1. Leadership and Safety Culture Across a Complex System
Derek Cartwright
Chief Executive

2. Complex Operating Environment
7m Popn
5.4k
Sq. Miles 4 33
76 MPs 46 8
30+ 5 5 29
100’s
100’s
1,420

3. NHS v Blue Light Service
Urgent & Emergency Care
Blue Light Collaborative

4. Regional Service: Local Delivery

5. Ambulance Turnaround & Delayed Transfer of Care

6. Hospital A : Manchester Infirmary
Hospital B: Salford Royal

7. 805k attendances to hospital.
2015/2016 highlights:
Over 1.1M incidents
Of Which, 480k REDS (serious and immediately life threatening)
Unprecedented growth of around +11% on previous year.
805k attendances to hospital.
358k conveyances avoided (through hear & treat /
See & treat)

8. The System We are all part of the one system
NWAS works with partners in the system to improve patient safety and experience in the community and EDs
Together we can improve the whole patient experience
Ambulance Trusts have lots to offer, BUT
The NHS has 999 patients at risk in the community
without any support at all
this is not safe
Hospital A : Manchester Infirmary
Hospital B: Salford Royal

9. This is not safe care Turnaround - Lost Time
1 minute increase = 2 x 24/7 Ambulances each day
That’s 336 patient episodes
5 ½ minutes Increase = 10 x 24/7 Ambulances each day
That’s 1680 patient episode
This is not safe care

10. Green 4 Response

11. But you have plenty of Ambulances!
Justification
But you have plenty of Ambulances!

12. Transfer of Care Hospital Amb delayed Amb Resource
Southport District General 3 5
Aintree University 11 10
Cumberland Infirmary 2 6
Furness General
Royal Blackburn 13
Wigan Infirmary 8
Royal Bolton 15 9
Royal Oldham
North Manchester General
Manchester Royal Infirmary
Stepping Hill 4 7
Longest wait for transfer of care on Monday 21st November 2106 at 1600
Resource is Ambulance and UCS at local station

13. Hospital Turnaround Time

14. Green 3 Response

15. Delayed Transfer of Care - Variance between Acute Hospitals

16. Suggested Mitigation – Get more Ambulances
We need eleven people to fully staff an Ambulance (24/7)
Paramedics are university educated, the recruitment takes three years
An Ambulance vehicle plus equipment can take up to a year to procure, build and get delivered
The total cost of a staffed & equipped vehicle = £700K
And won’t they just join the queue!

17. We have very expensive, university educated, corridor assistants.
Royal Bolton Monday 21st November 2016

18. Early hours Fri/Sat/Sun shows sustained pressure through the night
Early hours Fri/Sat/Sun shows sustained pressure through the night. Taking much longer to subside
Daily mid-morning surge of 999 activity. From ~60 per hour to ~210 per hour mid-day.
AE attends subsequently surge from 40 per hour up to around 115 per hour early afternoon.

19. Why do you convey everyone to ED?
Hospitals Say:
Why do you convey everyone to ED?

20. 999 Patients

21. ED Patient Conveyances

22. 528
Nov 2015

23. 12
1714
Nov 16

24. Quality/Safety Measure
SIREN report (safety monitoring)
Red 1 and Red 2 incidents with excess attendance time > 60 minutes:
December 2016; Red 1 was 13 and Red 2 was 623.
January 2017; Red 1 was 20 Red 2 was 605.
Analysis of the 20 Red 1 calls with excess attendance have shown that they were all a result of upgraded calls.
We understand we have got a problem with long waits across the board
Whilst cardiac arrests are what many think we are here for and every time you hear a siren we are off to a clinical emergency –you know this is not true!
Long wait, create long waits but also could be worsening care outcomes for some patients – not all, but our triage system is not good at figuring this out

25. NWAS and the System
Even with an increase in 999s, in 15/16 NWAS took less patients to the Emergency Departments than the previous year
NWAS managed more than 33% of patients without transportation anywhere (H&T, S&T) – minimal re-contact rate
NWAS transported a further 8% of the patients it attended to destinations other than an ED
More than 40% of 999 patients don’t go to the ED
Hospital A : Manchester Infirmary
Hospital B: Salford Royal

26. Key Recommendations 1) Whole system approach 6) CAD system visibility
2) Working together
7) Streamline process
3) Financial penalties
8) Modelling capacity & forecast
4) Definitions
9) Escalation
5) Key performance indicators
10) Regional capacity management
NHS Confederation (2012) Zero tolerance: Making ambulance handover delays a thing of the past.

27. What can we do together to improve the situation?
Now
Our (NHS) Patients are unsafe in the community
Our (NHS) Patients think that none of us care
Bad in reputational terms for all of us in the NHS
Bad for all our People
The issue has become normality – for all staff groups – we must change this mind-set
What can we do together to improve the situation?

28. Thank You, Any questions. email: Derek. Cartwright@nwas. nhs
Thank You, Any questions? Tel: