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Urgent Care Development Plan

2014-16

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Version Control Version Date Reviewed By Comments

Draft 0.1 12 March 14 SP Presented to Transformation Programme Management Group

Draft 0.2 25 March 2014

SP Presented to Public Trust Board

Version 1.0 28 April 2014 SP Final version with comments from Public Board meeting included

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Contents

1. Introduction Page 4

2. Strategic Context Page 5 The Urgent Care Void Page 5 National Perspective Page 6 The YAS context Page 8

3. The YAS Urgent Care Development Plan – Overview and Key Objectives Page 10

4. Service development priorities Page 12 ECP/Advanced Paramedic roles Page 12 NHS 111/Care Co-ordination Page 13 Managed service portfolio Page 15 Technology enabled services Page 16 Urgent care transport Page 17 Direct delivery of primary/community care Page 17

5. External stakeholder engagement Page 18

6. Developing internal focus and capability Page 20 Paramedic Pathfinder Page 20 Development of NHS 111/Clinical Hub Page 21 Enabling strategies Page 22 Governance Page 22

7. Conclusion Page 23

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1. Introduction This document sets out the strategic context and Trust priorities for the development of urgent care over the next two years. The Urgent Care Development Plan is fully aligned to national strategy for urgent and emergency care and builds on existing Trust strengths and recent developments in urgent care delivery. The plan sets out the areas where YAS as a regional provider can add specific value to the delivery of urgent care, and also how YAS intends to engage with commissioners and other partners to develop innovative services based on the core YAS offer, to meet local needs. This plan forms part of the wider YAS Service Transformation Programme, reflecting the central importance of urgent care development to the wider Trust strategy over the coming years and the impact of the developments across the whole organisation. The Urgent Care Development Plan will be underpinned by detailed business cases and project plans for each key aspect of development, to ensure that the developments are systematic and fully aligned to the wider Trust business plan, and that milestones and benefits are explicit and measurable.

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2. Strategic Context The Urgent Care Void The provision of 999, Emergency Medicine and Accident and Emergency is high cost/low volume/unpredictable, whilst provision of, routine primary and community services is generally low cost/high volume and predictable. Urgent care sits in between and in the main relates to the patients who are frail and elderly with two or more co-morbidities +/- dementia and are often socially isolated. Relatively minor changes in their medical or social circumstances will result in them seeking urgent care often in the so-called Out-of-Hours period resulting in a 999 or a 111 call, and an ambulance request for transfer to the Emergency Department. These patients are often referred to as ‘avoidable admissions’. Figure 1 – The urgent care void

• “The 30% who have one or more long-term condition account for £7

out of every £10 spent on health and care in England” (call to action 8th July David Nicholson)

Urgent care is not commissioned as a single entity. No single organisation has the responsibility for providing urgent care and it is this void of ownership that leaves many patients confused, with a poor experience and loss of control over their care. As the only regional health care provider, and the provider of the regional NHS 111 urgent care service, YAS is uniquely placed to help fill this void.

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The ‘Holy Grail’ that all commissioners seek is to move the graph in figure 1 to the left, away from unplanned to planned care. The benefits will include fewer 999 calls, A&E attendances and hospital admissions, reduced costs and a better patient experience. The National Perspective

With rising demand and greater costs, the urgent and emergency care system is consuming resources at a greater rate each year. Fragmented and diverse services present a confusing and complex picture to patients, who find it extremely difficult to access care when they most need it. There is a clear need to adopt a whole-system approach to commissioning more accessible, integrated and consistent urgent and emergency care services to meet patients unscheduled care needs.

The vision for urgent care in the national urgent and emergency care review http://www.nhs.uk/NHSEngland/keogh-review/Documents/UECR.Ph1Report.FV.pdf has established a vision for the changes needed to deliver improvements in urgent and emergency care and delivering better outcomes for patients by moving care closer to home, underlining the significant and unique role ambulance services can play in managing patients closer to home through enhanced paramedic skills and the provision of NHS 111. The following are identified as key elements to the delivery of this vision:

• Supporting self-care – including better and more accessible information, accelerating the development of comprehensive and standardized care planning.

• Helping people with urgent care needs to get the right advice or treatment in the right place, first time – including enhancing the NHS 111 service.

• Providing a highly responsive urgent care service outside of hospital so people no longer choose to queue in A&E – including faster access to primary care and community services, developing ambulance clinicians to provide mobile urgent care treatment, supporting the co-location of community based urgent care services in co-ordinated Urgent Care Centres.

• Ensuring that people with more serious or life threatening emergency needs receive treatment in centres with the right facilities and expertise to maximize chances of survival and a good recovery.

• Implementing the findings of the NHS services, seven day week forum, shifting a substantial amount of care out of hospitals and into community settings.

• Connecting the whole urgent and emergency care system together by implementing care co-ordination through networks and free flow of information.

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Figure 2 – Overview of national strategy

The collaboration between providers of emergency and urgent care services is essential to provide a responsive, effective and personalised service outside of hospital for those people with urgent but non-life-threatening conditions, thus ensuring they receive the right advice in the right place at the right time. “Everyone Counts: Planning for Patients 2014/15 -2018/19’’ calls on Commissioners and providers to adopt a whole system planning approach in order to ensure plans address the healthcare needs of their local community. The guidance also underlines the importance of a shared digital patient record with the NHS number as the primary patient identifier for all providers. Effectively collecting, interpreting and sharing medical information is key in improving care integration and outcomes. It is essential that the ambulance service and NHS 111 are able to access patients’ medical records and individual care plans to improve decision making and patient outcomes. One of the greatest challenges is the task of integrating urgent care across primary, secondary and community care and providing the right care to people with long-term conditions. The ambulance service is already demonstrating that it has the potential to be a significant lever for positive change both as the provider of 999 emergency and urgent care and NHS 111 services, with a beneficial impact on management of wider system demand.

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The ambulance service has the skills and capability to triage and signpost patients appropriately across the whole health economy whilst also gathering information identifying gaps in the system to support improved commissioning decisions to best meet local patient needs. Services such as NHS 111, tele-health, community based enhanced paramedics and PTS are key to local solutions to support seven day services providing an improved patient-centred service across emergency and urgent care settings to enable older and vulnerable people to live independently at home following discharge from hospital. If these opportunities are to be fully realised a number of challenges must be overcome including; improving engagement with Commissioners and partners within urgent care in relation to the role ambulance services play, particularly in, long-term conditions management; the continued development of information systems that will support continuous improvement and integrated urgent care delivery and the continual development of the Directory of Services as a joint enterprise across the urgent care system to enable Commissioners to understand where appropriate services should sit to ensure patients receive the right care in the right place. The YAS Context In developing our strategy we have taken into account the national context as outlined above and the key themes within local strategies including those developed by the region’s Urgent Care Working groups, that are relevant to our services, people and communities. Our plans and mission focus on our commitment to quality and ensuring we deliver safe, effective, caring, well led and responsive services to the communities we serve. Our services, clinical capability and technology have improved dramatically in recent years with staff now administering many treatments at the scene of an incident which would previously only have been carried out in a hospital setting. Through the 999 and NHS 111 services we are the largest single gateway to healthcare services across Yorkshire and the Humber. This places us in a key position to lead and support the transformation, integration and alignment of healthcare services across the region to best meet the needs of local communities ensuring patients are managed in the most appropriate setting. At the core of our strategic priorities for the next two years are:

• The expansion of community based Emergency Care Practitioners (ECPs) and Advanced Paramedics, to bridge the gap between the need for an initial urgent response and community based planned care services

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• Building upon the existing NHS 111 service skills and infrastructure to expand our role in Care Co-ordination and provision of local community Single Points of Access for health and social care services

• Developing managed services for specialist groups such as frequent callers, people with mental health needs and palliative care

• Development of Urgent Care Transport and inter-facility transport solutions to ensure timely and appropriate transport is available to convey patients including GP Urgent, discharge and falls services

• Through focused investment in ICT solutions we can radically improve our delivery of healthcare services to support care at home. We assist decision making at scene by providing front line clinicians with the technology and information to access patient and pathway information and, through provision of tele-health and tele-care services, to support patients living independently in their own homes.

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3. The YAS Urgent Care Development Plan - Overview and Key Objectives

The Trust Urgent Care Development Plan is a key part of the wider Trust Service Transformation Programme. An Urgent Care Steering Group has been established to oversee the development and implementation of the plan and to support greater cross-directorate co-ordination of urgent care development activity, ensuring that clinical and patient experience, business and operational perspectives are adequately addressed and integrated in any urgent care development activity. Through delivery of this plan, the Trust aims to:

• Provide and facilitate for the people of Yorkshire and Humber an urgent care service that will deliver the right care in the right place at the right time, enhancing access to health care and the patient experience.

• Deliver urgent care as close to home and local communities whenever possible, by developing the use of health information and technology.

• Provide care which is patient centred, evidence based and delivered by collaborative teams, with YAS at the heart of the wider urgent care system.

• Enable shared decision making between patient and health provider across the continuum of care and support patient self-management and individual responsibility for their health.

The key objectives of the plan are as follows:

1. To establish and communicate the Trust vision for urgent care development, supported by clear information about the priority YAS urgent care service developments and the associated benefits for patients and the wider health system.

2. To develop concrete business models for YAS urgent care service developments aligned to wider Trust strategy.

3. To develop and deliver effective stakeholder engagement to support urgent care service development.

4. To work with commissioners to develop and implement locally tailored packages and service delivery models based on the core YAS offer and to develop and exploit new care pathways to meet identified gaps in patient need.

5. To influence future urgent care models and commissioning intentions nationally and locally.

6. To develop the YAS workforce and leadership across all service lines, to meet the changing needs of urgent care delivery.

7. To maximise the use of technology and Trust assets to support the development of innovative and cost effective urgent care services.

8. To evaluate new developments, building the evidence base to underpin future urgent care provision.

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These key objectives will be delivered through work on 3 cross-cutting themes: • Service development priorities • External stakeholder engagement • Developing internal focus and capability

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4. Service Development Priorities

A number of priority service developments are identified in the Urgent Care Development Plan, where YAS can offer added significant value to patient care, exploiting the position of the Trust at the heart of the wider urgent care system. These should be considered as a package of potential services, which can be tailored to meet specific patient needs in local health economies in different urban or rural settings and with varying demographic profiles. Key to the Trust Urgent Care Development Plan is the need to engage with commissioners to consider the relevance of the YAS offer and to agree how this can be best deployed to bring maximum benefits to the local population. The Trust plan also focuses on ensuring that any new service developments are commercially and clinically viable, aligned to the wider Trust strategy. Figure 3 – Overview of YAS service development priorities

The following are areas identified as priorities for future service development: Emergency Care Practitioners/Advanced Paramedic roles ECPs and other Advanced Paramedic roles are practitioners with additional skills in assessment, diagnosis, treatment, referral and discharge. Their key

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focus is on providing the initial response to an urgent care need and bridging the gap between that and ongoing health care services. These services will contribute to:

• Treatment of more patients at home – particularly those with long term conditions

• Avoidance of attendance at ED through non-conveyance and direct access admission

• Reduction in admissions, tests, and other associated secondary care costs.

• Management of direct referrals from nursing homes, with high non-conveyance from this group.

• Management of fallers including assessment/treatment/arrangement of transport if needed.

• Keeping palliative care patients at home • Increased patient satisfaction

There is strong potential for further development of ECP and other Advanced Paramedic schemes, linked to partnership work with commissioners and other providers on access to appropriate patient referral pathways. There is also potential for ECPs and other Advanced Paramedics to contribute as part of a wider multi-professional team to the delivery of Out of Hours primary care services, particularly in the overnight period. The Trust is working with partners to develop a clear competency and career framework for Advanced and Specialist Paramedic practice, to support consistency in the professional model across the service both within YAS and nationally. The intention is to work with commissioners to identify the potential application of the model within the local context and available patient pathways, recognising that these could vary in different urban and rural settings. A collaborative approach will be adopted to co-develop an Advanced Paramedic service based on a core YAS model, which is fully integrated with the wider health system. NHS 111+/Care Co-ordination Service YAS is now delivering the region-wide NHS 111 service and there is an opportunity to deploy the NHS 111 infrastructure and the skills of its staff to support other telephone based services. This is consistent with the national aspiration to ‘significantly enhance NHS 111 so that it becomes the smart call to make, creating a 24-hour, personalized priority contact service, which will:

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• Have knowledge about you and your medical problems, so the staff advising you can help you make the best decisions. Clinicians in the new NHS 111 service will have access to relevant aspects of your medical and care information, if you consent to this being available. This is particularly advantageous for people with long-term conditions or rare disorders, and those who are receiving end of life care.

• Allow you to speak directly to a wider range of professionals (e.g. a nurse, doctor, paramedic, member of the mental health team, pharmacist or other healthcare professional) if this is the most appropriate way to give you the help you need.

• If needed, directly book you an appointment at whichever urgent or emergency care service can deal with your problem, as close to home as possible. That could include a booked call back from a GP, a pharmacist review at a local chemist open for extended hours, an appointment at an urgent care centre, or a home visit by a community or psychiatric nurse.

• Still provide you with an immediate emergency response if your problem is more serious, with direct links to the 999 ambulance service, and the enhanced ability to book appointments at Emergency Centres.’

Working with commissioners to develop this enhanced NHS 111 service is central to the Trust’s Urgent Care Development Plan. The enhanced service will bring significant benefits to patients and the wider health economy. Where possible NHS 111 needs to consider how to derive greater benefit from the call centres over the whole 24 hour period, drawing on the strengths in the estate, technology and expertise in call centre management. In addition to the core NHS 111 service, the Trust can make wider use of the NHS 111 infrastructure and skills to provide other similar telephone based services. An example is the provision of a Single Point of Access (SPA) in local areas. The SPA is a patient bureau type service, with the objective being to ensure the seamless, safe management and referral of patients that would benefit from community service intervention, either to prevent an admission, support early discharge or coordinate care ‘closer to home’. The key aim of this service is to support the referring clinician by ensuring a simple referral pathway that will match the patient’s needs to an appropriate service in the locality nearest to the patient’s own home. This service will support integration by being one point of contact into all community services and will be supported by a comprehensive directory of services, which will identify all community services capacity and availability by time of day. The Trust will continue to explore the potential for development of Single Point of Access services, building on current pilot developments. There is an opportunity, consistent with the concept of an enhanced clinical service set out in the national review, to build on NHS 111 as a single, free

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access point for patients, to develop a care coordination service for specific patient groups, which could include:

• Patients with palliative and End-of-Life conditions • The frail elderly • Patients with urgent mental health needs including a place of

safety • Patients requiring urgent dental advice

These are patient groups with complex needs, where hospital admission is often not the optimum care required and where effective co-ordination of care across agencies is key to success. As the gateway to urgent care for the region NHS 111 needs to work closely with Urgent Care Working Groups to help shape future services including the further development of the care coordination concept. There is significant value to be added to the urgent care system where enhanced care co-ordination can be fully aligned to other urgent care services delivered by YAS or other providers. Managed Services Portfolio YAS currently operates a frequent caller scheme, which:

• Identifies individuals at risk who may not have been identified through the routine application of the Trust’s normal safeguarding procedures and inform the Primary Care Practitioner.

• Ensures individuals are directed towards the most appropriate healthcare for their needs, reducing face-to-face NHS contact and improving productivity.

• Ensures people have a positive experience of care in the NHS by directing them towards the most appropriate healthcare for their needs.

• Increases NHS productivity by enhancing care for individuals suffering long term conditions such as mental health, COPD, dementia and diabetes.

• Assists in the achievement of national quality indicators such as ambulance response times, Emergency Department waiting times and Emergency Department attendances

• Facilitates multi-agency collaboration between NHS organisations and other care providers, ensuring a holistic approach to care provision.

This scheme currently operates for frequent callers to the 999 service, with a pilot operating in the NHS 111 service. There is an opportunity to lower the threshold for identifying 999 frequent callers to allow management of such patients accessing both the 999 and NHS 111 services more rapidly at an earlier stage.

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Effective frequent caller management will deliver significant benefit in terms of demand reduction for the wider health system. Beyond this, the Trust will continue to work with commissioners and other service providers to develop and access integrated care pathways for specific patient groups. The Trust will explore opportunities to build on the frequent caller and pathway development work in order to develop a wider managed care service, focused on adding value through the co-ordination of care and access to specific referral and treatment pathways for patients with specific, identified health care needs. Technology enabled care services In line with NHS England’s ‘integrated care for 3millionlives’ strategy we need to achieve better health outcomes and innovations to support people to live more independently. The challenge being how to integrate these technologies into the wider NHS and health and social care services. More specifically the use of assistive technologies including telehealth, telecare, telemedicine and telecoaching in admission avoidance and supported discharge programmes. Telecare The YAS telecare service will maximise the use of available technology, either as an individual Trust or in partnership with others. The service will provide a focus on support for vulnerable older patients, including those who have a history of falling or fear of falling in the home. The Trust will engage with local authority commissioners as well as CCGs to support the development and to realise a wider health and social care system benefit. This service will build on the existing call centre infrastructure and expertise and provide potential added value through integration with mobile care services, such as those responding to patient falls. Telehealth The Trust focus is on tele-monitoring, capturing vital signs and other key indicators for patients with one or more LTC’s, working in partnership with others to develop the appropriate processes for setting appropriate parameters for patient monitoring and early intervention to reduce inappropriate A&E attendance. The Trust will engage with commissioners and other community service providers to align the telehealth service with referral into the wider YAS/health economy for continuity of patient care, 7 days a week. The service will build on existing call centre infrastructure and expertise and plans will be developed focused on providing added benefit to patient care

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through telecoaching in support of those with LTC’s and integration with wider YAS clinical services and access to patient pathways. Urgent Care Transport The current PTS contract arrangements are not supportive of level discharge planning or seven day working. There is potential to address this gap, building on successful initial out of hours discharge pilots. Analysis also indicates a volume of calls, predominantly received during the daytime, could be managed differently within a co-ordinated Unplanned Transport and Booking Service. There is an opportunity to develop a tailored service to meet the specific needs of this group of patients, better and more cost-effectively meeting discharge requirements and on-day demands. YAS will work with Clinical Commissioning Groups to explore and develop this service option. Direct delivery of primary/community care The Trust can potentially offer benefits to the wider health system in supporting cost effective overnight OOH provision, aligned to the wider development of Advanced Paramedic roles. The Trust will work with commissioners to explore this potential as part of wider health economy development. Where opportunities present the Trust will also engage in tenders to provide such services, either independently or in partnership with OOH service providers.

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5. External stakeholder engagement The Trust recognises that development of effective urgent care services, tailored to patients’ needs and expectations, cannot be delivered in isolation, but requires extensive engagement and collaboration with a wide range of stakeholders. This includes:

• Clinical Commissioning Groups, Urgent Care Working Groups and local health economy redesign/reconfiguration groups. There is a need to work with commissioners to develop a clear picture of local needs and service development or reconfiguration plans across the region and the implications and/or opportunities for urgent care development. The co-ordination of attendance and intelligence is essential and the Trust plans to develop an account manager model to facilitate consistent engagement, anticipate commissioning intentions and co-production of service specifications.

• The Academic Health Science Network and local/regional clinicians, to support the development of urgent care clinical networks as vehicles to support the commissioning and development of evidence based urgent care services.

• National urgent care leads, including the NHS111 Futures programme, to influence development of the new NHS 111 service specification.

• Other healthcare providers across hospital, community and primary

care settings, and third sector organisations, actively seeking the development of new partnerships to support innovative service models across the patient pathway.

• Health and Well-being Boards to ensure that the extensive data on patient needs held by YAS can be used to contribute to future commissioning intentions.

• Social Services Departments and Local Authority Commissioners, to enable the development of new services which meet patients’ needs across the interface of health and social care.

• Healthwatch, Patients and the Public to ensure that YAS services reflect the needs and expectations of patients and carers.

• Health Education England and Higher Education Institutions, to support the development of a workforce with the relevant knowledge and skills to meet future urgent care needs and to operate within new service models.

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Engaging with such a wide range of stakeholders across the region is a significant challenge and the mapping and analysis of stakeholders is therefore a high priority to ensure that YAS engagement is focused to best effect, of a high quality involving the right level of decision-makers, consistent and well co-ordinated. The development of stakeholder information on the YAS ‘urgent care offer’, which will support structured discussions with commissioners and other partners is also a priority.

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6. Developing internal focus and capability The delivery of urgent care is not discrete, but is integral to all of the Trust’s service lines. As such, it is essential that the Trust develops the whole of its workforce and key systems to support delivery of its urgent care objectives. Key elements include:

• development of paramedic pathfinder, • development of the NHS 111 clinical workforce • development of opportunities for the clinical hub/NHS 111 integration, • development of a greater commercial awareness/focus on urgent care

amongst leaders and managers, • the potential use of ECIST or other external body to support/facilitate

developments. Paramedic Pathfinder Paramedic Pathfinder is a decision making support algorithm tool based on the Manchester Triage System that uses a reductive symptom discriminator process to identify those patients requiring Emergency Department attendance, a community service referral, or self-care management. Paramedic Pathfinder aims to improve the use of community services and reduce the conveyance of patients to Emergency Department. This has the potential to deliver a significant cost saving to the NHS at a local level and, if adopted Trust wide, at a regional level. A study by North West Ambulance Service NHS Trust following the implementation of Paramedic Pathfinder concluded that the tool was of value in supporting clinicians in correctly identifying patients needing Emergency department admission and those who were suitable for urgent care centre, alternative pathway or home care. The study also identified the opportunity and scope for non-paramedic emergency vehicles to act as the conveying mode of transport to keep paramedic crews available for emergency calls. If Paramedic Pathfinder is introduced into YAS then the anticipated key benefits are -

• Reduction in number of patients transported to emergency departments

• Improved patient experience as patients will receive the right care in

the right location

• Increase in use of urgent care services

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• Decrease in the average length of ambulance cycle

• Increase in the number of patients managed by RRV paramedics (with no double ambulance crew)

• Increase use of existing care pathways

• Potential improvement in 'see and treat' from 24% to 30%

• Improvement in DoS utilisation through reduction in missed referrals

and use of alternative care pathways

• Assistance for paramedics through the use of a decision support algorithm

Introducing Paramedic Pathfinder into a specific area first will enable the through development of alternative patient pathways with the Urgent Care Working Group or other local commissioning group, to include referral to GPs, walk-in centres and minor injury units. It is the robust development of these joint working practices that is seen as critical to the success of this project and by working in a small area first any challenges can be quickly managed and solutions reached. The current plan is to introduce Paramedic Pathfinder on a phased basis between 2014-16. During the first year implementation will focus on West Yorkshire, with roll out to Leeds completed in quarter 1 of 2015/16, and final roll out to other localities following this. The implementation will be closely aligned to delivery of the ECS roll out plan and partnership work with local commissioners on available patient referral pathways, to ensure that maximum benefits can be delivered through full alignment with local services and use of supporting technology. Development of the NHS 111 clinical workforce and NHS 111/Clinical Hub Integration Building on the experience of multi professional clinical staff within NHS 111 the Trust will aim to create a workforce strategy that will be best placed to provide excellence in care which is aligned to the NHS 111 ‘futures’ specification. There is significant overlap between the functions of the 999 Clinical Hub and NHS 111 Clinical Adviser roles and clinical triaging processes. The Trust recognises the potential benefits in integrating these functions and will explore and develop a plan to achieve this during 2014/15, with a view to implementation of potential changes in 2015/16.

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Enabling Strategies Delivery of the Urgent Care Development Plan will be underpinned by a number of key enabling strategies, including:

• The ICT strategy, which underpins the delivery of innovative care solutions, information and expert support for staff delivering direct patient care and free flow of patient information across the patient pathway.

• The workforce strategy and annual education and training plan. • The commercial strategy, which will support the development of robust

plans for new services meeting both the clinical needs of patients and the needs of the organisation to ensure that services are financially sound and sustainable.

• The Trust stakeholder engagement strategy. • The Service Transformation Programme, including potential

developments arising from the Bright Ideas scheme and support from staff trained in service improvement skills.

Governance Executive Leadership for the plan rests with the Executive Director of Standards and Compliance, working closely with the Executive Medical Director and his team who provide clinical leadership and direction, the Executive Director of Finance and Performance and Commercial Director, and the Executive Director of Operations. The Associate Director of NHS 111/Urgent Care provides leadership for development of the NHS 111 service and its interface with the wider urgent care system. An Urgent Care Manager will provide the senior management leadership and co-ordination for delivery of the plan, supported by a dedicated administrator role. The Urgent Care Steering Group has been established to support and oversee the development and delivery of the organisation’s Urgent Care Development Plan in line with the wider organisational strategy, co-ordinating and supporting the alignment of relevant clinical, operational and business development work streams. The Urgent Care Development Plan is a key part of the wider Service Transformation Programme. Progress against identified milestones and delivery of benefits will therefore be monitored through regular reports to the Transformation Programme Management Group.

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7. Conclusion

YAS is a key player in the delivery of urgent care through its regional 999 service and the NHS 111 service, which provides a single point of access for patients across the region requiring urgent care. In addition, the Trust has experience of delivering a range of other locally tailored services to meet urgent care needs, including Advanced Paramedic schemes, management of frequent callers and others with specific care needs, supported urgent discharge from hospital. The Trust aims to build on this strong platform to offer a range of enhanced solutions to commissioners. The YAS Urgent Care Development Plan will maximise the benefits of YAS’s position as regional provider and facilitator across patient pathways and will build on the Trusts’ existing expertise and infrastructure to deliver a real impact on patients and on the wider urgent and emergency care system. The Trust will develop business models and cases which are aligned to wider Trust strategy, delivering patient benefits and value for money for the Trust and wider health economy.