1. Information & Performance Cells

2. Performance Cell Who are we? West Midlands Ambulance Service NHS Foundation Trust 5.4 million population Over 5000 square miles – 80% rural 2,200 incidents per day 1,400 patient journeys per day PTS operations Fleet of 850+ vehicles 4 Air Ambulances 4,000+ staff, 1,500 volunteers

3. Performance Cell Trust Vision, Values and Objectives Vision Delivering the right patient care, in the right place, at the right time, through a skilled and committed workforce, in partnership with local health economies Vision Delivering the right patient care, in the right place, at the right time, through a skilled and committed workforce, in partnership with local health economies Achieve Quality and Excellence Accurately assess patient need and direct resources appropriately Establish market position as an Emergency Healthcare Provider Work in Partnership Service Delivery Objectives Deliver Service Improvement Increase Efficiency Develop our Workforce Transform our Technology Infrastructure Values World Class Service Patient Centred Dignity and Respect for All Skilled Workforce Teamwork Effective Communication Values World Class Service Patient Centred Dignity and Respect for All Skilled Workforce Teamwork Effective Communication Strategic Objectives

6. Performance Cell

7. Position before Pathways introduction Triage Process CSD NHSD 4% 96% Response R1,R2 G2 G4 68% To Hospital Performance Cell Red 1 = Life Threatening Calls Red 2 = Potentially Life Threatening Green 2 = Not Life Threatening Green 4 = Potentially suitable for treatment within the wider health community

8. Performance Cell Clinical Triage System NHS Pathways introduced in 2011 Improved clinical assessment during call Increased volumes signposted to alternative care pathways Hear and Treat increases via Paramedic Triage Directory of Services (DoS) to link in with wider health community Allows for more appropriate use of other resources

9. Performance Cell Process since Pathways Introduction Performance Targets Call ColourResponse Target Red 175% in 8 mins Red 275% in 8 mins Green 290% in 30 mins Green 490% triage in 60 mins

10. Performance Cell Alternative Pathways Directory of Services Patients go to the Right Place, First Time, All of the Time Improved patient journey and experience Better use of available services Cost base for assessment and referral to care much reduced Inappropriate ambulance journeys avoided Reduction in 999 conveyances and A&E attendances Gives commissioners world class data on what services are needed GAP analysis aims to improve the quality of the services available by supporting intelligent commissioning and decision making for services redesign.

11. Performance Cell Operating Model Historically: Traditional ambulance stations Inappropriate for increasing activity levels Expensive In need of modernisation Transformation to: Hub and Spoke model Benefits More efficient use of resource Fleet maintenance Better facilities for staff

12. Performance Cell Current Operating Model HUB and SPOKE model Pioneered in Staffordshire Centralisation of Operations Hubs: Make Ready system used AFAs prepare vehicles Reduced costs/downtime Spokes: Community Paramedics Advanced skillset Improve response efficiency Projected completion: 2014

13. Performance Cell Patient Treatment Aim: Deliver the right patient care, in the right place, at the right time Where were we… 98% of patients received an ambulance response 68% transported to hospital Skill mix: 52% paramedic Resource mix: Ambulance: 80%; RRV: 10%; Other: 10%

14. Performance Cell Where are we now - Treatment Types 63% - Transported to hospital 31% - Treated on scene 6% - Treated in the wider health community or over the phone Falls account for the greatest proportion of emergency activity but 44% of Falls are treated on scene. Could this group of patients be treated elsewhere in the community? Only 49% of Assaults are taken to hospital. Could we improve the efficiency of our response?

15. Performance Cell Working with Hospitals Key relationship within health economy Ensure only appropriate patients are taken to hospital Quick patient handover essential to keep system moving Improving handover completion: Hospitals arent penalised for any delays in the crews booking clear from hospital and vice versa

16. Performance Cell Hospital Turnaround Target: 30 minutes Handover: 15 minutes; Crew clear: 15 minutes Continuing improvements in use of handover button SOC service within the EOC acts as a central intelligence hub between Acutes and WMAS operations. Delays at hospital deplete resource availability and hinder the ability of the Trust to provide a safe service. Use of 14 HALOs at the Regions hospital aims to improve turnaround efficiency. Publication of daily reports to WMAS extranet increases visibility of turnaround issues.

17. Performance Cell Looking Ahead: 111 Improves access to local NHS healthcare services Targets patients in non-emergency situations, signposting them to urgent care Safety route built in to direct emergency patients to 999 services Continuing work to improve safety and reliability of this link

18. Performance Cell Looking Ahead: 111 111 and 999: System allows for direct transfer of patients requiring an ambulance response onto 999 dispatch stack without the need to speak to a 999 call handler Modelling estimates that 10% of all 111 calls will require an ambulance response, increasing typical 999 activity by 18-20% (300-500 extra incidents) per day

19. Performance Cell Looking Ahead: Working with CCGs Ensure the CCG understands the new operating model and strategic direction of WMAS Ensure the future direction is integrated into the future planning of Commissioning group modelling Working to enhance local partnership, working to enable shared locations and/or services to reduce costs Develop alternative and appropriate services for patients, utilising NHS Pathways WMAS to share knowledge and experience to enhance local service delivery to patients and healthcare professionals, evidence based through available data

20. Performance Cell Any Questions