Emergency & Urgent Care Ambulance Service Haringey CCG: 30 th March 2017 Performance and Demand Management Andrew Grimshaw – Interim CEO Peter Rhodes – Assistant Director of Operations London Ambulance Service NHS Trust 1
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 2
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 3
North Central London context 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): London Ambulance Service NHS Trust 4
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 5
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 6
Trustwide – what have we been doing? CQC re-inspection, undertook a comprehensive inspection of the Service on 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 7
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 8
Questions London Ambulance Service NHS Trust 9
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