Nhs Plan Feedback Group

DRAFT

ROYAL BERKSHIRE AMBULANCE

NHS TRUST

NHS PLAN PROGRESS

2002 - 2003

Begun in January 2001, this is the third annual report for RBAT

Compiled by Catherine Breen, Clinical Effectiveness Officer

Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

Preface

Page 2 /

Cost effective services

Involve the Finance Department in all projects

Finance Dept

Costing database

Page 4.
Item 5 /

Cycle of continuous quality improvement, include quality of life and the entire patient experience. All those providing care will work to make it ever safer. Support culture where we can learn from and effectively reduce mistakes

Involves Clinical governance

Analyse complaints

Clinical audit

Patient Satisfaction surveys
Risk management Training
Culture change /

Operations

CETeam
Risk
Training
Human Resources /

. Patient surveys in Cat C, Community Nurse response to minor ailments and injuries and Forestcare response to elderly fallers

. A Clinical Governance Action Plan (begun in Jan ’01) has been enhanced by actions from a partial CHI review in Oct 2000, which were felt would effect further improvements in the Royal Berkshire Ambulance NHS Trust CHI will perform a complete review in Nov 2003.

. A PALS has been implemented.
. PPI is being monitored and a strategy formulated.
. Adverse events and complaints are monitored and lessons learned.
Item 6 /

Strength of NHS lies with its staff who deserve to be with respect and dignity. Provide opportunities for individual staff to progress

Involves Personnel and training

Staff satisfaction surveys

Human Resources

Training /

The Trust is committed to continue with a Staff Satisfaction Survey – however have recently changed from a Quarterly Survey to an Annual Survey to enable the Trust to have more time to act on any suggestions.

Page 5. Item 8 / NHS to be shaped around the needs of the patient. Develop partnerships and co-operation /

Liaison with external partners

Access patient views ? by collaboration with acute and community care

CETeam, Training

Staff in acute care are aware through our links with the Berkshire Audit Group that we would appreciate inclusion on any relevant focus groups

Item 9 /

Focus on prevention, before ill health occurs

Liaison with Health Promotions

No smoking adverts on PTS vehicles

CED

Sickness, re-engineering and re-location in Health Promotions prevented progress in this area

Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

Item 10 /

Provide open access to information about services, treatment, and performance. NB: patient confidentiality , improve quality of service, generate new knowledge

Involves PR, Corporate Services, Caldicott, Training

Corporate Services, Human Resources,

CED /

A brochure has been written intended for patients describing the level of training in various grades of ambulance personnel.

Documents intended for patients have in them included a paragraph on how they can access information and on data protection, warning that information received from patients may be used in an anonymised form for training, audit and research purposes

We have a patient suggestion scheme

Executive Summary

Page 10 /

NHS has

a lack of-National Standards

Over-centralisation

Involves Controls Assurance

Controls Assurance, CED

Board /

We have attained level 1 in Controls Assurance

RBAT is working towards developing UK Guidelines with all other ambulance services in the UK

Page 11 /

NICE to ensure cost effective drugs not dependant on area that patients live in

Medical Advisor, LAAPs

Medical Director involved with NICE assessment of Pre-hospital Thrombolysis (through BASICS) and, in future, the use of Pre-hospital fluids in trauma

Page 12 / Increased levels of service / Extra staff required, increased finance required / Letter to BHA / Operations, HR, Finance / SaFF

Social services and NHS to work together

Eg Falls in the elderly

Operations

Extension of quality based contracts for GPs

? for ambulance trusts also and other services which ambulance trusts employ eg private ambulance during winter pressure

Corporate services

Greater opportunities for nurses and other staff

?ambulance staff to extend their roles? eg. thrombolysis

Training

New role of consultant therapists

? PECs

Training

Smoking cessation. / Trust policy due to extend to external areas of Trust property in April / Occupational Health, HR / Do not have a Policy – had a statement of intent. Will be issuing a Policy to all staff in due course.

Letters about individual patients care will be copied to patient

Will that include PRFs

? Corporate Services

We should make better use of private facilities that are available. / ? private ambulancetoo / Have involved private ambulances during winter pressures / Operations, EMCC, CETeam, local private organisations / We continue to use private ambulance services for Doctor’s Urgent transportation and for some minor (Cat C) calls when short of staff
Patient advocates will be developed / Liaise for patient satisfaction surveys / CED / The Trust has failed to attract funding for PALS
Page 12 cont / More patient surveys / Analysing one in PTS
Data collection at present for Cat C
Another planned April for all A&E cases / CED, PTS, EMCC, Operations + local hospitals / Delayed until new assistant procured
Page 13 / Long waits in Accident and Emergency Department / Reduce unnecessary patient transport / Alternative responses to Cat C calls / Operations, EMCC, CETeam, local hospitals. Others when alternative response projects identified / 8/1/01: Re: Cat C project in initial information collection stages
May '01 - preliminary report distributed
Project with Community Nurses to develop protocols for their response to suitable 999 calls (e.g. slipped catheter)
Rapid access chest pain clinics / Would we be able to deliver patients there? Probably not that kind of service but may have an impact on transport / Wait and watch for opportunities / PTS
The Mental health care teams also are to form immediate access clinics / Would we be able to deliver patients there directly? Could they provide an alternative for DSH? / Liaise through DSH project / CETeam
? PTS / Liasing with Berkshire Mental Health NSF Implementation Group
Smoking cessation. / Trust policy due to extend to external areas of Trust property in April / Occupational Health, HR / April 2001 - second stage of policy established
Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

Introduction by the Secretary of State
Page 15 / Inspection and accountability / Probably Finance and Corporate service also as well as CED / Financial audit Internal audit
Clinical audit / Finance Dept, Controls Assurance, CED, Training / Already happening
Page 15 cont / Other health professionals will be given bigger roles / Development of larger roles
Involve PECS - other health professionals will develop bigger roles, that could be the PECS again. / ? thrombolysis / LAAPs / 12-lead ECG and Pre-hospital thrombolysis training scheduled for this year.
Training department working with Oxford on a common national academic base for University Paramedic Education as part of the Practitioner in Emergency Care (PEC) development.
Resources would be available for routine use / Wait and watch for opportunities
1 / DoH vision
1.1 / Fast and convenient care, at a high standard / Operations
1.2 / Childcare
Staff not rushed off their feet and constantly exhausted, paid properly for good performance / Should we be accessing hospital facilities, or will we be providing our own in the ambulance service. / HR / Staff make their own arrangements at present There is no funding but HR will continue to enquire into possible links with other providers. HR is working towards implementing an EAP which will involve assistance for staff in accessing childcare facilities.
1.5 / Assessing new medicines / ? thrombolysis / Medical Advisor, LAAPs / Medical Director is active member of National Ambulance Clinical Guidelines Group which is systematically reviewing current and future treatments by the Ambulance service.
Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

1.8 / Occupational Health / Wendy Laine is leaving, is she to be replaced, she was asking for more hours, two days a week is not enough, is it possible we can share an occupational health nurse with a local hospital or with Oxfordshire Ambulance Service? / Available for use at RBH / HR / June 2001 - for 2 days a week RBAT has a new nurse contact with WBOH – Cathy Macrow (0.4 WTE.) The HR team are currently working on improving the existing SLA to improve efficency e.g. through better communications. This may, if effective, supersede the proposed need for increased WTE. HR is also working towards the implementation of an EAP which will compliment existing services of WBOH as well as replace the Counselling Services currently provided by TVU.
1.9 / Self care at home will become an NHS resource people routinely use every day to help look after themselves / ? increased transportation / PTS
1.10 / NHS PLUS / The NHS PLUS will provide information for publication material / Access any useful information - encourage information on abuse of service / PR / Campaigns “999 is a Lifeline Use it Don’t Abuse It !” and “Is Your Number Up !”
Frequent radio interviews (BBC Radio Berks & Star FM) re Self Help appropriate use/self help.
1.10 / Digital channels for providing patient education health care information / Mike Stephenson is working with A&E to provide video information for patients sitting waiting to be seen. It is possible that we may be able to provide information on Cat C calls and advice on not to contact 999 for some simple matter. (Public information broadcast - BBC / digital NHS TV channel)
Working with Howard Rayner/ Jon Burton hopefully very soon, to develop a web page, similar to the police web page, 999 "Don’t call the police if you have locked yourself out", etc. / We need to talk to A&E about this. When drafted, would need to go through the ethics committee. / PR / MS
HR
CED / The Trust has an Intranet site with access to information and advice for patients
Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

1.11 / NHS Direct / NHS DIRECT is supported as the gateway to health care / Access for Cat C patient advice / EMCC, CETeam / Meeting with Oxford Development Management 13/6/01. Milton Keynes will shortly be advertising NHS Direct availability in Berkshire
1.11 / Single call to NHS Direct to access all services, use of E-mail etc / Emergency service involvement?- not supported - would result in delayed response. / Letter to HA / Operations
1.12 / The ambulance should be equipped with video and monitoring equipment / Finance required for equipmentand links with acute care - liaison with 24 hr.doctor service in casualty / Operations/ CETeam /MS
1.13 / Electronic patient record forms (EPRF’s) - patient to hold key / Project trialing EPRFs about to start
??? / CED (EPRF working party / Held a demonstration day (5 companies attended) with representatives from other ambulance services and acute trusts in Berkshire.
Held a trial of an EPRF which was also attended by representatives from other ambulance services and acute trusts in Berkshire.
Drafted OBC but failed to get funding from LIS
1.14 / Multipurpose GP teams / Can we use for alternative responses? / Wait for developments / Medical Advisor / Working with local GP Co-operative on protocols for taking some patients to Primary Care Centre rather than A&E when appropriate.
New GP contract may provide further opportunities for GPs to work in Immediate Care.
1.15 / Special one stop diagnosis and treatment centres / PTS involvement
The bus service could be extended to drop off outside the hospital to alleviate PTS workload
The rights of the patients also bring responsibilities, it may be their right to have an ambulance to hospital but it is also their responsibility that they don’t take that away from people who really need it. / Liaise with bus also to extend service
Letter to HA / PTS
1.16 / Travel to specialist centres / May involve increase in PTS / Letter to HA / Operations Director
Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

1.18 / Speed up discharge from hospital when patients are ready to leave / PTS / HDU involvement / ? develop service / PTS / CG development group / February '01 - HDU service under review
1.19 / Shorter stays in hospital for stroke and elderly patients, more intensive rehabilitation / Intensive rehabilitation for stroke patients and elderly who will be encouraged to leave hospital sooner may mean we would be transporting them to hospital. / Letter to HA re: increased PTS involvement requires PTS to be supported financially to enable increased activity / Operations Director
1.20 / Rapid response and hospital at home services / ? increased ambulance / PTS support
Investigate for alternative responses to Category C calls / Express interest and wait for developments / PTS
CETeam
1.21 / Regular patient surveys / How regular? Involve linking organisations when appropriate / CED / February 2001 - PTS satisfaction survey
March 2001 - Cat C patient satisfaction survey
2001 – 02 Community Nurse and Forestcare Projects included a Patient Satisfaction element
1.22 / National Standards: drugs and treatments shown to be clinically and cost effective used / Standard protocols, audit and research / Clinical Effectiveness programme / CETeam / 2000 – 2001 Tramadol audit complete
1.25 / Extra staff to provide services / Extra funding required / Identify and communicate with each new project team / Operations / PTS / HR / HR to use the Workforce Plan alongside Emergency Services and Customer Services statistics for delivery of service to help bid for extra funding in the S&FF process.
Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

1.28 / Improving quality of NHS through National Service Frameworks (NSFs) and National Institute for Clinical Excellence (NICE) and an independent inspectorate The Commission for Health Improvement (CHI) / RBAT Action plan for CHD has been drawn up.
Ethnicity issues addressed through induction programme.
Information for nation audits provided for acute care trust (on PRFs)
Monthly monitoring of response times, aspirin and glucose administration for cardiac arrest, MI and stroke patients. / Monthly review of the actions from the plan / CED / Improvements in cover points, introduction of predictive software, procurement of additional co-ordinator in EMCC, 3 more First Response vehicles, training of 15 extra A&E staff and further 15 staff trained to paramedic standard to reduce activation times
2 further Co-responder schemes introduced with Fire Service
6 of the 17 defibrillators beyond recommended life have been replaced
Commercial training department has provided AED defibrillation training to 8 companies in the SE region
2 / The NHS now
2.5
The NHS now / Typical Day

33 000 get the care they need in A&E
8 000 are carried by ambulances
90,000 doctors
300,000 nurses, etc
6 500 paramedics

/ At RBAT - 1000./ week PTS
- - 1000 / week emergency
- / Operations
Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

2.8 / Top ten things public wanted to see

reduced waiting times
new ways of working
more convenient services
better conditions for NHS staff, reward and recognition for the work they do
better help and information on healthy living

/ Suggests more staff / Identify needs and communicate with BHA / Operations Director
2.8 / NHS staff wanted to see the same / Could we have some money for that? / Identify needs and communicate with BHA / Operations Director
Less bureaucracy /

Reduce administration and bureaucracy and improved funding systems
Care centered on patients , system is too focused on its own needs and doesn’t properly meet the need of individual patients

/ Board
2.12 / Tailor made services / Operations
2.14 / National NHS standards / CG, Controls assurance
2.15 / Planning and deploying resources / Operations, HR / Liaising with Emergency Services and Customer Services the Workforce Plan will help HR plan for recruitment.
2.15 / Planning and deploying resources / Operations, HR
Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

2.17 / Information is not shared and investigations are often repeated causing delays / Copy of PRF given at handover.
Monthly monitoring of completion of the forms / Operations
2.18 / Unnecessary boundaries, up to 40% of patients seeing an orthopaedic consultant in outpatients would be better off being treated by a trained physiotherapist first, frustrates staff and creates longer waits for patients / Alternative locations for transportation / PTS
2.23 / Removal of institutional barriers to service - particularly mentions delayed discharges / Put the needs of the patient first. PTS involvement in discharge planning / PTS
2.28 / Comparison of services. Managers unable to compare costs of services / Controls Assurance / Finance department / / Yes and no depends on the level of detail and what service
2.29 / No systematic way of independently assessing NHS performance / Corporate Governance / Corporate Assurance, CED / Monthly review of Key Response Areas in response times, completion of PRF and clinical aspects of cardiac arrest, MI and stroke
2.30 / NHS needs a system which spots problems early and takes action swiftly / Monitoring keeps a finger on the pulse of the organisation
Complaints process, risk management and critical incident reporting well established.
Only 2 internal auditors for BSI left in the organisation now. / Complaints, Risk Management
BSI, Controls Assurance, CED / . March ’03 - Have trained 7 further internal auditors for BSI
. Effective Risk Management and monitoring systems are in place in RBAT.
. Injury, accidents, assaults against staff and manual handling injuries are showing year-on-year improvement and are at the lowest recorded level.
2.31 / Overcentralisation / Ownership better with local agreements / Board
Number /

Item

R.B.A.T. comments

Action

Person responsible

Progress

2.32 / Freedom to run local services, operating under clear national standards / Liaison through LAAPs cmte / CE group / Corporate services, LAAPs, CED / Medical Director working with National Ambulance Guidelines Group has developed guidelines which include guidance on local variation where geographic and local health provision dictates.
RBAT currently running projects with District Nurses, Falls assessment team and Forestcare on Category C calls and non-injury falls assessment.
Page 31 / NHS lacks sufficient doctors, nurses and other skilled staff, too many staff are rushed off their feet / The Emergency Services Directorate is currently over-established however for the ES team to maintain current levels of service increased funding to provide more staff is required. / HR, training / See 1.25 and 2.15. The new HR team is currently working with a R&R working document to establish greater control over vacancies and recruitment.
2.34 / Patient's voice / Interviews / Surveys / Participation in acute / community patient focus groups / CETeam
3.0 / Options for funding
3.3 / Charges for services to raise revenue and encourage responsibility / Can we charge? Could the ambulance service make these charges. The plan also talks about insurance companies, now road traffic accidents are billed if participants have caused the accident - only about 3% are due to a faulty car, the rest are considered to be negligence as they are due to human error. / Need to speak to a solicitor to find out if it is possible for us to charge because if the hospitals are charging the insurance companies for their services, then surely we can do the same. / Finance / Does not apply to Emergency Services but does to PTS / commercial
3.32 / Treatment is based on peoples’ ability to benefit / Investigating appropriateness of responding to some Cat C calls / CED / May '01 - preliminary report distributed
Number /

Item