Emergency & Urgent Care Ambulance Service Haringey CCG: 30 th - - PowerPoint PPT Presentation

Emergency & Urgent Care Ambulance Service Haringey CCG: 30th March 2017

Performance and Demand Management Andrew Grimshaw – Interim CEO Peter Rhodes – Assistant Director of Operations

London Ambulance Service NHS Trust

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Background & challenges

The challenge:

• Managing a large volume of incidents, 1.1m – significant increase in demand
• The duration of each incident being quite short and variable
• Having tight response times to achieve, for 0.5m incident arrive at 75% within 8 minutes
• Pan London

How is this achieved? Through a balance of;

• Predicting demand patterns;
• Mobilising capacity to match demand;
• Estimating job cycle time (mobilisation of vehicle to green up at hospital);
• Assessment of the “Multiple Attendance Ratio” (MAR), some incidents require more than one

vehicle;

• Maintaining a utilisation level that allows variation in the volume, distribution and duration of

demand to be managed;

• Maintaining a pan-London response model.

London Ambulance Service NHS Trust

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2016/17 Plan

Defined a model for 2016/17 which;

• We agreed with LAS Commissioners demand, assuming 2.36% growth.
• Defined patterns that were even across London, with an assumption of 2% demand management

from September.

• Defined a Job Cycle Time (JCT) and Multiple Attendance Ration (MAR) – with some

improvement from October.

• Calculated an establishment and recruitment plan to employ the associated staff.

This model didn’t;

• Secure 75% A8 performance for 2016/17. 67.7% for year, with an exit run rate of 71.2%.
• Didn’t address utilisation - this would only improve once trajectory was met.

Meaning variation in one of the key metrics (demand, capacity or JCT/MAR) would result in a movement in the trajectory.

London Ambulance Service NHS Trust

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North Central London context

London Ambulance Service NHS Trust

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 A8 performance against trajectory for the North Central London was hit last week (NC Actual: 71.10% - NC Trajectory: 68.70%). Performance in March (to 30/3/17):

Operating Context - Haringey

• Operate from legacy estate – Tottenham (St Anne’s), Bounds Green, Friern Barnet.
• No specialist centres in Boroughs of Haringey, Enfield or Barnet.
• HASU (UCH – Camden), MTC (RLH), HAC (RFH – Camden).
• Acute Trusts with long ambulance handover delays (data for 2017).

London Ambulance Service NHS Trust

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Action Plan in Place for Haringey

• Redeployment of Training Station and Private Ambulances into Sector.
• Deployment of Motorcycle to Tottenham (Fire Brigade dependent).
• Extra response car at Bounds Green 24/7.
• Redistribution of response cars across Sector to displace Northwards.
• Work towards a tethering arrangement for certain response cars (inc JRU).
• Increase the deployment of Tactical Response Unit cars into South of Sector.
• Move Sector staffing to 100% (achieved by end Q1).
• Work with CCG to increase pathway coverage (lower conveyance = lower JCT).
• Further integration with 111/IUC hub for advice and discharge.
• Continue to work with Acute Trusts to reduce ambulance handovers across Sector.
• Work with CCG/blue light collaboration colleagues re. estate.

London Ambulance Service NHS Trust

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Trustwide – what have we been doing?

CQC re-inspection, undertook a comprehensive inspection of the Service

• n 7,8,& 9 February 2017

Quality Improvement Plan, identified workstreams:

• Making the LAS a great place to work (eg Retention – Band 6, Advert

to Action – recruitment, Bullying & Harassment – awareness training / ‘speak up’

• Achieving good governance (eg Risk Management, Improving Incident

Reporting)

• Improving patient experience (eg Bariatric)
• Improving environment & resources (eg Fleet prep & Make Ready)
• Taking pride and responsibility (eg Medicine Management)

London Ambulance Service NHS Trust

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Challenges & opportunities

Pressures:

• 2016/17 demand on our service and the wider healthcare system.
• 2017/18-19 growth.
• Marauding Terrorist Fire Arms Attack (MTFA), resilience and capability in our capital.
• Workforce and retention (Band 6 for paramedics).

Opportunities:

• Demand Management (111, HCPs, Frequent Callers, Met DG).
• Job Cycle Time (JCT) > need for pathways and decreased handover times.
• Ambulance Response Programme (ARP), aim to improve response time to critically ill patients.
• IM&T investment for our staff, collaboration with health & social care systems .
• Integrated Urgent Care model (111/OoH).
• Care Pathways, consistent and unified pan London.

London Ambulance Service NHS Trust

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Questions

London Ambulance Service NHS Trust

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