our Annual Governance Statement. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 54

An Open Culture At the Welsh Ambulance Service, we recognise the value in listening to our staff, patients and the wider public about their experience of our services, so that we can continue to learn and improve. We do this is in a number of ways, many of which are outlined in our Annual Quality Statement. Our Public Engagement and Community Involvement Team visits hundreds of community and patient groups, together with events large and small, during the year, listening to what patients and the public have to say and sharing what they hear with the organisation to help us learn and improve. This year, we ve established our Quality Steering Group, which allows us to bring all our learning and feedback together in one place, whether that be from patients, the wider public or our staff and stakeholders. We hope that, by doing this, we will be able to identify themes and trends more easily and address any issues more quickly, so that the quality of our services continues to improve. Concerns and compliments also help us learn what we do well and where we need to do better. Staff greatly appreciate good feedback and a lot of people who used our services found the time to get in touch and give positive praise. There were 759 compliments recorded throughout 2016/17. That s more than last year when we received 728 compliments Top themes in these positive comments include: Good care and attention Professional attitude of staff Polite, friendly, helpful staff Reassurance given to patient/family Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 55

This year, we ve put a real focus on managing our concerns better, dealing with them more promptly and, where appropriate, resolving them as on-the-spot concerns, which can often be sorted out with a straightforward telephone call. We ve also adopted a similar approach for concerns and correspondence which come to us from politicians, taking a more constructive approach of briefings and personal contact where appropriate. This has been welcomed by politicians and is working well. We always take concerns very seriously. Sometimes, we need to investigate what has gone wrong in partnership with another organisation, for example a health board. Where this happens, we try to investigate the concern jointly and respond jointly, so that it s easier for the patient and so that we can learn together as organisations. We received fewer concerns than last year, with the 2016/17 total standing at 1382, as opposed to 1419 in 2015/16. We also dealt with a far bigger percentage as on-the-spot concerns, as can be seen from the table below. 1 April 2016 to 31 March 2017 Total Percentage On the Spot Concern 1005 73% Formal Complaint 254 18% Joint Response - Other Trust/HB Lead 67 5% Redress 56 4% Totals: 1382 100% Figure 11: Number of Concerns Our staff reported 1691 incidents relating to patient safety in 2016/17, which is up on the previous year s figure of 1578. However, we actively encourage staff to report patient safety incidents, near misses and hazards as we believe this represents a developing safety culture. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 56

There were 13 concerns which were escalated to the Public Service Ombudsman for Wales in 2016/17. This is a very small percentage of the concerns we receive. Currently, four of those remain with the Ombudsman for investigation, while the remainder have either been returned to us for local resolution (4), closed after initial consideration (4) or the complaint has not been upheld (1). Freedom of Information (FOI) We dealt with 209 requests for information under the Freedom of Information Act in 2016/17. This is significantly up on the 2015/16 figure of 152. If you would like to request information under the Freedom of Information Act, you can email us at FOI.amb@wales.nhs.uk or write to our Board Secretary using these details: Mr Keith Cox Board Secretary Welsh Ambulance Services NHS Trust Headquarters HM Stanley St Asaph Denbighshire LL17 0RS Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 57

Working Across Boundaries The Well-Being of Future Generations (Wales) Act 2015 came into force in April 2016 and places a statutory duty on Public Service Boards and certain named public bodies to improve the social, economic, environmental and cultural well-being of Wales in accordance with the sustainable development principles. While the Welsh Ambulance Service is not a named organisation subject to the new duties, we are committed to working within the spirit of the Act, as outlined in our Integrated Medium Term Plan (IMTP). During 2016/17, the Trust Board met with Sophie Howe, the first Future Generations Commissioner for Wales, to help it think through the opportunities for collaboration and participation, using the well-being goals outlined in the Act as a compass in identifying how we can add value to the Well-Being of Future Generations Act agenda. During 2017/18, we will be focusing on a number of areas where we believe there are opportunities for us to deliver more for patients, and for Wales, as part of this work, including on how we work better with our emergency service partners, where we can develop collaborative solutions to our estates challenges and in identifying shared opportunities in training and occupational health, for example. Blue Light Partnerships We already work closely with colleagues in the other emergency services on a range of initiatives, from co-responding support with the fire services across Wales to working through our collaborative options in relation to our Clinical Contact Centres. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 58

This year, we have had a number of notable successes in this field, for example with our ground-breaking emergency services partnership that swept the board at the annual Gwent Police Awards. At the start of July 2016, a Joint Response Unit was launched by the Welsh Ambulance Service and Gwent Police after it was found that, between October 2015 and March 2016, the two emergency services attended 2,249 incidents together. Under the pilot scheme, a paramedic and a special constable carry out shifts covering the Aneurin Bevan Health Board area, attending incidents such as assaults and road traffic collisions together, to provide medical assistance and free up their colleagues to help others. Their work was recognised at the police force s awards event held at the Celtic Manor Hotel and the initial pilot scheme has been extended. We also celebrated the official opening of a new Emergency Services Station, which sees all three blue light services based under the same roof for the first time in south Wales. Emergency services leaders jointly opened the new Emergency Services Station in Abertillery, which is part of our estates strategy of co-locating with other emergency services where possible. Since January 2017, Welsh Ambulance Service crews, Gwent Police officers and South Wales Fire and Rescue Service crews have all been operating from the station. In north Wales, we have been working with North Wales Fire and Rescue service on a joint venture Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 59

designed to support people who have fallen in the community. In 2017/18, we will develop an Ambulance and Fire Service Strategy for Wales, which will help us start to look longer term at the collaborative opportunities that these important relationships present. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 60

The Emergency Medical Retrieval Service (EMRTS) and Wales Air Ambulance Charity The Welsh Ambulance Service works closely with the Wales Air Ambulance charity and the Emergency Medical Retrieval and Transfer Service (EMRTS), working together to help some of our most vulnerable patients, often in challenging conditions. The Wales Air Ambulance Charitable Trust relies on donations to raise 6.5 million a year and has seen its three helicopters carry out more than 25,000 missions since its launch on St David s Day 2001. In 2016, the Charity also introduced a fourth aircraft dedicated to inter-hospital transfers. EMRTS Cymru is an exciting service for Wales, launched in April 2015, that provides Consultant and Critical Care Practitioner (CCP)-delivered pre-hospital critical care across Wales. It is a partnership between NHS Wales, the Wales Air Ambulance and Welsh Government. Services offered include: Pre-hospital critical care for all age groups (i.e. any intervention/decision that is carried outside standard paramedic practice). Undertaking time-critical, life or limb-threatening adult and paediatric transfers from peripheral centres (including Emergency Departments, Medical Assessment Units, Minor Injury Units) for patients requiring specialist intervention at the receiving hospital. In addition, the service provides an enhancement of neonatal and maternal pre-hospital critical care, both for home deliveries and deliveries in free-standing midwifery-led units (MLUs). Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 61

Finally, it provides a multitude of roles at major incident or mass-casualty events and, for the first time in Wales, a strategic medical advisor is available 24/7. This advisor is known as a top cover consultant. The service is operational seven days a week between 08:00hrs and 20:00hrs from the Wales Air Ambulance Charity bases in Llanelli and Welshpool. EMRTS Cymru will be introduced into the Charity s Caernarfon operation in autumn 2017. The service is tasked via the Charity-funded Air Support Desk (ASD), based at the Welsh Ambulance Service Clinical Control Centre in Cwmbran. The ASD is staffed by one EMRTS Cymru CCP and one Welsh Ambulance Service allocator. Welsh Ambulance Services NHS Trust: Annual Report 2016/17 Page 62