2. Areas of Focus Our CQC Inspection – Adam Levy, Strategy & Planning Manager Emergency Preparedness – Kevin Bate, Deputy Director for Central Operations Areas of Outstanding Practice – Briony Sloper, Deputy Director of Nursing & Quality

3. We wanted to look at working differently to support Mental Health (MH) patients in crisis……….

4. Focus groups with MH users told us…..
Seven focus groups conducted:
‘Keeping on the line is seen as important if possible, with regular call-backs if staying on the line is not possible’
‘More training, more understanding, more knowledge, listen to us and learn more’
‘Patients should speak to a mental health professional’ ‘doesn’t need to be a paramedic to attend.
The Challenge
A significant workforce development
Moving away from a purely paramedic model
Culture and integration
Hear and Treat model
Risk management
Raising awareness & Inspiring confidence
Identifying the correct personal specification and finding people to match

5. Our Mental Health Nurses
6 permanent full time posts were created for mental health nurses (RMNs)
Went live operationally in February 2015
Experienced in acute crisis care management – ED psychiatric liaison teams, PICU, forensic units etc.
Provide expert mental health advice for mental health callers
Improve LAS staff confidence and ability to manage patients in crisis
Reduce avoidable ambulance dispatches
Reduce avoidable conveyances to Emergency Departments
The Role
Referral of mental health patients to the most appropriate MH teams enabling direct patient referral/warm transfers
Direct call handling of complex phone calls and/or situations where continued support over the phone is required
Support call handlers with challenging calls from people with mental health problems
Support frontline ambulance crews with mental health related issues at the scene of an emergency or incident
Screen calls carried out and review and upgrade as required using a risk assessment tool
Improve staff confidence mental health awareness and skills training, supervision etc.

6. Activity Staff Feedback
Total activity for Mental Health Nurses for 2016/17 was 7294 calls
5873 incidents relate to instances where vehicles arrived on scene and Mental Health Nurses rang back patients.
A total of 1,421 mental health calls were closed by Hear and Treat (no vehicle was dispatched) by the mental health nurses compared to the previous year; this is an increase of 52.3%.
No complaints of serious incidents since commencement
• 68.6% of all MH calls (141,333) were responded to with a vehicle by the LAS.
• 68.1% of all MH Incidents (96,944) were conveyed.
80.87% of EOC staff have found the presence of Mental Health Nurses beneficial
84.61% of EOC staff felt that Mental Health Nurses have a key benefit including improved patient assessments and support
73.03% of EOC staff felt that Mental Health Nurses have improved access & communication with external agencies in relation to mental health
50% of EOC staff felt that Mental Health Nurses have impacted on their individual learning, confidence & knowledge about MH presentations

7. The Future The role is now embedded
Continued recruitment to support 7/7 presence of an RMN within the CHUB
Monitor the impact on patient experience and staff experience
Publish & share with other providers
Working with Mental Health Trusts and NHS England to look at :-
Rotational posts into LAS for Mental Health Nurses
Systematically identifying which crisis services work and which don’t to improve services pan London working with the Cavendish Square Group
Joint response models
Joint training models
Co-production with service users
Frequent callers

8. Improving Maternity Care

9. Improving our maternity care
Significant number of maternity calls each year
13,035 maternity related calls in 2016
9,505 handled as emergencies
We have employed a Consultant Midwife
Significant training has been provided to increase skills and address gaps in crew knowledge
We have held a maternity risk summit
We have introduced a series of ‘maternity cards’ to help guide clinical decision making
We are introducing midwives into the control room to provide expert advice to crews dealing with difficult maternity cases

10. Recruitment and development of Australian Paramedics Tina Ivanov, Deputy Director Clinical Education & Standards

11. Our Recruitment of Australian Paramedics
What our Australian Paramedics have told us they like
What they told us they don’t like
We have conducted 5 recruitment trips to Australia
Good mentoring experience
Visas cannot be renewed in the UK
90% are still working for LAS
Expanded clinical skill set
High cost of living in London
We have recruited 543 Australian paramedics since 2014.
We recruited 184 new staff from the trip in April 2017
Hugely varied workload
Issues with rosters (have now been improved based on feedback)
Very friendly staff & great teamwork
Enjoy being lead clinician
Sometimes took a long time to get C1 driving license
Jeremy Hunt & Theresa May personally intervened to change the registration and immigration processes for our recruitment of Australian Paramedics
Good management & support
Enjoyable working in London

12. How the Victoria & London systems compare Education
University trained Paramedics
Yes
Yes – Target to fully transition by 2020
Registered Profession
No – recent decision will see change
Yes - registered on graduation
Graduate Paramedic Internship
Yes – compulsory for practice as Qualified Paramedic – 1 year program
Yes – introduced in April 2016 – 2 year program
Clinical Placements
Socialisation
Integration
Supply of Graduates
Over-supply
Under-supply
Paramedic mentors
Yes – in-service course
Yes – university accredited course

13. How the Victoria & London systems compare Operations
Australia
London
Volunteers / First responders
Yes
Co-response with other emergency services
2-tier response system
Yes – Paramedic and MICA
Yes – technician and Paramedic
Air support
Yes – Fixed wing and rotary
Yes – rotary only
Specialist triage pathways
Paramedics employed in allied health roles No

14. The Changing Picture of the Urgent & Emergency Care Sector Heather Lawrence OBE, Chair

15. The NHS Five Year plan articulates a medium term strategy for the NHS that shifts the model of care to one that is proactive rather than reactive
Proactive care for very few people
Primary and community care for some
Urgent and residential care for the majority of people
Urgent
& residential care only
when
necessary
Proactive care for the majority of people

16. London Ambulance Service
We are committed to integrating our 999 and 111 services further, primarily through an integrated Clinical Hub, where callers can access specialist advice and can be discharged as a result of a telephone consultation
999 Calls
111 Calls
Hear & treat
See & treat
Transfer to ICC
See & convey to A&E
London Ambulance Service

17. Any Questions?