1. NWAS Presentation to Greater Manchester Health Scrutiny Committee
Wednesday 12 July 2017
Steve Hynes – Deputy Director of Operations
Pat McFadden – Head of Service

2. Our Services

3. Greater Manchester Demography
12 CCGs / 1 GM UECNB / AE Improvement Boards
503 GP Practices
12 Hospitals (10 Acute Hospital Providers)
2.8 million population
1500 PES Operations Staff
124 Emergency Ambulances & 45 Rapid Response Vehicles.
1 Emergency Operations Centre – Parkway (1 of 3 Regional Centres)
Responding To / Providing:
600, Calls a year (Red Activity 48.7% Green 51.3%)
573,000 NHS 111 Calls answered in 2016
527,000 PTS Journeys (taking over from Arriva on 1st July 2016

4. Workload 10% Life threatening: 90% Urgent care
Advances in cardiac care, stroke, major trauma, cardiac arrest
Acute service reconfigurations-maternity, paediatrics, surgery
Trauma centres
Improving response times
Sharing data to review clinical effectiveness of care and clinical outcomes
90% Urgent care
Advanced and specialist paramedic roles-expanded clinical decision making, advanced clinical assessment, diagnostic skills, prescribing
Paramedics working alongside community, primary care, social care, mental health
Increase care closer to home

5. Regional Performance

6. GM Performance

7. Main Issues Impacting Ambulance Performance
Growth in Volume and Acuity of 999 activity
Delays in Handing Over Patients at Hospitals

8. Daily mid-morning surge of Greater Manchester 999 activity
Daily mid-morning surge of Greater Manchester 999 activity. From ~25 per hour to ~75 per hour mid-day. Greater Manchester AE attends subsequently surge from 15 per hour up to around 45 per hour early afternoon.

9. Handover & Turnaround – lost time
NHS Standard Contract Requirements:
Patients arriving by ambulance to be handed over to acute clinical colleagues within 15 minutes
Ambulance crews must clear site within 15 minutes of handover being completed
Handover & Turnaround times are deteriorating with average turnaround times across GM at 38 minutes compared with 30 minutes at this point last year, and 27 minutes in April 2015.

10. Hospital Handover Times

11. The Impact of Poor Handover
NWAS take circa 60,000 people to hospital each month
An 8 minute increase on the average (Dec 16 vs. Dec 15) equates to:
480,000 minutes (8,000 hours over the month)
258 hours per day
Just under Hour Ambulances
£5.7 million of ambulance resource delayed at hospitals

12. NWAS Working Differently
3 Major Functions:
Refinement and best use of high acuity outcomes and services (999, ED)
Deploy the most appropriate clinical skillset at the optimal place in the patient journey to improve outcomes and increase system capacity, particularly for complex calls:
These may include mental health presentations, the frail elderly, unwell infants and others
However do need to develop robust methods for identifying some of these groups (and recognise that some may already be captured by 1 above)
Support decision making in difficult scenarios:
Decisions made in isolation are riskier and as a consequence are more likely to default to a higher acuity for safety

13. Hear & Treat/See & Treat

14. Transformation Clinical Contact Centres – enhanced clinical support
Clinical Assessment Service (CAS) – previously referred to as the integrated Virtual Clinical Hub
Ambulance Response Pilot (Steve to consider if this should be included)
Health Care Professional (HCP) /Inter-Facility Transfer (IFT)
Frail & Elderly
Clinical Leadership
IMT
Communication

16. Other Initiatives Paramedic Pathfinder
Community Care Pathways and Plans
GP Acute Visiting Scheme
Community Paramedics
HCP Bureau
Frequent Callers Initiative
Nursing Homes
Inter-facility transfer
Blue Light Collaboration – Cardiac Arrest / JCC / Estates

17. Manchester Arena Incident 22 May 2017

19. Incident Timeline

20. Resources Number of resources by type: Paramedic Ambulances– 60
RRV – 8
APs/CPs – 6
Doctors – 5 at scene
HART – 3 teams (2 NWAS teams)
Total staff – 300, including EOC and supporting corporate staff

21. Mutual Aid Carlisle Centre inundated
WMAS – 10 Ambulances + an Officer plus HART deployed to border
YAS – 6 Ambulances + Officer
EMAS – 5 Ambulances + HART team to scene
WAS – 2 Ambulances + 1 RRV

22. Support Thank you to the people of Greater Manchester
Positive comments from public, media and stakeholders
Stations and corporate offices inundated with gifts and cards
Thousands of messages on social media
Political visits/attention
Drop in arrangements in place   
Reflection event for staff involved took place on 21 June
Structured formal debrief taken place
Medium and long-term staff support as required

23. Thank you – any questions?