Issuu

OUR

ACHIEVEMENTS

THE A – Z OF WHAT WE DO BEST

A–Z

Our ambition is to be the best ambulance service in the UK by providing the right care, at the right time, in the right place; every time. We believe we are well on our way to achieving this and, in this book, we are proud to show you how we are continually developing to meet the needs of our local population - both now in the 70th year of the NHS and in the future. To achieve our aim we are changing the way we deliver our services to make sure clinical decisions are taken earlier in the patient journey. Whether it’s over the phone, in our NHS 111 or 999 services, or face to face with our teams in non-emergency patient transport and urgent and emergency care, we are working on a number of positive and innovative service improvements that will help us to support patients as early as possible in their NHS experience.

We’re proud of what we do across the North West and are pleased to share details of our progress with you in ‘The A - Z of what we do best’.

North West Ambulance Service - Our Achievements

ADMISSIONS AVOIDANCE CARS In keeping with our aim to provide the right care, at the right time, in the right place; every time, we use a number of resources to help patients with less serious conditions to ensure they can stay out of emergency departments which can often be detrimental to the health of elderly and vulnerable people. Our admissions avoidance cars work in different ways; some respond specifically to patients who have fallen, some are staffed by occupational therapists who work alongside paramedics and so on.

The Ambulance

Response Programme,

or ARP, has had a significant

AIR AMBULANCES Patients in the North West benefit from two air ambulance charities; North West Air Ambulance, which covers most of our region and Great North Air Ambulance, which covers the North of our patch in Cumbria.

impact since going live in the

North West on 7 August 2017.

Our paramedics work as part of the teams on the three North West Air Ambulance helicopters alongside doctors and pilots.

AMBULANCE RESPONSE PROGRAMME (ARP) The national standards were designed to change the rules so that ambulance service targets are met by doing the right thing for the patient.

The cruising

speed of an air

ambulance is 160mph

so they can reach critical

patients, provide essential,

life-saving interventions

and get them to hospital much faster than ambulances on the road.

Under previous targets, life-threatening and emergency calls should have been responded to in eight minutes, which meant we often sent more than one vehicle to have the best chance of meeting the eight minute target. By changing this target to focus on sending the right response, more vehicles and staff will be free to get to emergencies. Now, for a stroke patient for example, we would send an ambulance to take them to hospital, after on-scene treatment, when previously a rapid response vehicle arriving would â€˜stop the clockâ€™, despite it not being able to take the patient to hospital. Ambulance service demand has increased by about 6% year on year. The new system enables ambulance services to be much more stable and able to deal 5

North West Ambulance Service - Our Achievements

Looking ahead, we are working nationally with

ambulance sector and emergency services colleagues with unexpected events and peaks in demand. ARP will ensure the best, most appropriate response is provided to patients, first time. The aim of the ARP programme is to improve patient care and survival. ARP is the result of the largest study of an ambulance system ever completed, anywhere in the world. More than 14 million ambulance calls were monitored as part of a trial, with no patient safety concerns reported. The redesigned system is strongly endorsed by expert organisations such as the Royal College of Emergency Medicine, the Stroke Association, and the College of Paramedics.

APPRENTICESHIPS We are committed to the development of apprentices as part of our future workforce model as they offer a way to provide high quality training and education, leading to a recognised qualification. We have successfully registered with the Skills Funding Agency as an apprenticeship employer-provider and completed our first Ofsted early monitoring visit. The Ofsted inspection was over two days and looked at areas such as leadership, learning and safeguarding. Our feedback was extremely positive and we were judged as making reasonable progress in all areas. We have used existing apprenticeship frameworks to develop apprentices in Fleet and ICT, and used them to support continuing professional development (CPD) for staff in our emergency operations centres (EOCs) and corporate departments. The apprenticeships currently being completed by more than 30 staff include team leadership, management, business administration, customer service, learning and development and finance qualifications.

to help develop further apprenticeships.

We are delighted to have met our public sector apprenticeship targets last year which require us to develop 2.3% of our workforce through apprenticeships. Using the apprenticeship levy has also allowed us to invest in more work-based learning support which will benefit all our staff.

AWARDS Sector Manager, Stuart Rankine received the Support Services Award at the Association of Ambulance Chief Executives (AACE) Leadership Forum Awards. Under Stuartâ€™s leadership, his team have set up excellent audit tools, been actively involved in vehicle design and frequently produced business cases to the Board detailing proposed improvements.

More recently, our Medicines Performance Facilitator, Joanne Hammond, was recognised by AACE for her innovative achievements in developing a new platform to source, store, distribute and monitor medicines. Following changes to medicines regulations a new platform was needed, a complex task which was led by Joanne, bringing cheerfulness, resilience and positivity to the project, whilst demonstrating innovation throughout. Thanks to Joanneâ€™s hard work we have a reliable medicines supply accessible via the medicines hub.

In addition, we are delivering the national Associate Ambulance Practitioner (AAP) programme to 125 new EMT1 recruits, with the first due to qualify mid-2018.

North West Ambulance Service - Our Achievements

Paramedic Lea Vaughan was recognised as a woman of the year at a prestigious awards event in London following the heroic efforts of herself and her colleagues after the Manchester attack. Lea joined a group of eight inspirational women from Greater Manchester to collect the award. They all played a very important role in helping patients on the evening of the terrible events with Lea volunteering to go inside the blast zone to help those injured. The Barclaysâ€™ Women of the Year Award was presented by Camilla, The Duchess of Cornwall, at the annual luncheon and awards ceremony which took place at InterContinental Hotel, London.

Advanced Paramedic, Paddy Ennis, who was first on scene at the tragic Manchester Arena terrorist attack, was given a Pride of Britain Award alongside the medical staff who worked tirelessly to save the lives of those caught up in the atrocity in Manchester on 22 May 2017.

leadership levels and we approached this by overhauling development opportunities for women. The Women into Leadership programme was launched at a conference for female leaders, as a deliberate, systematic approach to maximising our use of the talent of our female staff. We also received the Fairtrain Gold Award which is a Work Experience Quality Standard and is a national accreditation which recognises organisations that offer high quality work-based learning experiences to students and employees.

BASIC LIFE SUPPORT Last year we trained over 39,000 people in Basic Life Support. This figure included over 16,000 secondary school children who were trained on European Restart a Heart day, an initiative we have fully embraced. We teamed up with 54 secondary schools across all five counties in the North West and enlisted the support of more than 250 volunteers to go in to the schools to deliver the training along with other NHS professionals and fire services.

Paddy and the Manchester medics accepted the â€˜This Morning Emergency Services Award for Special Recognitionâ€™ on behalf of all the medical staff involved in treating the victims. Some 300 of our staff were involved in the response on the night both behind the scenes coordinating the response and on the frontline treating the injured and answering emergency calls. We were delighted to receive the Princess Royal Training Award in 2017. This is a national award, honouring employers who have created outstanding training and skills development programmes. We recognised that we needed to improve female representation at

North West Ambulance Service - Our Achievements

Our volunteers also attended English football league fixtures, during October, to show football fans CPR techniques. The current bystander CPR rate within the North West is approximately 66%, which is evidence of people wanting to help others in their time of need. To promote these easy skills we created an animation which shows a character called Agent Lifesaver saving a life - you can watch this on our YouTube channel.

BE THINK DO A key objective from our Workforce Strategy was to develop a leadership model. To develop an understanding of what the model should be, we engaged with a broad range of staff and managers to find out what they thought were the key qualities of a great leader. It became clear that it was not about what you did as a leader, it was also how you did it and who you are. At the centre of the model is our staff and our patients and here we focus on sense of purpose, role model and healthy leadership. The model then develops three areas; what a leader needs to be, how a leader needs to think and what a leader needs to do. This developed into our Be Think Do leadership model which launched at our Leadership Conference in March 2017. A two day induction programme focused on self-awareness, role modelling, personal resilience and developing leadership skills in line with the model, has been piloted and rolled out to over 150 managers and will form the basis of future inductions for staff new to their role. Talent management is also a key element of the Be Think Do leadership philosophy and we have developed a talent management framework (shown right).

The framework has been used to develop a guide and toolkit to support managers to have talent conversations with their staff. This will support us in ensuring that we can identify staff with potential and that they can understand and access an appropriate leadership development pathway. Further developments have seen the leadership framework embedded into management appraisal processes and used as a framework to support recruitment. Our status as a Chartered Management Institute (CMI) accredited centre also provides us with the opportunity to deliver in-house management, leadership and coaching qualifications to our leaders and aspiring leaders. This underpins the focus on leaders and managers as coaches, while enabling us to establish an internal coaching network. During 2017-18, 56 managers have completed an accredited course through the CMI route.

North West Ambulance Service - Our Achievements

CAFE FOR 111 PATIENTS Clinical Advisor Front Ending (CAFE) ensures a better patient journey for our callers who are contacting us regarding children under five years old. This age group inevitably requires clinical input so by enabling the caller to speak to a clinician directly, without waiting for a call back, reduces anxiety and provides a better service for this group of patients. This also reduces the impact on our clinical queue and allows our clinicians to complete a full assessment from beginning to end without the caller having to repeat any information. This initiative assists at periods of high demand for access into the 111 service to ensure that this particularly vulnerable age group receive an assessment and care advice as quickly as possible. We have clinicians who have paediatric training that enjoy working on this initiative, as they are using their skills and knowledge effectively. Recent feedback from clinicians has highlighted that many of them prefer this way of working.

CARDIAC SMART We are continuing to promote our ‘Cardiac Smart’ award in order to promote awareness, support innovation and recognise the dedication of those who work to develop safe and healthy communities built around the chain of survival principles.

CARDIAC ARREST We reported to the Department of Health that 350 (9.4%) of our patients who had a cardiac arrest and were treated by ambulance clinicians survived and went home from hospital.

36 This is

more patients than last year!

CHILDREN’S CARE In the North West we receive nearly 95,000 emergency 999 calls a year relating to patients under 16 years old and more than 400,000 urgent 111 calls. Our aim is to ensure the highest standard of care is provided both over the telephone and face-to-face. To achieve this we are actively engaging with children, their parents and carers. The Children’s Patient Priority Group, set up as part of the Transforming Patient Care programme, works within four key domains that are aligned to advanced practice; research, education, clinical practice and leadership. These four domains are evident in the way we approach and collaborate with our internal stakeholders, external partners and patients. This collaborative approach with academics and clinicians ensures that children across the North West receive the highest standards of care and allows us to lead the way for prehospital paediatric care.

The Patient Priority Group is currently working on projects including: ✓ paediatric Observation Priority Scoring (POPS)

We hosted a Cardiac Conference

in 2016 which had world renowned

✓ cessation of rigid collars in paediatrics trauma

speakers discussing how we

✓ restrictive fluid regimen for children with diabetic ketoacidosis

survival, followed by a lifesaver

✓ paediatric pathfinder algorithms

can further improve the chain of

✓ paediatric sepsis screening

ball to recognise individuals who have made a difference. 12

North West Ambulance Service - Our Achievements

CLINICAL ASSESSMENT SERVICE AND THE ACUTE PATIENT ASSESSMENT SERVICE Over the past two years, we have worked with commissioners to further develop the Clinical Assessment Service (CAS). Previously known as the Integrated Virtual Clinical Hub, the CAS aims to use resources from across the wider healthcare system to manage low acuity 111 and 999 calls more effectively, reducing pressure on acute services. The expansion of the Clinical Hub supports the CAS by triaging low acuity 999 calls. The development of the Acute Patient Assessment Service (APAS) complements the work of the Clinical Hub by helping to reduce the number of patients going to the emergency department who could get more appropriate care elsewhere.

We are now looking to

expand APAS

When a patient calls NHS 111, if the outcome suggests that they should attend the emergency department or a non-emergency ambulance should be sent, we will instead advise the patients that they will get a call back from a GP from our APAS schemes for clinical assessment.

for low acuity 999

calls, increasing the potential for many

more patients to be

supported without having to be taken to hospital. We are piloting a multi-

disciplinary response from

primary and community care

services to add a see and treat capability to the CAS. 14

This early clinical intervention aims to reduce the number of patients attending A&E who are more suitable for a GP assessment which gets the best care for them and means NHS resources are being used wisely.

CLINICAL HUB As part of Transforming Patient Care we are developing and significantly expanding our Clinical Hub, which includes the Urgent Care Desk (UCD), clinical support to ambulance crews and Health Care Professionals Bureau (HCPB). Developing our clinical hub means we can resolve more patientsâ€™ issues over the phone or at the screen than we have done before; keeping people out of hospital. Within our Clinical Hub there are currently a number of pharmacists working and available to support patients and our clinicians. The pharmacists offer telephone triage and support to patients who have called 999 or 111, as well as our crews on scene. The pharmacists have access to C3 and Adastra â€“ the systems we use for handling 999 and 111 calls. The pharmacists undertake empathetic probing and active questioning of calls in order to identify the current situation but also wider issues and concerns which have resulted in 999 or 111 being called. Each call is different, so the team members are skilled at identifying and addressing issues and fears in order to provide a person centred approach at all times; each pharmacist has experience within primary, community, or hospital based pharmacy service. 15

North West Ambulance Service - Our Achievements

A specific feature of the pharmacy service is the ability of crews to call in to obtain support or advice.

Typical types of call that the pharmacists can assist with are: ✓ overdoses or ingestions ✓ mis-dosing of medications ✓ minor injury and illness ✓ any other pharmacy related enquiries

The pharmacists are also able to identify any potential safeguarding needs e.g. how was a child who has accidentally taken prescription medication, able to do so? The majority of the pharmacists have also undertaken training in extended scope to enable them to assess a range of minor illness and injury calls from both 111 and 999. The Clinical Hub team has expanded to include emergency medical technicians (EMTs) as part of a pilot to help manage requests for ambulances from healthcare professionals. The EMTs liaise with the requesting healthcare colleague to ensure that the patient receives the response that is most appropriate for their healthcare needs.

CLINICAL LEADERSHIP Paramedics of today are providing care and treatment which ten years ago would have only been undertaken by doctors. These days, paramedics play a unique role at the heart of urgent and emergency care which intersects healthcare, public health, social care and public safety.

The role of the paramedic has developed considerably in recent decades, and today they are responsible for providing many patients with the most appropriate treatment at their first point of contact with a health professional, particularly as healthcare shifts towards being delivered more in the community. These advancements have seen the development of a leadership structure which places clinicians and their value at the heart. At North West Ambulance Service, the leadership structure for clinical practice mirrors the one set out by College of Paramedics. Our ambulance crews are clinically supported by senior paramedic team leaders, who report to our expert advanced paramedics, who are overseen our team of consultants. We are extremely proud that we’ve been able to introduce two additional consultant paramedic roles, taking the total to six consultant paramedics who report to our Chief Consultant Paramedic. A consultant paramedic is an expert practitioner undertaking a role that encompasses clinical practice, education, research and management.

Our consultants

work strategically to

develop areas of new

and innovative clinical

practice for paramedics delivering patient care.

North West Ambulance Service - Our Achievements

CLINICAL LEADERSHIP IN EOCS Emergency operations centre colleagues play a vital role in making sure the best care is delivered to patients. We’re exploring how extra clinicians within EOCs can support our teams and add another layer of patient safety when pressure and demand is high.

COMMUNITY CARE PATHWAYS AND CARE PLANS We work collaboratively with community and primary care professionals on the development of pathways and individual care plans for patients. Care planning ensures that any ongoing and long-term care needs, including baseline observations, are available for the attending ambulance crew. The presence of a care plan should be flagged to the crew.

COMMUNITY FIRST RESPONDERS (CFRS) ;

We’re helping to: ✓ make extra support available in EOCs ✓ improve patient experience and reduce waiting times ✓ ensure patients get the right care, at the right time, in the right place; every time ✓ work more efficiently so we can free up resources and help to reduce pressure on our busy service

Clinicians can help to: ✓ free up call handlers time by clinically supporting decisions to terminate calls which may otherwise result in prolonged calls ✓ support call handlers when they ring back patients experiencing a long wait who may have worsened and require a more immediate response ✓ work with the dispatch suite to focus on serious cases so that when resources are limited the patient who is most at risk receives help first

We are extremely proud to have one of the largest and longest established CFR schemes in England with some 1,000 active CFRs operating in 150 teams across the North West, providing an effective complementary service in their local communities. This type of resource is particularly valuable in the more rural areas of our region and we are very grateful for the assistance these volunteers provide. CFRs are volunteers who live and work in local communities. They are trained and activated by us to attend certain calls, such as chest pain or cardiac arrest, where time is critical and can make the difference between life and death. The responder provides care and support to the patient until the arrival of an emergency ambulance. Quite often, the role of a responder is one of reassurance and, in some instances, simply giving oxygen can make a big difference. However, in extreme cases, the CFR can perform cardio-pulmonary resuscitation (CPR) or use a defibrillator to restart the heart.

1,000 active CFRs

operating in 150

teams across the North West.

COMMUNITY RESUSCITATION

North West Ambulance Service - Our Achievements

Chances of survival decrease by 10% with each minute that a person’s heart has stopped beating correctly and having a CFR available in the local area can result in a quick response to ensure that treatment is started as early as possible. Our regional CFR forum meets on a quarterly basis to facilitate regular engagement with our volunteers and ensure that standardised clinical governance arrangements are applied across our various schemes and information is shared across the region to bring about change.

We work proactively with partners from a variety of sectors and our awareness campaigns have resulted in the placement of 1,038 automated external defibrillators (AEDs) in settings ranging from community centres to local shops and larger commercial business settings. In addition, we have installed 486 community public access defibrillators (CPADs). These are units that are placed in locked, coded, heated cabinets and are available 24 hours a day, 365 days a year. Members of the public can be directed to these units by our emergency control centres in the times of an emergency. We have 1,659 CPADs registered in our system within the North West area and a total of 5,668 AEDs at businesses, shops, buildings and so on.

COMMUNITY SPECIALIST PARAMEDICS Our community specialist paramedics (CSPs) work within local communities to support people to stay well. The CSPs work with healthcare professionals and the local community to maximise awareness of appropriate use of ambulances resources and make sure only patients that need to go to hospital are taken. Our current cohort of CSPs were finalists in the Health Service Journal Awards 2017 which recognises the finest achievements in the NHS, within the ‘Workforce’ category. They have also featured in articles published by NHS England on the unique role, as an example of working differently to support individual communities.

Survival rates can be as high as

80%

The role is to support the community by improving their health and experience of local populations by working with patients and healthcare professionals with innovative solutions that improve equity, quality and efficiency in the delivery of urgent care. CSPs are based in communities rather than ambulance stations and are aligned within primary care, to identify and support the patients in different ways. The role is more pro-active, in contrast to the normal reactive paramedic.

if an AED is

used within the first four minutes of the cardiac

arrest occurring.

North West Ambulance Service - Our Achievements

The focus of CSPs is to: ✓ improve the health and experience of patients ✓ provide safe care closer to home wherever appropriate

DEMENTIA To demonstrate our commitment to increasing the awareness of our staff of conditions such as dementia, we became a member of the Dementia Action Alliance. Our people have access to learning packages that are tailor-made to suit both our emergency and patient transport services.

✓ reduce 999 demand and unplanned hospital admissions The learning covers elements such as: Whilst each CSP has tailored their role bespoke to their area, there have been some themes that have run through the majority. All CSPs have been working with local care and nursing homes to keep, where possible, older more frail patients at home safely. Many CSPs train local groups in basic life support. They also encourage groups to identify and fundraise for automated external defibrillators (AEDs). On average there are an extra 30 AEDs in areas that we have CSPs, with one rural area identifying an extra 72 defibrillators that were previously unknown to the ambulance service. The CSPs also respond to 999 calls, and their local knowledge of services and links with primary care have enabled patients to stay in their own homes after treatment 32% of the time in contrast to the overall trust average of 21.5%. 22

✓ understanding dementia ✓ adaptive communication techniques ✓ patient specific assessment

We provide staff with an online education resource containing dementia specific modules to be completed as part of their continual professional development. We are also supporters of the Dementia Friends initiative with staff champions rolling out the initiative across the organisation to ensure we provide a dementia friendly service.

Dementia Friends is

the biggest initiative

run by the Alzheimer’s Society which aims to

transform the way the

nation thinks, acts and talks about dementia.

END OF LIFE AND CARE OF THE DYING

North West Ambulance Service - Our Achievements

End of life and care of the dying is one of our key clinical patient priority areas.

EMPLOYEE SELF SERVICE Our electronic staff record (MyESR) was launched in 2017. It allows staff to access their payslips, view and change their personal details (including bank details and home address) and is where EOC, 111 and corporate staff access and complete mandatory training. It is easier for staff to keep their records up to date and means payslips are available to view before the hard copy arrives at their base location.

EMT1 PROGRESSION AND DEVELOPMENT We have always recognised the value of investing in the development of our staff, so it was essential for us to create a new approach to developing our existing EMT1 workforce on routes which will enable them to qualify as our paramedics of the future. 83 staff completed a Higher Education Certificate in Healthcare last year which contributed to 49 of the 80 staff progressing to become paramedic students that year previously being EMT1s. In 2018, we started a programme to ensure ongoing development for those EMT1s interested in progressing their careers to become paramedics in the future, with 70 staff starting the AAP We also programme this spring and further supported 45 cohorts planned every quarter. Overall 221 EMT1 staff (22% of staff that lacked formal the eligible workforce) are qualifications to complete access on a development route courses. These staff are now going to paramedic studies with 82 of them already having on to complete an Associate commenced their paramedic Ambulance Practitioner (AAP) diploma. This represents a significant investment in our qualification which will enable paramedics of the future.

A key objective of our patient care group is to reinforce relationships with palliative and end of life care providers such as hospices, in the patient’s best interests. The group is also developing an End of Life and Care of the Dying procedure, to support and inform colleagues to ensure that all patients who are nearing the end of life are treated with dignity.

ESTUARY POINT We’re investing in a new corporate building for our staff in Cheshire and Merseyside which will also be home to one of emergency operations centres where 999 calls are handled. Estuary Point is a major investment for us and will provide our loyal workforce with a modern and integrated workplace that is fit for the future. The building in Speke is relatively new, has three floors, and an impressive 3,700sqm of open plan space. It is located on Liverpool International Business Park – a 157 acre site next to Liverpool John Lennon International Airport and the Mersey Estuary. The process of buying the building is now complete – it’s ours. We now have project teams busy sorting out the refurbishment and fit out the building. We hope to achieve full occupancy in 2018. Estuary Point will be our brand new base for the Cheshire and Merseyside area, housing the emergency operations centre, urgent care, 111 and patient transport control. In addition, it will provide accommodation for our support services including the secretariat, ICT, human resources, training, health and safety, risk and patient experience.

them to access future

paramedic training.

North West Ambulance Service - Our Achievements

We are particularly skilled at assessing and evaluating a person’s home environment, examining the challenges it presents and suggesting how they may be overcome, which equipment or adaptations for example, to enhance safety. We also assess for care and support packages, and provide rehabilitation and reablement. We work to build self-reliance, rather than dependence on services. Due to the service being new and innovative, and proving its success with this model of service, it has caught the attention of national agendas from the Royal College Of Occupational Therapy in which we were featured in their recent paper “The value of Occupational therapy”, this was featured on BBC Breakfast and in the Guardian newspaper.

While it is a major change for We have built in future-

We were showcased as one of the 45 case studies in the recent Allied Health Professionals (AHP) Mandate for Change report and featured at the launch event in London in January 2017; and have also been the subject of a Health Education North West video case study.

Point will provide the very

In September 2017 we were asked to present at the AHP ‘Harnessing the Value of Allied Health Professionals’ event at the Kings Fund.

us all, it is also an opportunity. proofing to ensure Estuary best accommodation for many years to come.

FALLS The East Lancashire Falls Response Service is an innovative scheme where a paramedic and occupational therapist work together to reduce hospital admission in older people following a fall in their own home. The duo responds to patients who have called 999/111 after falls occurring in their own home, whether living independently or in care. The response to every incident is led by the paramedic following the Pathfinder triage tool for all patients, and utilises the falls self-care pathway when applicable. We assist patients off the floor using the moving and handling equipment where possible. The occupational therapy assessment only begins when the patient is deemed to have satisfactory observations and no injuries. 26

The service has received a lot of

interest from other organisations both inside and outside of the UK.

A number of these services have spent the day shadowing the Falls Response car and learning about how we set up

the service in order for them to start to take similar steps in their regions.

North West Ambulance Service - Our Achievements

FRAILTY Work is underway to provide support and e-learning collateral to colleagues in relation to recognising and managing frailty, as the presentation of an older person with frailty, in an emergency or urgent care situation, is not always straightforward. Frailty scoring of patients, utilising the Rockwood Clinical Frailty Scale, will be rolled out trust-wide during 2018.

This group of patients often contact 999 for some form of human contact which could be their only contact with the outside world. This then becomes a regular pattern which brings a great strain on the service and one that we can’t sustain. Our intervention through the frequent caller team is very powerful as we work with the person to understand what their interests are and explore what help is available for them in the community. We encourage them to re-engage in the community support which helps to boost their confidence and help with their social isolation and loneliness.

FREEDOM TO SPEAK UP Freedom to Speak Up (F2SU) is a method that staff can use to raise concerns at work and was set up following the Francis Report into the events at Mid Staffordshire NHS Foundation Trust. An active culture of F2SU is encouraged within the trust to demonstrate an open and honest culture. Once a concern has been raised, a F2SU Guardian will ensure the concerns are investigated in a timely and independent way by an investigator. They will also provide feedback to the concern raiser during the investigation to keep them updated on progress and can, in certain cases, protect the identity of concern raisers. F2SU is now embedded within the trust and we have had 60 cases raised in the 13 months since it went live. This is a very positive sign that staff feel safe in speaking up.

We work closely with other health

FREQUENT CALLERS Over 1,500 people across the region regularly call 999 to seek help from the emergency ambulance service. We have a dedicated team of clinicians dedicated to tackling ‘frequent callers’ by helping these patients to sort out the issues that lead them to call 999 in the first place. There is a belief that all people who frequently call 999 are delinquents, trouble makers and hooligans. But that is far from the truth with many calling due to their unrealistic expectations or because they are at risk, vulnerable or accessing the incorrect healthcare for their needs. 28

and social care providers. This

holistic approach means we can identify

unmet care needs which includes looking for

patterns to the calls, staging interventions and sharing the patient’s information with other healthcare providers to make sure the best possible care is given.

North West Ambulance Service - Our Achievements

GOODSAM We are the third ambulance service behind London and East Midlands to partner with GoodSAM (Good Smartphone Activated Medics); an application that uses innovative technology to link a qualified lifesaver with a patient in cardiac arrest. The scheme launched in December 2017 and sees frontline emergency ambulance staff and community first responders who sign up to the GoodSAM app be alerted to potential cardiac arrest patients within a 500 metre radius. The technology behind the app is embedded within our control rooms and is automatically activated when someone calls 999 with a life-threatening emergency that is thought to be a cardiac arrest. An ambulance resource will be dispatched to the patient as normal and the GoodSAM system automatically alerts the three nearest volunteer responders. The aim is to get qualified first aiders to the patient as quickly as possible and perform CPR until the ambulance arrives.

HEALTH AND WELLBEING Health and wellbeing is a fundamental part of our approach to improving staff engagement and experience. In 2017 we launched ‘Invest in Yourself’ a new approach to improve the health and wellbeing of staff both in and out of the workplace through a dedicated microsite for staff to share stories, tips and ideas, to help them to be happy, healthy and fit. There is a ‘Your Support’ page which provides information and guidance if staff need to access support and contact information. Also on the site are details of upcoming events, training and a discount page with money saving offers. We teamed up with Urbanwalks to design a number of short walking routes around our main trust sites to encourage staff to be more physically active during breaks at work as part of the health and wellbeing initiative. The annual NHS Staff Survey results are used to ensure that actions developed around health and wellbeing are in direct response to our staff and the particular issues pertaining to ambulance services. 30

To support staff in increasing physical activity levels we took part in the Global Challenge which was a 100 day event where employees around the world competed in teams of seven. Staff tracked their daily activity and worked towards a daily target of 10,000 steps, with their step entries unlocking new locations along the way. More than 300 employees took part and the programme was fully signed up to in less than a week. Advice was also given on nutrition, sleep and general wellbeing. The feedback from the programme was overwhelmingly positive with participants reporting improved physical activity, sleep and mood. Promoting good mental health is also a critical part of supporting staff health and wellbeing, which is why we have pledged to support the MIND Blue Light programme and the Blue Light Champions to help them challenge stigma and encourage open conversations about mental health. We have also supported the roll out of the PTS Peer Support Programme, Trauma Risk Management, and we’re continuing to develop our Occupational Health offering. Engaging with both Edge Hill University and Manchester Stress Institute, we delivered resilience, nutrition and fitness programmes across 111 and the emergency operations centres. The programmes were designed to offer staff a range of wellbeing interventions and raise awareness of long-term mental and physical resilience including coping strategies, personalised dietary and nutrition advice and fitness.

We continue to be a part of the North West Games, an annual event which brings together NHS trusts from across the

region to compete in a variety of events such as rounders,

football, badminton and much more.

North West Ambulance Service - Our Achievements

HEALTH FAIR To coincide with our Annual General Meeting and the launch of the Annual Report, we host a Health Fair every year which is open to the public and is always a great success.

The programme used a variety of methods to give everyone the chance to participate, including 121 consultations, workshops and podcasts. For example: ✓ step 121 Stress Resilience Programme ✓ drop-in resilience launch event ✓ 15 minute resilience and stress management webinars (available to staff 24/7) ✓ wellness zones at each office - sections include sugar free / healthy fats / low salt foods

More than 500 people attended last year’s event which took place at Leigh Sports Village in Greater Manchester. To attract as many stakeholders as possible, the event takes place in a different county each year. The day always includes a range of interactive information stands from the different services we provide to our emergency service and NHS partners as well as other health organisations. Visitors can also view our vehicle display, find out about recruitment and job vacancies and can take part in various demonstrations such as CPR.

✓ food swaps and healthy takeaway food demonstrations on-site ✓ mini mindfulness podcasts available 24/7 ✓ desk stretch and de-stress sessions ✓ cognitive behavioural therapy and neuro linguistic programming (NLP) disassociating from indirect trauma workshops ✓ pop-up taster sessions - combating the perils of night time working ✓ book club - sharing positivity

YOU COULD BE THE HERO NEXT DOOR! VOLUNTEER. BE A HERO. CHANGE LIVES.

FIRST RESPONDER ENHANCED FIRST RESPONDER

FIRST RESPONDER

Community First Responder

HERO NEXT DOOR The ‘Hero Next Door’ campaign launched in August 2017 with the objective of recruiting 25 new community first responders. The campaign had an overwhelming response from the public with 558 potential volunteers contacting the service. The campaign launched with an event in Burnley to find the ‘North West’s safest street.’ We set up in an ordinary street and asked local residents to come along and learn CPR with us so they knew how to save a life. The idea was that if everybody on the street knew what to do in the event of a cardiac arrest then it would be the North West’s safest street. This linked in with the Hero Next Door campaign, as the kindest and best thing you can do for your neighbour is to save their life. We taught around 50 people life-saving skills on the day and sent a press call and release to local media resulting in positive coverage in local news outlets including North West Evening Mail, Burnley Express and 2BR radio. We had four existing CFRs that volunteered to be case studies. We transformed these CFRs into cartoon characters which were used to symbolise the hero next door and used as visual digital content for social media. A video was created in-house by our Communications team with one of the case studies which showed him getting on with his normal routine before being called out to an emergency and then turning up at someone’s door with a smile on his face. This followed on with the message that any normal person can be the hero next door.

HOMEWORKING Homeworking is available to all 111 clinicians who meet agreed criteria. We currently have 15 clinicians who homework and a further eight who have commenced the process. Clinicians are able to work up to 50% of their shifts at home saving them travel time, parking issues and fuel costs. Homeworking enables clinicians to offer extra hours from home which assists the service in meeting demand. Recent feedback requested from current homeworkers has been very positive with staff enjoying a more flexible way of working which enables a better work/life balance. The service has benefited as small gaps in demand can be met by these staff.

INTERFACILITY TRANSFERS Last year, healthcare professional (HCP) requests accounted for 11% of all our activity, with interfacility transfers (IFT) accounting for approximately 7% and admissions at 4%. We know that around 55% of these requests are for an emergency response and a further 25% requested as a 60 minute response. This could be, for example, a request to transport a patient from one hospital to another or a call from a GP practice asking for an ambulance to take a patient to hospital. We have evidence that some HCP requests are booked in a way that result in spikes in demand for ambulances. These spikes can create unplanned pressures within local healthcare systems, for example, where several patients arrive at a medical assessment unit at the same time by ambulance. Increases in demand may also result in us not deploying the most appropriate resource. Inappropriate requests for emergency or paramedic resources by HCPs can lead to reduced local emergency ambulance cover, potential delayed responses to waiting 999 calls, unnecessary cost to the NHS and poor utilisation of available non-emergency resources. A workstream has been set up to look at IFT and HCP admission requests, which aims to better understand areas of high demand and make changes to address this.

North West Ambulance Service - Our Achievements

We introduced an IFT procedure and matrix for pilot in June 2011, which was revised in 2017 and is referenced within the North West Critical Care Network Transfer Policy. The IFT matrix supports the allocation of patients into one of five distinct categories which directly relate to the clinical condition of the patient, and therefore the type of ambulance and crew skill set required.

Other areas of development include: ✓ an initial pilot of the IFT matrix with the Cheshire and Merseyside Cardiac Network ✓ the development of a multi-occupancy conveyance model for stable percutaneous coronary intervention (PCI) and pacemaker patients with the Liverpool Chest and Heart NHS Foundation Trust. We are currently engaged in discussions about upscaling this work ✓ initial development of specific interfacility matrices for children, working with Royal Liverpool Children’s Hospital, and for mental health patients, working with Mersey Care NHS Trust ✓ collaborative working with the critical care networks, cardiac networks and other clinical networks around safe inter-hospital transfer ✓ collaborative work with the North West Neonatal Operational Delivery Network around their reconfiguration of services ✓ development of a revised IFT matrix and uplift transfer criteria for urgent care centres with East Lancashire Hospitals NHS Trust

INVESTORS IN PEOPLE (IIP) IIP is a national standard for public and private sector organisations. It assesses across 196 elements of business standards and, as such, the award has a high degree of credibility across public and private sectors as an indicator of high performing organisations. Following the assessment of NWAS, IIP confirmed that we met a total of 181 evidence requirements, achieving IIP Gold and Champion status, and becoming the only ambulance service in the country to hold these awards. The report confirmed that we demonstrated many of the characteristics associated with high performing workplaces and world class people management stating: ”It is commendable that, through its people, NWAS has developed its practices and demonstrated a range of performance improvements against a backdrop of significant cultural change in the NHS.” In addition to the IIP Award, we have also been accredited with the Health and Wellbeing Good Practice Award. This award provides a more in-depth focus on issues such as: effective planning, supportive management, supportive culture, work-life balance and evaluation.

JOINT ESTATES We are continuously reviewing our estates portfolio; assessing every one of our sites to ensure they are fit for purpose and, where they are not, looking at the options available such as refurbishment or relocation. The review has been undertaken with three main considerations, to maintain or, where possible, improve the service delivery for the communities we serve, to improve the working environment and facilities for our staff and to establish whether we are using our resources as effectively as possible. As a result of our review, many of our stations are now shared premises with our fire and police colleagues. As well as the financial benefits this brings, it helps to improve working relationships and practices. Shared facilities are a positive demonstration of partnership working and responsible financial management by publicly funded organisations.

North West Ambulance Service - Our Achievements

KNIFE CRIME We worked with a national TV company on a knife awareness video which will be shown on Channel 5 in summer 2018. Our crews in Blackpool are actively involved in knife crime awareness and have been liaising with the local council about reintroducing our sessions for school children on the dangers of carrying knives.

LIBRARY SERVICES Our library and knowledge service has been in place for a number of years, supporting staff who are studying or carrying out research and ongoing continuing professional development (CPD). In 2018, a new library service Library and Knowledge Service for NHS Ambulance Services in England (LKS ASE) - was introduced and is provided through a partnership of eight English ambulance services. LKS ASE provides four core services:

1. Request an article - complete an online form and request any article you need.

2. Request a search – complete the online form to request a literature search.

3. Current awareness – sign up for monthly current awareness updates. 4. Guides and help – the library has written a guides on topics related to searching, research and paramedic practice.

LKS ASE is a virtual library service but is also working with Manchester University NHS Foundation Trust (MFT) library services to deliver the document supply component of the core offering.

LEARNING FORUMS Learning forums were created to investigate complaints, concerns and incidents in a consistent and high quality manner within reasonable timeframes. They involve reviewing themes and steps used during investigations to identify and share learning opportunities in an equal, open and fair manner to protect the confidentiality of patients and staff. We work proactively with stakeholders to share knowledge and understanding arising from the review process and embrace a culture of openness and sharing in line with our commitment to provide high quality patient care.

MAKE THE RIGHT CALL Our make the right call campaign launches each year in the run up to the winter period to try and educate the public into considering other healthcare options during what is the busiest time for our emergency service. In 2017, the campaign saw us using social media to positively promote use of 999 for life threatening emergencies. We also posted examples of some of the more bizarre calls under the heading ‘WTF – ways to fail’ to catch the attention of our following. To spread the word in communities on how people can ‘make the right call’ we hosted engagement events in the region’s shopping centres. Many of our frontline staff supported the events at the Trafford Centre and Botany Bay which turned out to be a huge success. We were also able share some of our partners’ health information and promote uptake of the flu vaccination. We had ambulances on display for people to explore, CPR demonstrations by our volunteers, mini health checks by 111 nurses, front line crews offering advice on staying well this winter and making the right call and also our fabulous, dancing mascot Pandamedic! Alongside the fun of interacting with the public, we also gave out some serious advice. Following the mini health checks, our NHS 111 nurses told some people to make an urgent GP appointment due to their high blood pressure reading.

MILITARY COLLABORATION

North West Ambulance Service - Our Achievements

We received the prestigious Gold award as part of the Ministry of Defenceâ€™s Employers Recognition Scheme last year. This award was given to celebrate the fantastic work we demonstrated (and continue to do so) towards the Armed Forces community.

choosing the right service will help you and your family get the best treatment self care

pharmacist

urgent care

nhs 111

a&e or 999

We are proud of our strong relationship with the military and we continue to support veterans and active service personnel where possible. This is achieved by offering honorary contracts to service personnel to support the upkeep of clinical skills through NWAS assignments.

For more information visit www.maketherightcall.co.uk

As part of the campaign we created an animation to highlight where people can get the right help, be that advice from a pharmacist for common health niggles, with their GP for health issues which will not go away, at an urgent treatment centre for minor illnesses and injuries or by calling NHS 111 for health advice.

You can watch the animation

on our YouTube channel

We have hosted insight days for service leavers and veterans to showcase potential careers within our service and inform and support those from the Armed Forces community in seeking employment. This is reinforced by our involvement with the NHS Step into Health Programme - a first access pathway programme to facilitate career transition from the military into civilian employment. We employ a number of reservists and continue to support leave and training commitments. We also recognised existing reservists by hosting a bespoke reserve day in conjunction with a local military hospital.

MOUNTAIN RESCUE TEAMS We are proud of our work with mountain rescue teams which comprise of volunteers and provide search and rescue services in rural and remote areas. Teams often respond with us when there is a problem locating a patient, or the terrain surrounding a casualty is difficult to access. Examples of such incidents include missing or injured hill walkers and people involved in mountain biking and climbing accidents and so on.

North West Ambulance Service - Our Achievements

MULTI-AGENCY INITIAL ASSESSMENT TEAM We have teamed up with colleagues from Lancashire Fire and Rescue Service and Lancashire Police to create a multi-agency vehicle meaning that all three services can work closely together. The trial in the festive period in 2017 saw a senior paramedic, a police sergeant and a watch manager responding to 999 calls from all three services. The typical incidents that the multi-agency vehicle has attended include assaults, road traffic collisions, mental health incidents and house fires.

90%

of incidents attended by the multi-agency

vehicle were able to be

We run the scheme

the need for hospital

Renaissance at Drugline,

resolved at scene without transportation.

in partnership with

Blackpool’s Community

Nursing Team and St John Ambulance.

NIGHT SAFE HAVEN The ‘Night Safe Haven’ is a mobile treatment centre and safe place for party goers in Blackpool and Poulton. The haven is open to anyone in need of medical help or advice, including those that may have drunk too much, taken drugs, got into a fight, lost their friends or even lost their shoes! On board the bus, people can get advice on sexual health, drugs and alcohol and can also be seen by paramedics from the ambulance service and nurses from Blackpool Teaching Hospital for minor ailments, preventing unnecessary emergency ambulance call outs and A&E visits. Free water, condoms, slippers, tin foil blankets and rain ponchos are all available to help keep people safe. Night Safe Haven offers party goers a place to feel safe, get advice and help with minor injuries. This helps people enjoy a night out safely, but also keeps ambulances and A&E free for people in the most serious conditions.

NORTH MANCHESTER CRISIS TEAM COLLABORATION We are working alongside North Manchester Crisis Response team to develop a pathway to support patients that have called 999, an ambulance has responded and the patient does not need emergency department treatment, but does need further assistance to be able to stay safely at home. In North Manchester there is a multi-disciplinary team lead by prescribing advanced nurse practitioners and including social care, physio and occupational therapists and more. They can support patients with up to 72 hours wrap round care at home if needed following assessment and treatment. The team has supported more than 1,000 patients at home as an alternative to transporting to the emergency department. This collaborative work was shortlisted for a national Health Service Journal (HSJ) Value award in the Clinical Support Service category.

North West Ambulance Service - Our Achievements

NORTHERN AMBULANCE ALLIANCE The ambulance sector has a long history of working together and sharing good practice on an informal basis. Closer working on a more formal basis is essential and to move this forward the three ambulance services in the North (North West, North East and Yorkshire) put in place formal processes to work together collaboratively on areas of mutual benefit to create a ‘Northern Ambulance Alliance’. The boards of directors of the three northern ambulance services recognised that addressing service efficiencies through a wide range of both incremental and transformational service improvements is essential to the continued delivery of clinically and financially sustainable services.

The alliance aims to deliver the following benefits: ✓ improve the quality and service delivery for all patients in the North of England ✓ maximise standardisation opportunities at scale across the North of England ✓ reduce the overall costs of the collective budgets of the three services

These aims will be delivered through maximising the opportunities from the Northern Ambulance Alliance by the three organisations working together strategically, planning for the future in relation to operational and support services, infrastructure and estate, manage recruitment and retention, and working with commissioners to improve health outcomes for patients.

NURSING AND RESIDENTIAL HOME TRIAGE TOOL We have developed a triage tool for nursing and residential home staff which enables them to determine themselves whether a patient requires an emergency ambulance or if it would be more appropriate for them to be cared for by a GP or urgent care service. Patients in care and residential homes are often much more comfortable being treated where they are without the need to be admitted into hospital and we will do everything we can to make sure this is possible. This tool is hugely beneficial to our service as it frees up our vehicles and crews for serious and life-threatening emergencies and it also means that the patient is treated in a surrounding that they are used to with people that they know. The tool works by allowing carers, who have prior knowledge of the patient’s health needs, to look at the symptoms being presented and using to tool to find the most appropriate care based on the world renowned Manchester Triage Tool. Using the tool has proven successful in trials and has reduced 999 calls to nursing and residential homes by over 50% in some cases.

Care home staff are

initially trained on how

to use the tool by an

NWAS professional and

are then able to refer to

the tool to help decide on

the most appropriate care based on the symptoms being presented by the patient.

North West Ambulance Service - Our Achievements

OCCUPATIONAL HEALTH PROVISION Occupational health provision forms an important part of health and wellbeing support for staff. Through this service, staff can get fast track access to physiotherapy and counselling, alongside the more traditional occupational nursing and medical support. We have also been seeking to expand the services available and have been trialling early access cognitive behavioural therapy (CBT) and supporting staff with suitable medical conditions to attend rehabilitation centres.

OUR BLUE LIGHT Our Blue Light aims to bring our emergency and essential services together, to improve mental health and reduce the stigma surrounding it - whilst also raising awareness of health and wellbeing and looking at how we can improve this. Our staff created Our Blue Light and work closely with all emergency service employers and their champions to ensure a productive and healthy future for all. This work aims to bring our communities together to open dialogue, where health and wellbeing is at the centre of everything we do - with the Mind Blue Light Programme and Time to Change supporting this ground breaking work.

The team has a unique approach believing that engagement and attitudes towards support is best done through fun activities. With this in mind we have held the first ever Dance Your Blues Away dancing competition, arranged the first ever Mental Health Relay, held the Blue Light Walk and even organised a very special dinner and dance at the annual Our Blue Light Ball which was attended by over 450 guests at the world-famous Blackpool Ballroom to support our main partner Mind. This work has not gone unnoticed and we have gained support from across a wide range of supporters, including the royal family, BBC Radio One, This Morning and the Gadget Show - to name but a few.

PARAMEDIC PRE-DEGREE EXPERIENCE PILOT The Paramedic Pre-Degree Experience Pilot offers the opportunity for people from diverse communities, with a focus upon black and minority ethnic (BME) communities, to gain operational experience to support applications to university to study the Dip HE/BSc Hons in Paramedic Practice/Science as a direct entry student. The scheme has been running since 2017 and has supported 13 candidates into employment with four successfully progressing onto university programmes so far. We have received funding to continue the programme for a further year. Promoting the programme also helps us to promote the trust as an employer and as a care provider to communities which may otherwise be hard to reach, with over 52 events attended during the 2017/18 campaign.

North West Ambulance Service - Our Achievements

PATIENT CARE STRATEGY After an extensive consultation with patients, carers and our staff, we published our radical Patient Care Strategy which sets out how we will change the way we provide care to patients in order to become the best ambulance service in the UK within five years. We are changing the way we provide out of hospital care to meet NHS England’s vision for the future of the health service – outlined the Five Year Forward View – which emphasises the need to redesign urgent and emergency care services. We are concentrating our efforts on improving the quality of care for all patients but also aim to work with colleagues in the NHS and social care sectors to address care for the nationally identified priority areas; children, maternity, mental health and dementia, older people and frailty and sepsis. Our new approach encourages help in the earlier stages of the patient’s experience with the NHS and takes account of health promotion and preventative behaviours. It also improves clinical support in our patient contact centres and up-skills staff so they can make better decisions about patient care as well as working closely with other organisations. Patients will continue to contact 999 in an emergency situation and 111 when their health needs are urgent but not life-threatening. Those with serious or life-threatening emergency care needs will get timely treatment from highly skilled clinicians and transport to the right place for the best chance of survival and recovery. Patients with injuries or illnesses that are not life-threatening can expect a responsive service close to home and they may be sent to other services if appropriate.

PATIENT EXPERIENCE BOARD GAME Our award winning patient experience board game offers users of our service a fun and interactive way of providing feedback on the care we provide to them. We are constantly seeking new ways to collect patient feedback, as we realise that listening to our patients is key to understanding their experiences, so that we can make necessary improvements to our service. We use various different methods to capture patient feedback, such as postal and telephone surveys, observations and community groups. Our board game is very simple to play, and brings a lot of fun to the table. As the game is played, a member of our patient experience team records all of the feedback provided which can be used to help make service recommendations and improvements.

PATIENT PAGERS Our Patient Experience team introduced a new patient pager system for patients using our non-emergency transport service in various hospitals, which alerts patients when their transport is ready to take them home. Staff give the hand held pager devices to patients, allowing them the opportunity to leave the waiting room and visit the hospital facilities if they wish to do so. The pager device provides patients with the reassurance that they will be alerted to return to the waiting room when their transport is ready.

PEOPLE Our hard-working employees are our greatest asset!

Whatever their needs, patients in the North West

can be sure that we will make sure they get the right

This includes our PTS and PES teams responding to patients, those in our control centres and 111, our corporate services teams, and not forgetting our hundreds of volunteers. Every single person has an important role to play in our organisation and we’re proud of everyone working across all our services.

care, at the right time, and in the right place; every time. 48

North West Ambulance Service - Our Achievements

POLICE TRIAGE A pilot was developed with police forces that supported police officers to access our Clinical Hub for advice and also for clinicians on the hub to target police requests for an ambulance that appear compatible with telephone triage. Before the pilot, the percentage of police activity managed through telephone triage was 1% of the total demand passed to our service from the five forces in the region.

Key results from the two-year evaluation of the pilot include: ✓ 5,294 triages of police requests across five forces ✓ 36% of requests triaged were managed through telephone advice (i.e. referred to a non-ambulance pathway of care) ✓ 35% of requests triaged results in a paramedic attending scene but not conveying the patient to hospital ✓ 29% of requests triaged resulted in conveyance to hospital by ambulance (vs 55% pre-pilot) ✓

98% of requests triaged were in the legacy Green 1-4 response categories, which translates to Category 3 (urgent) and Category 4 (less urgent) within the current NHS Ambulance Response Programme (ARP)

✓ the top five natures of police requests triaged were mental health, assault, non-specific illness, falls and overdose/poisoning ✓

The ability to provide telephone triage to some police requests is improving outcomes for patients by assessing them much earlier in their ambulance journey. Police calls most likely to be compatible with telephone triage fall into the current Ambulance Response Programme (ARP) categories 3 and 4 and relate to patients with mental health (including overdose), non-serious injury or wounds (e.g. assault) and non-specific illness. Further work is needed in the form of a larger mixed-methods pilot or study, including assessment of time and efficiency benefits by using this approach.

PTS PEER SUPPORTERS PTS Peer Support is a network of staff that are passionate about supporting their colleagues within the workplace. This network is led by operational staff, rather than managers, who have a wealth of experience, both work-related and personal, and are keen to create a mentally healthy workplace for staff. Peer supporters may have experienced poor mental health themselves in the past, have cared for someone with poor mental health, or perhaps have trained in this area before joining NWAS. Sometimes staff feel that they cannot speak to their manager and would find it much easier to chat to a peer about their concerns whilst on shift. Peer supporters are easily accessible and approachable and may be able to spot the signs if a colleague is having problems. Peer supporters help their colleagues in a variety of ways by signposting to support depending on the issue. They can arrange to work a shift with an individual to allow them time to talk, liaise with team leaders to ease the pressure a little, assist on a phased return to work after a long period of absence, challenge inappropriate behaviour as and when appropriate, or simply have a chat over a brew. By being approachable and non-judgemental it is hoped that staff will feel happy talking to a peer supporter with even the smallest issue before it escalates into something more serious.

data from a five month co-location pilot during the two year period showed that the natures of calls corresponded with the triage charts used by nurses and paramedics, with higher volumes of calls being managed with telephone advice

North West Ambulance Service - Our Achievements

QUALITY IMPROVEMENT In a bid to improve the quality of care we provide to patients, we created a Quality Improvement and Change Agent (QICA) programme. The QICA programme consisted of five cohorts of agents who attended four day sessions. A total of 75 agents attended the programme which was part of a commissioner funded project aimed to enhance quality improvement capability in our trust and develop quality measurement and monitoring.

We have a research and development (R&D) strategy that aims to build research capacity and capability, maximise engagement and collaboration and to share findings to enable us to grow; from being a host of research activity to being a collaborator and initiator of high quality ambulance focused research. R&D is led by our corporate consultant paramedic in collaboration with our clinical quality team, librarian and a growing band of research paramedics. The research steering group meets three times a year to develop a supportive wider team of research interested colleagues from across directorates.

During the programme, agents picked an initiative within their own working environment. They were given the skills and tools to support them in exploring quality improvement through their chosen initiative so that they, in the future, are able to make positive changes that will result in improvement.

This approach is designed to promote research beyond the clinical workforce and encourage different directorates to build a positive research culture. The R&D team continues to support internal and external student projects including BSc, MSc and PhD level studies in the UK and overseas. In addition, clinical trials and data sharing form a growing part of the R&D portfolio.

RAPID HANDOVER

We also deliver clinical trials through the Paramedic Acute Stroke Treatment Assessment (PASTA) study which is, in collaboration with the Greater Manchester Clinical Research Network, supporting the appointment of research paramedics in Greater Manchester, Cumbria and Lancashire.

Throughout 2017 there were local initiatives to improve handover times and patient experience. Colleagues from Aintree, Arrowe Park, Royal Liverpool, Southport, Warrington, Whiston, Lancaster, Blackburn, Preston, Bolton and Stepping Hill hospitals all took part with support from NHS Improvement and the Emergency Care Improvement Programme. The project started in April and ran for an initial 90 days; all 11 trusts improved handover times. Royal Liverpool reduced lost ambulance hours by 69%. Key to this improvement was the introduction of a senior nurse, available to triage patients conveyed by ambulance. They also tested a frailty streaming tool with ambulance patients to help vulnerable older patients. Similar initiatives underway include â€˜Fit to Sitâ€™ which is being adopted within several hospital trusts, throughout the North West.

RESEARCH AND DEVELOPMENT

The R&D lead has worked hard to establish links with local clinical research networks, multiple university partners, researchers from other ambulance trusts through the National Ambulance Research Steering Group. All research paramedics are supported to undertake additional training in clinical research. Five colleagues are engaged in PhD study, with the first NWAS paramedic to complete their PhD this year. We will support these paramedics to begin their post-doctoral research journey and provide opportunities to act as Principle of Chief Investigators.

SAFEGUARDING We are a regulated provider of healthcare with a duty to protect patients and the public who receive care from our services and we are committed to safeguarding vulnerable people. During 2017 mandatory training in relation to safeguarding and the adoption of a holistic approach when on scene, prompted very positive feedback from colleagues. 53

SCHWARTZ ROUNDS®

North West Ambulance Service - Our Achievements

SAFETY ON THE ROADS Safe Drive Stay Alive is a partnership between North West Ambulance Service, Salford Royal NHS Foundation Trust and Greater Manchester Casualty Reduction Partnership which sees representatives from the ambulance, police, fire and health services talk about their experiences of dealing with road traffic collisions and the impact it has on them personally, alongside families who have lost loved ones and victims of serious incidents on the roads. Each year, thousands of young people from Greater Manchester are brought together to come face to face with the consequences of dangerous driving as part of the initiative, in the hope that the number of young lives being lost or ruined on the roads will be reduced. The initiative won the NHS Collaboration Award at the 2017 Health Business Awards. Held on 14 December at the Grange Hotel, London, the awards recognise and celebrate the significant contributions made each year by organisations and individuals that work inside and alongside the NHS. Ambulance crews see first-hand the horrific and devastating impact of serious road traffic collisions. Anything that we can do to help prevent death or life changing injuries and to reduce the pain and anguish caused by such tragedies, even if it’s just for one person, is worth it. A similar initiative runs in Lancashire throughout the year. In 2018 we attended the Isle of Man TT motorcycle race event to promote bike safety and first aid awareness. We have also supported a number of elderly driver awareness events along with drink driving campaigns over the Christmas period. Equally by sharing our casualty data we have assisted in the correct locations for the new average speed cameras which have in only a short period of operation already reduced accidents and speeding to a near zero incident level. 54

Find out more about Safe Drive Stay Alive here:

www.safedrivegm.co.uk

Schwartz Rounds are meetings which provide an opportunity for staff from all disciplines across the organisation to reflect on the emotional aspects of their work. Research into the effectiveness of Schwartz Rounds shows the positive impact that they have on individuals, teams, patient outcomes and organisational culture.

Three Schwartz rounds were delivered last year with around 80 staff attending, covering the following topics: ✓ the emotional impact of caring ✓ emotional wellbeing and making sure we are at our best to look after others ✓ how does violence and aggression affect the patient care I offer?

SEPSIS SCREENING In 2014 there was a national driver for change in relation to sepsis when a National Patient Safety Alert stated that clinical staff should have access to sepsis screening and treatment tools. As an emergency and acute care provider, we, until recently, provided variable levels of care to patients with sepsis, leading to under and over triage. With that in mind, our challenge was to establish evidence-based guidance that would allow our staff to consistently provide excellent and appropriate care to patients and the medical directorate confirmed sepsis as one of the five key clinical priority areas for development over the next five years. Following the creation of a sepsis working group, our sepsis screening tool was developed and now 95% of operational staff are trained to use the tool and are actively using it. We are currently in the process of developing a bespoke audit tool to measure success. Feedback from NHS partners in regard to the effectiveness of the tool in early diagnosis of sepsis is extremely positive.

North West Ambulance Service - Our Achievements

SHOCTOBER For two years, during the month of October, we have run a social media campaign titled ‘Shoctober’. It saw the public, schools and organisations using the hashtag #FindTheDefib to locate defibrillators that could potentially be used to save a life in the event of a cardiac arrest. We asked our followers to ‘send a selfie to save a life’ whenever they came across a defibrillator and post its location on social media so that we could check it against a list of defibrillators that our 999 call handlers use to direct callers to when trying to save the life of a person in cardiac arrest.

SIMULATION SUITE Staff in Lancashire identified the need for simulation equipment to facilitate observed and assessed practice sessions for colleagues that had not achieved an adequate number of logged events. They went on to create a simulation room which has medical observation cameras installed as well as equipment such as multiple advanced life support mannequins, airway mannequins and a number of child and baby advanced life support mannequins. Complex emergency scenarios are practiced using an advanced simulator mannequin and the cameras. The video and sound is streamed into the main classroom where learners can observe. This means up to 20 people can be involved in any simulation activity and still experience the learning. The team behind our simulation suite, along with some of our advanced paramedics, have so far hosted a series of ‘Resus Academy’ courses to improve and develop high quality resuscitation techniques for senior/specialist paramedics. They have also held a number of refresher skills sessions focussing on airway management, trauma and cardiac arrest skills.

SPECIALIST TEAMS We have a number of specialist teams that respond to incidents. These include the Hazardous Area Response Team (HART), which responds to major and complex incidents alongside fire and rescue services within the “inner cordon” (or “hot zone”) of a major incident. Their job is to triage and treat casualties and to save lives in very difficult circumstances.

SORT is the Special

We also have additional support teams made up of staff volunteers who work on ambulances and RRVs as their day-to-day job but take on extra roles in the case of a major incident. The Ambulance Intervention Team (AIT) is made up of paramedics and EMT2s who, in the case of a serious incident such as a terrorist attack, would be called upon to work in the hot zone, an area ambulance staff previously would not have worked in due to the risks associated. 56

Operations Response Team.

Again, these are volunteers

who, in a major incident, may be required to respond, wearing

specialist personal protective equipment (PPE) to

undertake decontamination of casualties or set up shelters for example.

North West Ambulance Service - Our Achievements

STAFF BENEFITS We have continued to increase the range of benefits available to staff in addition to the discounts offered generally to NHS staff. In addition to the offer of childcare vouchers and cycle to work schemes, we offer a lease car salary sacrifice scheme and also launched a home electronics salary sacrifice scheme.

STAFF NETWORKS The local LGBT network is well established and is well represented throughout all areas. This year the network is focussed on working with the National Ambulance LGBT Community to identify opportunities to support LGBT staff in the ambulance service with mental health issues. This will include working with Blue Light partners, other trusts and the NWAS leadership team. The LGBT network will be hosting the National Ambulance LGBT conference which is being held in Manchester in 2018. We held a Women in Leadership Conference in April 2018 and excellent feedback was received from attendees, which will inform the networks programme for the coming year.

Since the launch of the Women into Leadership network in 2016 there has been a programme of events including workshops on the following topics: ✓ personal resilience ✓ personal impact

SURGICAL AIRWAY Our advanced and consultant paramedics are performing a procedure previously restricted to the remit of doctors. Surgical cricothyroidotomy (airway) was introduced into the scope of practice of our advanced and consultant paramedics in 2011 as an emergency airway management intervention for otherwise unmanageable patient airways resulting from traumatic or medical causes. A recent service evaluation demonstrated a favourable success rate when compared to other professional groups undertaking the procedure. The service evaluation was completed by our Consultant Paramedic Steve Bell and is believed to be the first published British paramedic cohort of peer reviewed evidence on the technique.

Steve’s work was nominated for a British Paramedic Journal award at the College of Paramedics’ National Conference 2018.

During the period between November 2012 and April 2017 pre-hospital surgical cricothyroidotomy was performed on a total of 36 occasions by our advanced and consultant paramedics. Medical cardiac arrest accounted for 18 (50%) and traumatic cardiac arrest for 12 (33%) of the interventions. The remaining six (17%) interventions were performed on patients with cardiac output at the time of the intervention. The overall success rate for pre-hospital surgical cricothyroidotomy, defined as the provision of adequate ventilation via surgical cricothyroidotomy with confirmation of tube position using end tidal carbon dioxide capnography, was 97% (n = 35). There were no reported complications or adverse incidents as a result of attempts of surgical cricothyroidotomy during the evaluation period.

✓ communicating with confidence ✓ leading on development and career progression

North West Ambulance Service - Our Achievements

TRANSFORMING PATIENT TRANSPORT SERVICES

SUSTAINABILITY Sustainability is embedded and disseminated throughout our trust using our approved Sustainable Development Management Plan (SDMP). As part of this plan we have subscribed to and use the Good Corporate Citizenship (GCC) model tool for promoting sustainability and which benchmarks nationally. We continue to be one of the most advanced organisations using the model nationally in terms of implementing sustainability.

The Patient Transport Service’s (PTS) Transforming Patient Care programme develops on our significant contacts with patients, with 1.5 million journeys in 2017/17, doing so in two ways; ✓

Working in partnership to help elderly, frail and patients with long-term conditions to age well and manage their own health needs with greater independence through increased awareness. This partnership work has seen collaboration with partners such as the Greater Manchester Health and Social Care Partnership, regional commissioning teams and groups such as Age UK in the development of leaflets that provide patients with information on health issues, public health campaigns or services. These have been given to our patients or given prominence in clinics/ ambulance waiting lounges in acute hospitals.

✓

A process has been piloted and is now being rolled out to provide crews with access to clinical support through the our Clinical Hub, to enable PTS staff and patients to raise concerns and reduce risks, supporting the use of locally provided appropriate services that are commensurate with the patient’s needs. This may support early intervention on matters such as risk of falls, fire or other issues such as isolation/loneliness, reducing the likelihood of these developing and requiring admission or attendance at treatment centres.

TRANSFORMING PATIENT CARE Since the latter part of 2016 we have been working closely with our commissioners to ensure that we can respond to the challenges of the NHS Five Year Forward View, and to ensure that we develop a service that enables us to provide sustainable, high quality urgent and emergency care in the future. Our ambitious transformation – Transforming Patient Care – is a two year programme of work centred on the concept of health promotion and prevention and early clinical decision making. The programme comprises core work streams and themes that run throughout such as workforce development, interoperability, organisational culture, quality improvement, communications and engagement, and clinical leadership. All areas of work are united by the common goal of taking clinical decisions as far forward in the patient journey as possible, or by reducing demand ‘before the call’.

North West Ambulance Service - Our Achievements

Another positive change has been our Raising Concerns for Patients Programme which is in the early stages of rollout, and is currently available to staff in Cumbria, St Helens and South Lancashire. Our first referral was for a patient in Cumbria who was isolated and lonely, with mobility issues following a broken leg. An onward referral to The Silverline has seen this patient now supported by their companionship through weekly keep in touch calls, they have also provided him with an advocate who has provided support through mobility aids for his property and support with his shopping, they are also looking for other available support for him, to allow him to stay independent and obtain any available assistance to do.

TRAUMA RISK MANAGEMENT In October 2015 we commenced a pilot scheme to train staff in Trauma Risk Management (TRiM) which aims to support staff that have been affected by traumatic events experienced within work. This was successful and we are now rolling out TRiM trust wide. TRiM is a trauma focused peer support system which is fully evidence based and advocated by the National Institute of Clinical Excellence (NICE). TRiM is not a form of counselling, therapy or critical incident debrief. It is simply a screening tool which aims to identify individuals who may benefit from further support, information or professional counselling. Due to the nature of emergency work we are constantly exposed to difficult incidents. Often it is the ‘drip feed’ effect of stress that can cause the problems. TRiM is designed to highlight individuals who may need support; it is completely confidential and available to all staff. We used TRiM in the aftermath of the Manchester Arena incident in 2017. This was part of a suite of support for staff including specialist trauma counselling, group debriefing, and guidance on the signs of mental health impact and signposting to external support services including the Resilience Hub set up especially in the aftermath of the event.

TEAM NWAS In a first for ambulance services in the UK, we launched an Instagram account (@TeamNWAS) which is entirely led by the different faces of our organisation. Each week somebody different takes control of the account, giving followers a behind the scenes peek into what life as an ambulance service worker is all about. We employ almost 6,000 staff in over 300 different roles across the region. From paramedics, dispatchers, ambulance care assistants and 111 health advisors, to urgent care practitioners, accountants, mechanics and educators – everyone contributes in one way or another to saving lives every single day. Since the launch of @TeamNWAS the public have seen visual behind the scenes stories of the working lives of a great selection of NWAS people including a resilience officer, emergency medical dispatcher, senior paramedic and a communications manager.

TWEETERS To attract people to work in our organisation and to help us be more open and accessible, we have trained staff to become official ‘Tweeters’ for the trust. Our online representatives highlight the diverse roles in the service; with a sustainability officer, LGBT team, research and development manager and human resources inclusion officer all joining the twitter team in addition to frontline operational roles. We also supported the launch of the pioneering initiative to lift the lid on the NHS through the voices of the people on its frontline via the @ NHS Twitter account.

Our

Consultant

Paramedic, Dan Smith

launched the national @

NHS account by sharing his

experiences with the nation

for one week. 62

North West Ambulance Service - Our Achievements

One day Dan was observing one of the many ambulance crews so they could benefit from his clinical leadership and mentoring, and the next he was popping into BBC Radio studios to discuss stroke research. The week ended with a fascinating video question and answer session.

URGENT CARE PRACTITIONERS Urgent Care Practitioners have recently deployed across the North West. These colleagues are solo responders who assess patients who can receive appropriate care within community and primary care, avoiding the need for conveyance or admission to hospital.

VOLUNTEER CAR DRIVERS A UK first, @NHS sees a different NHS patient or member of its 1.3

million staff become curator each week and report first hand their

experiences of the health service.

Our volunteer car drivers live and work in the local community and they give up their time to assist our Patient Transport Service by taking patients to and from hospital appointments. For the patients they help, our volunteer drivers provide that friendly face and listening ear by putting them at ease during what can be an anxious and stressful time. They provide that personal touch to brighten their day as they collect a patient from their home, help get them to where they need to be at the hospital and make sure they get safely back to their own home. Our drivers often become a regular part of someoneâ€™s life and for some their journeys together may be the only chance a patient has to get out of the house for days or even weeks.

North West Ambulance Service - Our Achievements

WIDENING PARTICIPATION The widening participation agenda seeks to support equality of access to employment opportunities for disengaged/disadvantaged groups. During 2017/18 we have actively supported the following schemes:

✓ placements for healthcare cadets totalling 20 cadets receiving placement opportunities from January- June

ZERO TOLERANCE

✓ bespoke work experience opportunities for learners within the communications team and corporate team

To demonstrate our zero tolerance stance on violence and aggression directed towards our crews, we launched the ‘Behind the Uniform’ campaign. This high profile media drive set out to raise awareness of shocking statistics which show that incidents of violence and aggression against our staff are on the rise.

✓ apprenticeships for new to role staff and development of existing employees ✓ careers, employment and community events across the North West ✓ pre-paramedic degree program ✓ Forces Champion Network

YOUR CALL We revamped our online staff, public and stakeholder magazine in 2017 and created a feature rich magazine focussing on real life experiences and personal stories. We use predominantly real life situations, images, our own adverts, interviews, personal accounts, and infographics to engage readers. The magazine can be viewed on our website www.nwas.nhs.uk.

The stars of the campaign launch were 11 children whose parents work on the frontline of the ambulance service – they feature in three videos talking about how they feel when people are ‘mean’ to their mum or dad. Our people are not just paramedics, technicians, dispatchers or 111 health advisors – they are mums, dads, brothers, sisters, sons and daughters. There is more to them than a uniform or voice on the telephone and for them to have to go home to their families hurt or upset is not acceptable. Leaflets were issued to our staff advising them on what to do if they are verbally or physically assaulted and encouraging them to report all incidents, no matter how minor, so they can be logged and, if necessary, a warning placed on the assailant’s address. We also used social media to highlight violence and aggression statistics and case studies. Using the hashtag #BehindTheUniform, our people have continued to post content that is unrelated to work to reinforce that there are real people behind the uniform with thoughts, feelings, hobbies, interests and families and as such, feel pain, hurt and upset like every other human being. You can watch the videos in full on our YouTube channel. Thank you to Jamie, Jack, Hermione, Delilah, Braedon, Charlie, Sophia, Scarlett, Leon, Isabel and Freya. 67

This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages upon request.

How to contact us: Tel: 0345 112 0 999 Email: nwasenquiries@nwas.nhs.uk www.nwas.nhs.uk

Our achievements