Rivers Building Tallaght • October 23rd • October 28th • October 29th

Kilkenny and Cork

October 27th

Limerick and Galway

November 2nd

Mullingar

November 19th

Donegal

November 27th

Kells

December 4th

National Ambulance Service Strategic Plan

Vision 2020

Staff Focus Group Meetings 2015

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Facilitators: Damien McCallion Martin Dunne Vincent Cronly

• Introduction – Damien

• Presentation Vision 2020 Strategic Plan – Vincent

• Discussion Session – Martin

• Session Close – Martin

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• Enables clarity for staff, patients and general public on direction of ambulance services

• Framework for the next 5 Years

- Process running over 12 months – workshops, international literature review - External input sought from >10 key partners including National Patient Forum - Consolidate all reviews and feedback into one single coherent plan

• Vision 2020 Steering Group

Acute Hospitals, Primary Care, Quality Improvement, Health & Wellbeing and other key HSE Divisions

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• Context for our Strategic Plan

• Our Goals and Objectives

• Draft Implementation Plan

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Internal HSE Review

• Completed mid 2014 • Commissioned as a result

of concerns from HIQA to provide assurance

• Review team comprised of senior HSE mgmt outside of NAS

HIQA Review

• Completed Dec 2014 • Key findings focused on

improving operational performance, effective leadership and mgmt, alternative models of care, DFB relationship and better ownership.

Capacity Review

• Completion October 2015

• Focused on improving NAS operational performance

• Key will be technology, dynamic deployment, additional resources and community response.

HR and OD Development

Strategy • Commenced April 2015 • Target Q4 2015 • Focused on developing a

clear people and organisation strategy

Review of Services in

Dublin

• Target Q4 2015 • Jointly commissioned

between HSE & DCC • TOR to identify optimal

approach for Dublin

Carndonagh Investigation

• Completed Oct 2014 • Initiated as a result of a

tragic death in LGH • Ambulance turnaround

framework developed as a consequence

• Implementation Group in place

Fleet & Equipment

Strategy

• Commenced May 2015 • Target Q4 2015 • Focused on ensuring an

appropriate and cohesive fleet plan, systems and structure to 2020

Quality and Patient

Safety Plan

• Commenced Q4 2014

• QIP developed to improve quality and safety of services

Key Challenges

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• Improve quality and patient safety systems, such as clinical audit

• Improve performance through dynamic deployment, single dispatch centre, and focus on patient outcomes

• Improve service in Dublin with Dublin Fire Brigade

• Develop and implement new models of care

• Ensure organisation is modern and fit for purpose

• Address manpower challenges to increase staffing in key areas

• Integrate ICT Systems

• Modernise fleet, infrastructure & control systems

• Improve our approach to patient engagement

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SWOT Analysis – NAS Vision 2020

Strengths

Statutory service provider

Patient centred services

Professional, skilled and motivated workforce

External accreditation of staff and systems competencies

Experienced consultant teams utilised for key specialists subjects

Enthusiastic workforce committed to improving patient centred services

High vehicles, equipment and technology investment

Financial balance consistently delivered

Good relationships with stakeholder organisations

Innovative and dynamic in our drive for continuous improvement

Increasing community involvement

Weaknesses

Patient, public and stakeholder engagement

Variations in service delivery

Inconsistent response targets

Often over-stretched resources

Need to continue to find recurring cost savings year on year

Limited clinical audit

Opportunities

Improving national fiscal position

Development of national integrated care programmes

Improved governance, management and leadership arrangements

Increased capacity based on review recommendations

Involvement of staff, public, patients and stakeholders in service development

An open learning environment

Increasing pace of change in clinical practice

Promotion of innovation, research and education

Staff development through implementation of new systems and processes

New systems to provide a more efficient and effective service to patients

Improved business continuity / resilience

Threats

Strategy dependent on additional funding

Funding not keeping pace with demand

Workforce/recruitment constraints – competition from other providers

Lack of resources may inhibit future service delivery/growth

Stakeholder resistance to change

Setting of unattainable targets

Individual workload

Unpredictable service demands may impact on implementation timescales

Future political changes may significantly influence delivery priorities

Non implementation of review recommendations (HIQA, PHECC, Lightfoot)

Emerging and International Trends in Pre-Hospital Emergency Care

• Increasing demand at 3-5% per annum.

• Developing alternative Models of Care: – Hear and treat call in Emergency Operation Centre – “low acuity”

– Alternative destinations for patients other than ED – minor treatment centres

– Treat and discharge patients where hospitalisation not required – Care Bundles for specific groups of patients

• Integrating within the broader health care system; Emergency and Urgent Care with hospitals and primary care

• Infrastructure investment and development – technology driven performance improvements in response times

• Leadership & workforce development (inc. paramedic shortfalls)

• Moving from single target focus on time based targets to broader set of measures focusing on outcomes

• Use of dynamic deployment to improve response times

• Use of Community First Responder Schemes in rural areas

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Sets out the HSE goals to improve the health service which are incorporated within the National Services Planning process

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Our Strategic Goals

What we will do

Play an active role in improving population health needs • Engage with Health and Wellbeing community promotion programmes • Participate in the delivery of community based educational/ training

programmes • Develop and implement a public information campaign – appropriate

use of 112/999 and use of alternative care pathways

Ensure a prevention focused approach to staff health and wellbeing • Implement the Health Ireland Framework within the NAS • Review NAS policies, procedures and practices to maintain staff safety

and welfare • Improve occupational health support to NAS

Our Goals, Objectives and Projects

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Goal 1

Promote Health & Wellbeing as part of everything we do so that our patients and staff will be healthier

What we will do

Improve quality of care and patient safety • Implement an electronic patient care record (ePCR) • Introduce additional clinical performance measures • Develop and implement clinical support capacity

Develop alternative models of care • Implementation of Hear and Treat in NEOC • Establish and agree basis for handling routine activity • Implement paramedic treat and discharge protocols

Seamless, responsive and safe service in Dublin region • Implement recommendations of the review group

Improve operational performance • Implement real-time performance and quality dashboard • Improve ambulance turnaround performance • Implement additional capacity • Optimise the location of ambulance resources • Expand national linked Community First Responder schemes • Expand retrieval services

Goal 2

Provide fair, equitable and timely access to quality, safe emergency services that people need

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Our Goals, Objectives and Projects

What we will do

Improve our engagement with patients and service users

• Develop and implement a Patient and Service User Engagement Strategy • Implement a NAS patient forum

Become more transparent and open with our patients, the public and staff

• Continue implementation of the HSE Open Disclosure National Policy – near & adverse advents

• Continue implementation of the National Standards for Safer Better Healthcare • Implement the National Incident Management System and Complaints &

Compliments Management System • Carry out an annual staff survey & implement an annual action plan on feedback • Strengthen leadership capacity to manage change – facilitative management style

Goal 3

Foster a culture that is honest, compassionate, transparent and accountable

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Our Goals, Objectives and Projects

What we will do

Engage with and involve our staff in the provision of service • Implementation of the ‘Public Health Services People Strategy’ • Develop an annual communications plan that includes focus on staff • Provide clinical services ‘web’ and email access to NAS staff

Strengthen NAS leadership, workforce and governance structures

• Implementation of NAS Human Resources and Organisational Development Strategy • Embed formal staff and managers performance management system • Implement recommendations of the Management Structure Review • Implement a management training and development programme

Provide a high quality, competent workforce to meet our model of patient care

• Implement a comprehensive workforce plan • Increase staff numbers to meet international norms • Implementation of a comprehensive education and competency assurance plan • 3rd level educational programme for paramedics • Regular review of staff development needs

Goal 4

Engage, develop and value our workforce to deliver the best possible emergency care and services to the people who depend on them

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Our Goals, Objectives and Projects

What we will do

Ensure that NAS fleet and equipment is appropriate for use • Implement recommendations of the NAS fleet and equipment strategy

Ensure that NAS has effective infrastructure • Review NAS deployment points • Carry out a fit-for-purpose review of current and future NAS estate requirements • Commence estate upgrade and new build programme

Improve our service efficiencies and effectiveness through the use of technology enabled solutions • Develop NAS eHealth strategy • Continue the development of the NAS CAD system • Continue the introduction of mobile data terminals and navigation tool • Implement a single national rostering/time (CORE) system • Implement NAS payroll system

Goal 5

Manage resources in a way that delivers best health outcomes, improves people’s experience of using our services and

demonstrates value for money

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Our Goals, Objectives and Projects

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Implementation Plan

Implementation is subject to:

• Completion of Reviews, Strategies and Plans

• Service Planning and Funding Dependent across the lifetime of the strategic plan

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Sample Implementation Plan

Goal Objective Project Start Finish Lead National Standards for Safer

Better Healthcare

Goal 2

Provide fair, equitable and timely access to quality, safe emergency pre-hospital services that people need

2.1 Enhance clinical competencies and governance arrangements to improve quality of care and patient safety

2.1.1 Implement an Electronic Patient Care Record (ePCR) Q1 2016 Q4 2017

NAS Medical Director

2.1.2 Introduce additional Clinical Performance Measures Q1 2017 Q4 2020 2.6

2.1.3 Develop and implement a clinical support capacity Q1 2017 Q4 2018

2.2 Develop alternative models of care to ensure that patients are directed to or taken to the appropriate location for treatment

2.2.1 Develop and implement Alternative Care Pathways:

- Implement Hear and Treat by setting up a clinical support desk in the NAS National Emergency Operations Centre

Q1 2016 Q4 2016 Care is provided through a model of service designed to deliver high quality, safe

and reliable healthcare.

- Work with partners to establish an agreed basis for handling routine activity with improved utilisation of ICV’s

Q2 2016 Q4 2016

- Implement Alternative Patient Destinations Model Q3 2017 Q4 2019

- Treat and Discharge / See and Treat Implement paramedic treat and discharge protocols

Q3 2017 Q4 2018

2.3 Ensure a seamless, responsive and safe emergency ambulance service in the Dublin region

2.3.1 Assume responsibility for the integrated call taking and dispatching of all emergency ambulance in Dublin

Q2 2016 Q4 2016 Director NAS

2.3.2 Implement recommendations of the review of services in Dublin

Q1 2016 Q4 2016 National

Director NAS

2.4 Foster a culture of strong performance management to improve operational performance

2.4.1 Implement a real-time Performance and Quality Dashboard Q1 2016 Q2 2017

Director NAS 2.4.2 Develop a balanced set of measure for emergency ambulance service between response times and patient outcome measures

Q1 2016 Q4 2016

2.4.3 Improve performance in the NAS NEOC through implementation of Capacity Review recommendations

Q1 2016 Q4 2019 NAS

HR Manager 2.4.4 Improve response times in urban areas with the recruitment of additional staff

Q3 2016 Q4 2020

2.4.5 Improve performance for ambulance turnaround times with acute hospital division and ensure safe handover of patients

Q2 2016 Q4 2016 National

Director NAS

2.4.6 Optimise the Location of Ambulance Resources

Director NAS

- Fixed Locations Q2 2016 Q4 2016

- Implement recommended Dynamic Deployment Points to both minor and major urban areas

Q1 2017 Q4 2018

2.4.7 Expand the number of linked Community First Responder Schemes as recommended by the Capacity Review

Q1 2016 Q4 2020

2.4.8 Expansion of the Paediatric Retrieval Service Q1 2016 Q4 2020

2.4.9 Expansion of Adult Retrieval Service Q1 2016 Q4 2020

2.4.10 Develop Aero Medical Services Q1 2016 Q4 2020

2.4.11 Assisting in the delivery of dedicated children’s ambulance service for routine, urgent and end of life journeys

Q1 2016 Q4 2020

Survey

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Consultation Feedback To Date

Survey Suggested Areas of Improvement

Improve Staff Health and Wellbeing

Develop Rosters

Introduce Deployment Points

Introduce Alternative Care Pathways

Introduce Patient / Public Relations/Education

Improve Management / Staff Engagement

Improve Clinical Supervision / Audit

Improve Staff Training & Development

Improved Fleet and Equipment

Introduce Management 24Hr Cover

Increase Staffing Levels

Improve relationship between Control and Operations

Station Upgrade

Improve operations with Dublin Service (DFB)

Next Steps

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Review Questionnaire Feedback

and

Feedback from External Stakeholders

Review of Services

in Dublin

Fleet & Equipment

Review

HR and OD Development

Plan

Capacity Review

Open Forum Discussion

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