annual quality statement 2014-15

AnnuAl QuAlity StAtement 2014-2015

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru

Welsh Ambulance ServicesNHS Trust

The Welsh Ambulance Service NHS Trusts Annual Quality Statement 2014-15 has been written and produced with the support of our staff. The style and content of the statement has been influenced by our service users.

This is your Ambulance service and without the involvement of people and patients we could not continuously improve on the care and services we provide. So we would like to extend our thanks to all those who gave us feedback over the year on how we could improve our services as well as to extend their thanks for the care they received.

We would like to also thank all our staff for their dedication and support in delivering services to the people of Wales 24/7.

The information shown in this statement has been taken from numerous reports and development plans produced by the Welsh Ambulance Service. Every effort has been made to ensure the information is accurate at the time of publishing.

Foreword 3

Our organisation 4

Our last statement 5

Being a patient 6

Improving our services 7

Self assessment 8

What we have done 9

Improving transport times 10

A year of modernisation 11

Responding to need 12

Did we deliver? 14

Improving public health 15

Health promotion 16

What is it like to be a patient 17

Learning from stories 19

Better communication 20

Future service 22

More information 24

CreditS ContentS

3Welsh Ambulance Services NHS Trust Annual Quality Statement 2014 -2015

The Welsh Ambulance Services NHS Trust delivered healthcare to nearly 1.5 million people who needed our help and advice over the last year. We recorded over 4 million visits to our NHS Direct Wales website from those searching for online information and advice. This Annual Quality Statement demonstrates how we have delivered safe, patient-centred, and high quality care to service users across Wales.

There is no doubt that 2014/15 has been a challenging year for the Trust. Last year we predicted a continued increase in demand for our ambulance services. What we did not predict was the unprecedented volume of calls received especially during the winter period. More than 40,000 calls were received in December alone, a record high for the Trust.

Throughout the year we have had to tackle long standing and complex problems to improve our performance as a Trust. In March we gave evidence to the Welsh Assembly’s Health Committee into the performance of the Ambulance Service in Wales. This gave us the opportunity to explain the complexities we face in improving ambulance performance and the actions we are taking to achieve sustainable improvements.

Our focus has been, and will continue to be, providing patients with the right care at the right time, at the right place. We believe that this quality statement, which should be read alongside our Annual Report, provides a true picture of the quality of care provided to our patients. With support from our staff, NHS colleagues, patients, public and other partners we will do everything in our gift to continue to deliver a quality service that we can all be proud of.

Tracy Myhill Chief Executive

Mick Giannasi Chair

Foreword

4 Welsh Ambulance Services NHS Trust Annual Quality Statement 2014 -2015

69% 31%

we Are tHe welSH AmBulAnCe SerViCeAnd tHiS iS our orGAniSAtion At A GlAnCe

Number of people served by the Welsh Ambulance Services NHS Trust3 million

315,394

739,040

Urgent or planned

514,909Total number of 999 calls

Non-emergency patients transported to hospital appointments

Number of staff employed by the Welsh Ambulance Service3,000

66% 34%

Operational staff

Non-operational staff

Emergency duties

Non-emergency services


We made a number of commitments last year to improve our services and the care and experience of our patients.

We said we would work closely with NHS colleagues to make sure improvements were made in addressing delays patients experienced for their treatment and care.

Addressing patient delaysWith support from Welsh Government and NHS Wales colleagues we have been working together to reduce the numbers of delayed ambulance handovers. An NHS Wales Hospital Handover guidance was developed in partnership with colleagues from across the NHS for use in all A&E departments to safely manage patients being taken to hospital by our ambulances.

During the year we issued further guidance to our ambulance staff to ensure they followed consistent practices when arriving at A&E. However, not all our patients were taken to A&E. Some were referred to alternative care pathways such as GP out of hours services and a range of patient pathways such as falls; Minor Injury Units and Local Accident Centres across Wales.

Improving the care of patientsLast year we said we would look at the level of care and professionalism of our staff in helping frail older patients as well as appropriate training for our staff on dementia by linking in with local dementia training teams and exploring what online resources are available for our staff to access.

The safe management and delivery of care to patients with dementia has been discussed nationally amongst other U.K Ambulance Services, and Higher Education Institutes. As a result they have been asked to incorporate awareness sessions within their education programmes.

As a Trust we are fully aware of the complex nature of managing patients with dementia and are continuing to pursue appropriate training for staff. We have now begun to roll out dementia training to front line staff as part of our commitment to treating patients with dignity and respect.

wHAt we SAid in our lASt StAtementwe Are tHe welSH AmBulAnCe SerViCeAnd tHiS iS our orGAniSAtion At A GlAnCe

Number of people served by the Welsh Ambulance Services NHS Trust


underStAndinG wHAt it iS like to Be A pAtient in our CAre

To appreciate what it is like to be a patient in our care we captured a wide range of patient feedback across the Trust to better understand and create a picture of the experiences of our patients, their carers and other service users. This is a snapshot of what people told us:

We promoted good news, feedback and experiences to all our staff as examples of good practice. Where we heard about things that were not so good we shared with staff and worked hard to make improvements. Many of the issues identified by patients are well known and are being progressed through the Trusts Modernisation programme.

Positives +◆◆ ◆Professionalism and caring staff

◆◆ ◆Excellent Service

◆◆ ◆Kindness of staff

◆◆ ◆Treated with respect and politeness

◆◆ ◆Knowledgeable staff

◆◆ ◆Helpful and Reassuring

Negatives –◆◆ ◆Longer than expected wait for ambulance

◆◆ ◆Hospital handover delays

◆◆ ◆Waiting times to be picked up

◆◆ ◆Long journeys

◆◆ ◆Anxiety for patients waiting to be picked up

◆◆ ◆Too many asked/repetitive questions on phone

◆◆ ◆Long wait for a call back


We believe we have. We have adopted a culture focused on quality and understanding, based on what it means to be a user of our services.

Delivering a quality clinical serviceHaving good quality governance is essential to ensure high standards of care are maintained and delivered. The Trusts ‘Quality Delivery Plan’ set out our aspirations towards achieving a ‘quality driven clinical service’ that provides safe high quality care, excellent patient experience and value for money.

In achieving this we have ensured that the six domains of quality have been firmly embedded into everything we do. These are the quality domains:

◆◆ ◆Safety Avoiding harm to patients from the care that is intended to help them

◆◆ ◆Effective Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively)

◆◆ ◆Patient-centred Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

◆◆ ◆Timely Reducing waits and sometimes harmful delays for both those who receive and those who give care

◆◆ ◆Efficient Avoiding waste, including waste of equipment, supplies, ideas, and energy

◆◆ Equitable Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status

HAVe we improVed SerViCeS And CAre to you oVer tHe lASt 12 montHS?


It has been acknowledged and agreed that the self assessment process that the Trust carries out in reviewing its services would benefit from a more rigorous and objective outcomes based approach. With this revised approach it was expected that the self assessment scores would reduce across a number of the Standards. This more detailed approach has provided a better foundation for the Trust to move forward, embedding outcomes based approach to the Health and Care Standards.

A strategic transformation programmeThe Trust pursued its transformation agenda for the Ambulance service throughout the year with many strands being taken forward to improve the emergency 999 service; modernisation of the patient care transport service and developing our workforce to ensure we have the right skills to help our patients in an ever developing dynamic environment.

We are moving away from being seen just as a transport service to one that delivers quality clinical care which is efficient and cost effective.

The Welsh Government has placed a great deal of emphasis on the need for the NHS in Wales to improve the quality of care provided with a particular focus on safety and compassion.

Improving health & wellbeing of staffThis year in recognition of its support for improving the health and wellbeing of its employees, the Trust was awarded the Silver Corporate Health Standard. This is run by the Welsh Government and is the quality mark for workplace health promotion in Wales.

To achieve Silver status the Trust worked hard to support staff and reduce high levels of sickness absence, this included: the development of a Wellbeing Support Service to provide help on a wide range of health and wellbeing matters affecting staff; an Occupational Health Service designed to prevent ill-health and support staff by helping them to stay in work or return to work after an illness.

Reducing the levels of absence and having staff fit for work has been a priority for us. We made good progress towards addressing some of the underlying issues of concern and taken positive action to improve the health, wellbeing of staff and their working conditions.

During the year absence figures decreased from 7.65% to 6.25%.

StAndArdS For HeAltH SerViCeS undertAkinG our SelF ASSeSSment


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199,515

Through close working with Local Health Boards and NHS colleagues we identified different ways in which we could deliver our services for the benefit of patients.

There has been significant modernisation and investment within the Trust. The modernisation programme is transforming the experience of staff and patients.

Delivering effective and responsive servicesWith support from the Health Boards and Welsh Government we have been monitoring the quality of our services throughout 2014 - 2015.

We have focused on:

The number of emergency calls to our service The number of Patient Care Services (PCS) journeys made The number of calls to NHS Direct Wales

999Emergency callsThese were imediately life-threatening calls which required an eight-minute ambulance response.

Patient Care Services (PCS) journeysPCS transported patients to appointments at various hospitals and healthcare settings across Wales and the rest of the UK.

Total contacts to NHS Direct WalesOver 300,000 telephone calls were made to the nurses and Health Information advisors based within NHS Direct Wales Clinical Contact Centres across Wales.

Over 4,500,000 web visits were made to the NHS Direct Wales website.

739,040

4,846,872

So, wHAt HAVe we done to improVe our SerViCeS?


We listened to staff and patients concerns about late arrivals and missed appointments for scheduled hospital appointments. Patients have been understandably anxious about being late for their hospital appointments and treatment; this has been a common theme from feedback.As part of our Strategic Transformation Plan we created an All Wales group to look at how the non-emergency transport service, known as NEPTS, in Wales could be improved. This group has looked at the experiences of patients in using the non emergency transport service and engaged with staff who deliver the service to ensure their views influenced decisions.

We have already implemented some improvements such as using a wider range of ‘approved’ transport providers to complement existing ambulance resources. We also introduced a ‘needs assessment process’. This process involved collecting vital information from patients to ensure they were eligible for a non emergency ambulance and that their journey to hospital was safer and considered their needs.

Later this year we will provide to Welsh Government our vision on how NEPTS should be provided in the future.

We have worked with other organisations to improve patient experiences. For example within Cardiff an agreement was reached with the local Authority and Council to allow our PCS vehicles with patients on board going to hospital to use the bus lanes. Previously only our emergency ambulances have been allowed to use them. This has made a difference to patients and saved precious minutes queuing in traffic.

Providing advice and information 2427 people submitted an online enquiry to the NHS Direct Wales Health Information Team via a dedicated email facility. This online facility has been providing a quick and confidential service to requests on a range of topics from information on a health condition to local NHS healthcare services.

More than 5000 people contacting the emergency ambulance service were assessed by our nurses. They were referred to the right service based on their need.

improVinG trAnSport timeS For HoSpitAl AppointmentS


Public Access Defibrillation Sites (PADS)A PAD is a defibrillator available for use by the public at a cardiac arrest before the arrival of an ambulance. They are found in public venues such as supermarkets, leisure centres and train stations. Once someone’s heart stops, their chance of survival decreases by 10% every minute before defibrillation.

PAD sites are a crucial part in the chain of survival for cardiac arrest patients. WAST attends around 2000 patients in cardiac arrest annually.

We are part of the ‘Defibrillator Alliance group’ that brings together the NHS and third sector, public access defibrillation providers who are united in the goal to save more lives in Wales.

Be a Defib heroThe Trust has launched an on line reporting tool to capture new and previously unreported PADS across Wales.

The link can be found on the Welsh Ambulance Service Home Page www.ambulance.wales.nhs.uk

EquipmentWe have continued to invest in our capability to provide excellent clinical care for patients by obtaining the following clinical equipment:

◆◆ Difficult Airway Kit this provides advanced airway management equipment

◆◆ Fingertip Pulse Oximeters a patient monitoring device for measuring blood oxygen levels

◆◆ New design Orthopaedic “scoop” stretchers for managing patients with pelvic and spinal injuries

◆◆ Paediatric monitoring equipment to enhance our ability to monitor babies and children

◆◆ Traction Splints for managing leg fractures that require mechanical traction to restore circulation and reduce pain

◆◆ Pelvic Binders for reducing blood loss in serious pelvic fractures

A yeAr oF FurtHer CliniCAl moderniSAtion


Corpuls3We purchased 143 new Corpuls3 ambulance based defibrillators. These state of the art defibrillators monitor a patient’s ECG, their blood pressure, and also confirms carbon dioxide levels to ensure the quality of ventilation provided to a patient who is not breathing. These monitors allow our paramedics to diagnose heart attacks and make decisions about the most appropriate destination for a heart attack patient to receive immediate cardiology treatment on arrival at hospital. The defibrillators have the capability to pass this information by telemetry to the receiving hospital or onto the patients GP.

3RUA resuscitation rapid response vehicle pilot began within the Cardiff and Vale Health Board area. In total 19 paramedics have been trained in leadership, crew resource management and clinical decision making in cardiac arrest scenarios. The British Heart Foundation funded the pilot in partnership with the Trust.

Clinical Response Model (CRM)As part of our Performance Improvement Plans and our review of the CRM to improve patient safety and experience the Trust Board agreed that, as an internal measure only, we would aim to reach calls categorised as ‘Green 1’ calls (serious but not immediately life-threatening like broken limb, imminent childbirth) within 20 minutes as a hot response, i.e. with lights and sirens. (Previously Green 1 response was 30 minutes). Responding with lights and sirens has meant reaching our patients quicker; shortening the job cycle and, releasing crews and vehicles to respond to the next 999 call.

We also introduced clinicians into our control rooms. They are sending the most appropriate resource to patients and provide additional support, advice to patients over the telephone and signpost them to alternative care where necessary.

reCoGniSinG And reSpondinG to need


Reducing hospital admissionsIn our drive to reduce the number of people going into hospital some of our Paramedics, with additional training, have provided specialist healthcare at the scene of an incident or at a patient’s home to try and reduce unnecessary hospital admissions. The launch of a ‘Taxi Scheme’ earlier in the year has seen many patients with less serious conditions go to hospital in a taxi or make their own way with a friend or relative freeing up our busy ambulances.

Paramedic’s are now referring patients across the whole of Wales who have had a non-injury fall, a resolved hypoglycaemic episode and resolved epilepsy episode to community falls teams and the patient’s own GP. Referrals in Betsi Cadwaladr UHB and Cardiff & Vale UHB began on 27 October and 30 November 2014 respectively. This work means that patients are not taken to the A&E.

Being inclusiveWe have strived to provide opportunities for people to be involved; this has extended to capturing feedback, comments, suggestions; promoting volunteers and delivering life saving skills. Through fostering good relations a number of successful initiatives were achieved.

We recognised that a lot of issues and barriers faced by minority communities went unreported. We worked with and engaged with local communities to encourage involvement. As a result new volunteer Community First Responders (CFRs) are active in communities. CFRs are volunteers who donate their spare time to attend appropriate 999 calls and provide first hand emergency care to people in their own community.

Community First Responders (CFR)There are over 2,000 CFR Teams equipped and trained to provide CPR – cardio-pulmonary resuscitation. CFRs last year volunteered over 250,000 hours of availability.

They contributed almost three per cent to the overall performance of 999 life-threatening call responses in Wales.


Delivering safe careWe have a clear responsibility to deliver high quality safe patient care to all across Wales. This includes reviewing staffing levels to ensure we are available to respond to emergencies, improving the way we deliver care and developing new systems to ensure that there is equal access to care for all patients throughout Wales.

Patient safety42 Serious Adverse Incidents (SAI) were reported throughout the year. SAIs are those incidents that are reported to the Welsh Government, Improving Patient Safety Team. All SAIs were reviewed and approved for reporting by our Executive Medical Director. SAIs were presented to the Trust’s Concerns Monitoring Group and to the Informing Patient Safety Team in Welsh Government.

Most of these related to timeliness in responding to life threatening emergency calls. A contributing factor to these was the delay handing patients over to Emergency Departments once at hospital. To reduce these delays the Trust worked with Health Boards and Welsh Government to develop a ‘Hand over’ guidance document intended to minimise any risks to patient safety during these periods. This guidance came in to force in February 2015.

During the same reporting period the Trust received 1584 patient safety incidents. The majority of these did not cause harm to patients. Those initially reported as potentially major or catastrophic were assessed for referral to Welsh Government as SAI.The number of patient safety incidents and SAIs received each month has been

received by the Trusts Quality, Experience and

Safety Committee through the Trust’s electronic adverse incident form called Datixweb and Integrated Performance Report. All learning from themes and trends identified from SAI and adverse incidents have been discussed at the Trust Organisational Learning Group (OLG). It has been at OLG where the learning from these incidents has taken place with recommended actions to improve patient safety.

Ensuring patient safety is a priority for the NHS in Wales and we aim to avoid all possible harm when we respond and treat patients in our care.

Roster reviewIn partnership with our staff and managers we started to review the duty rosters for our Emergency Medical Services. This was to ensure our staff are available to meet demand. Many rosters have now been reviewed and are now in place. The review will continue as we look at the duties in Patient Care Services, Clinical Contact Centres and NHS Direct Wales.

Local Alternative Pathways of CareA number of pathways were introduced in a number of Health Boards, including:

◆◆ Mental Health Pathway in Cardiff & Vale and Cwm Taf Health Boards respectively

◆◆ Community Integrated Assessment Service (CIAS) pathway in Cwm Taf

and

◆◆ Ambulatory Care Pathway in Cwm Taf

did we deliVer A SAFe SerViCe?


We have an important role in delivering public health messages, especially in helping our staff and the public to stay safe, healthy and avoid getting ill.

Special responseOur staff play an important role in saving people’s lives in hazardous incidents. These incidents include flooding, building collapses, mining incidents, tunnel explosions and major transport collisions. Our staff deal with chemical, biological, radioactive, nuclear and terrorist incidents.

This is a legal duty (under the Civil Contingencies Act 2004) that the Trust must meet and works in partnership with other agencies to prepare and plan for serious and challenging incidents.

Our Hazardous Area Response Teams (HART) and Special Operations Response Teams (SORT) are enabling us to have a resilient organisation, protect our services and respond to patients. These teams have specialist vehicles and equipment to be able to respond to patients in challenging environments including at height, confined spaces, off road and areas of difficult access, they also have specialist personal protective equipment to allow them to work in hazardous environments.

In the last year there were 632 incidents that specifically required a HART response.

Infection Prevention Control (IPC)In delivering care and treatment to our patients there are three areas where staff face the risk of transferring infections to patients. These are:

◆◆ Having contact with many patients

◆◆ Using devices like a needle to administer drugs and catheters to drain urine

and

◆◆ Treating patients in environments where there is a risk of infection such as outside in the street or in the back of an ambulance

As part of our commitment to ensuring that patients are not exposed to infection and are cared for in a clean, safe and modern environment, we carried out a review of our Infection Prevention and Control systems. We now have an approved ‘Code of Practice’ for the Trust that is based on the Welsh Government Code of Practice (2014) for the Prevention and Control of Healthcare Associated Infections and identifies minimum standards of IPC required within the Trust.

SafeguardingWe have a shared responsibility to promote the well-being of children and vulnerable adults in our care. To support this we have ensured;

◆◆ The recognition and safeguarding of children and adults identified as vulnerable who are at risk of abuse or harm

◆◆ The recognition of children in need of social care and support

◆◆ The correct referral to Social Services is made

To improve our service we have, over the past year, worked collaboratively with Welsh Womens Aid to develop a groundbreaking pathway to enable victims of Domestic Abuse to access support services safely.

We are in the process of reviewing our procedures and guidelines to ensure compliance with new legislation and the best use of Information Technology for the prompt reporting of concerns.

How HAVe we ContriButed to improVinG puBliC HeAltH?


Hand hygieneMost health care-associated infections are preventable through good hand hygiene. Throughout the year we promoted good hand hygiene to all our staff and the public providing messages on importance of cleaning your hands in the right way.

For children we used the Trusts mascot ‘Jack’ to promote clean hands leading into the winter months along with a series of simple posters. All primary schools were provided with Jack posters to display in hand washing areas; an interactive ‘bug blaster’ game was promoted as a fun way for children to learn more about hand hygiene. In promoting key public health messages to schools we also raised awareness and provided information on head lice which resulted in a large number of people accessing the Head lice symptom checker online.

Flu virusIn protecting our staff and patients from catching flu a flu vaccination programme was carried out. Staff were encouraged to be vaccinated to protect themselves and keep patients protected from contracting the flu virus. The number of staff having flu vaccinations increased to 1200 staff across the Trust.

HeAltH promotion


Improving the experiences of patientsIn 2013 the Welsh Government launched the Framework for Assuring Service User Experience to enable service to ensure that people had positive first and lasting impressions, that they received care in safe, supportive and healing environments and that they understood and were involved in their care. We have implemented the framework fully into our work and have undertaken surveys through many different mediums to get people’s views on our services, both good and bad and how we could improve.

Types of feedback we received during the year included compliments, complaints, adverse incidents, patient safety issues and patient experiences/stories. This patient feedback has given us a true picture of the quality of service patients and the public received.

A total of 1649 surveys were undertaken by post, phone and face-to-face. The results of the surveys were reported to the Trust’s Quality Experience Safety Committee (see page 6).

Putting things rightThis year we received 453 formal complaints; this was less than the previous year of 506 formal complaints.

Complaints we received were split amongst our services:

◆◆ 50% Emergency Medical Service (EMS)

◆◆ 42% Patient Care Transport Service (PCS)

◆◆ 6% NHS Direct Wales (NHSDW)

◆◆ 2% Other

The top primary subject of all complaints was timeliness with a delay of ambulance arrival.

We saw an increase in the number of ‘on the spot’ (OTS) concerns; these were issues that were dealt with informally within a short timescale. The number of the OTS concerns received went from 627 last year to 879 this year. We have worked hard to engage with patients and the public to resolve their concerns informally wherever appropriate to do so and in doing so have resolved their concern as quickly as possible whilst still capturing and learning from their experience.

Throughout the year we participated in a number of workshops to take forward the recommendations of the National Evans Review to seek the views from public/patients of the work so far and improve the access and process involved in making complaints.

The result of these workshops has been to have agreement on an all Wales basis for changes to

So, wHAt wAS it like to Be A pAtient oF tHe welSH AmBulAnCe SerViCe?


be made that will improve the complaints process and make it easier and consistent across the whole of the NHS in Wales.

We recognised the value and importance of including concerns data with patient experience data to maximise learning and sustained improvements whilst ensuring patients receive a positive experience.

We are now categorising compliments in the same way as patient experience however most of the letters we receive are an expression of the public’s gratitude for our timely response, caring staff and professional service.

This year we received 724 compliments.

Compliments we received were split amongst our services:

◆◆ 75% Emergency Medical Service (EMS)

◆◆ 6% Patient Care Transport Service (PCS)

◆◆ 15% NHS Direct Wales (NHSDW)

◆◆ 4% Other

Patient engagementOur Partners in Health Care team (PIH) engaged with over 4559 service users and members of the public who shared their views with us whilst we were out and about at community events.

We have visited and met different people, groups and communities including schools, older people’s forums, hard of hearing groups, visually impaired forums and many more. This has given people the opportunity to meet us and tell us their views,

their suggestions and experiences so that we can improve our services. The feedback we have received from engaging with people has added a great deal of value to us in our work. We have been able to provide useful, relevant information based on people’s feedback and tailor it to meet their needs.

Choose Well

The Clinical Contact Centre’s support service is a good example of how we are working with colleagues across the Welsh NHS to meet the needs of patients and reduce pressure on busy emergency services. When people are ill there is a range of options available to ensure they are given the right treatment. Our aim is to provide the care patients need where they need it, and that does not always need a paramedics or a visit at local A&E.

We have engaged with local communities reminding the public that they have a role to play in helping us deliver the best and appropriate level of care. We have continued to urge the public and patients to give us feedback at every opportunity; to ‘Choose Well’ and use their ambulance service responsibly.

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Throughout the year we have opened the Quality Delivery Committees and Trust Board with a patient story along with updates on progress of the learning from these very personal stories from patients and staff.We use patient stories to focus on quality and drive service improvement. They give us a clear picture on what is working well or not from the point of view of the patient and their families.

The following is an example of how a patient story can make a difference:Feedback received to a Trust survey from an elderly man who made an observation about ECG pads. He had called 999 and our staff had undertaken a ECG. The ECG pads were left on his chest because he was told that the hospital will likely to another ECG on him on arrival. The nurses removed the pads and told him that the pads were not compatible with their. He asked the question as to “Why we use one type of ECG pad and the hospital use another” Could the same ECG equipment be introduced to avoid a waste of resources.

As a result of this story we have now changed over products to the dual purpose electrodes that can be used by both our staff and hospital ECG machines without removal. Our new supplier also agreed to monitor the adhesiveness of the gel used in the electrodes in order to minimise patient discomfort on removal.

During the year 10 patient stories were presented to our Trust Board and Quality Committee. Where consent was given from patients we share their recorded stories via our website and social media channels.

Non Emergency Patient Transport Service (NEPTS) in WalesThe NEPTS is very important to us and we began this year to look at how it could be improved so that those who use it receive high quality care and get to their appointments on time.

An extensive work programme has been developed which has patients’ stories of their experiences of using NEPTS at the heart of our service improvement.

The changes being progressed in partnership with a range of groups and stakeholders will continue throughout 2015 - 2016.

leArninG From StorieS

Maureen O’Brien, NEPTS / PCS service-user


Being good at communicating is important in delivering high-quality care, information and messages to patients, public and our staff.

Improving communication between staff and patientsGood communication between our staff and patients is essential to them experiencing better care and treatment. We have introduced a number of initiatives to ensure better communication and a wider spread of information on what the Trust is doing in delivering quality services.

Welsh LanguageWe received positive feedback from the Office of the Welsh Language Commissioner that has influenced our Welsh Language Skills Strategy. This strategy helps us identify the Welsh language skills of our workforce and to look at our workforce planning, training and recruitment so that we can close any Welsh language skills gap that exists within the Trust, this extends to our recruitment guidance that determines Welsh Language Skills for any vacant posts that we have across the Trust.

Deaf communities Deaf communities told us that they often have a poor experience when using our services. Over the years we developed and launched a number of steps to improve their experiences, more recently we launched a film to school frontline crews on basic sign language. To reduce anxiety and worry in an emergency it was suggested for frontline staff to know a few British Sign Language (BSL) phrases. As a result we filmed and widely shared an educational film showing five key signs suggested by Deaf communities that would encourage them learn.

It includes a ‘Hello, my name is...’ introduction, which is part of a wider campaign to encourage staff to introduce themselves to patients in order to establish a human connection and build trust.

Social mediaThe Trust fully embraced social media throughout the year as a way to engage, build relationships and encourage people to participate. Social media has helped us to fully interact with all our service users, stakeholders and communities using Facebook and Twitter. Using social media has been another way for us to listen and learn and gage the feelings of our patients and stakeholders.

Welsh Ambulance: www.facebook.com/welshambulanceservice

NHS Direct Wales: www.facebook.com/nhsdirectwales

@WelshAmbulance

@NHSDirectWales

You can also follow the Trusts’ Engagement team:

@WelshAmbPIH

did CommuniCAtion Get Better witH StAFF And pAtientS?


We used social media to promote key messages; the following are just some examples:

“Stop, think... do you really need 999?” This explains how the Ambulance Service prioritises emergency calls, and how dealing with non-urgent and hoax calls can potentially delay responses to more serious cases. This video has been viewed over 600 times.

Thanks to East Midlands Ambulance Service we re-produced information posters.The bilingual posters, which feature slogans like ‘You wouldn’t call the fire service to blow out a candle’ have been disseminated through social media in a bid to get people to ‘Choose Well’ and use our ambulance service appropriately.

Over 6,000 posters have been posted to services and organisations across Wales with an additional 17,000 people ‘reached’ through social media. NHSDW website

The NHS Direct Wales website has been providing reliable health information and advice to the people of Wales. It has experienced record breaking visits, over 4.5 million throughout the year. Success has been achieved because of service users input in continuously ensuring that the website meets their information needs. People can search for up to date health information, find local services and carry out their own self assessment on a range of health topics. The biggest attractions to the site are the online self assessment symptom checkers. More people went online and carried out a self assessment instead of calling the NHS Direct Wales 0845 service.

4.5m website visits in the last year

Health Topics Services Symptom Checkers

Through the roof!

http://www.nhsdirect.wales.nhs.uk


Moving forwardA year for change 2015-16The expectations on the Welsh Ambulance Trust to deliver high safe quality and timely care are high. The scale of the challenges we face to improve on our performance and the way we care for patients is considerable. The next year will see a positive difference to the way we deliver services. The changes set in motion over this last year will continue with the clinical transformation of our services; workforce modernisation and building strong relationships with Local Heath Boards, Trusts and Welsh Government.

Transforming the Welsh Ambulance ServiceWe want to be seen as a vital part of the NHS in Wales. We will be changing the focus of our service to establish it as a clinically led, clinically driven emergency medical service, non-urgent patient care service and a 24 hour health care and advice service that focuses on delivering the best clinical outcomes for our patients. To do this we will develop our own Integrated Medium Term Plan (IMTP)

The (IMTP) will cover a one year period- 2015/16 and build on and will replace, Working Together for Success 2011-16, the Trusts Integrated Business Plan 2014/15-2016/17 and Annual Delivery Plan 2014/15. The IMTP will be reviewed throughout the year with a view to gaining approval of a three year plan from 2016/17.

Through the IMTP the Trust will provide a clear statement of ambition that will benefit patients, the public of Wales, Trust staff and NHS partners (together with other external stakeholders).

The IMTP will provide the framework for the Trust to:

◆◆ provide a clear statement of ambition for the benefit of patients, the public of Wales, Trust staff and NHS partners (together with other external stakeholders)

◆◆ set out how we will deliver the Commissioning & Quality Delivery Framework agreed with the

Emergency Ambulance Services Committee

◆◆ describe fully the modernisation of the non-emergency transport services and;

◆◆ support the transition of health advice and information service ‘NHS Direct Wales’ to the planned 111 service being introduced in Wales at the end of 2015 and throughout 2016

We will develop a community engagement strategy to enable us to interact with all our stakeholders and promote community ownership of the service. This will include a plan to reduce the number of inappropriate 999 calls to the ambulance service and promote information and choice for patients so that they have better patient outcomes. The Trust’s ambition will be to gain the trust and confidence of patients, the public and key stakeholders within Wales.

wHAt iS tHe Future For tHe welSH AmBulAnCe SerViCe?


NEPTS Transformation ProjectNEPTS Transformation Project is due to submit its report to Welsh Government in the form of a Business Case by September 2015. The current model of delivering NEPTS will change and become more patient centred and responsive to patient needs.

Quest for quality improvementA new ‘Quality, Patient Experience and Safety Committee’ (QuESt) will be set up with responsibility for overseeing the improvement and outcomes in quality, patient experience, effectiveness and safety and in delivering the Trusts new Quality Improvement Strategy (QIS). This Committee will seek assurances on behalf of the Trust Board with the focus on ensuring the quality and safety of healthcare.

The QIS will be developed and will help shape the future of the quality of our services. This will mean adopting a continual cycle of learning lessons and adapting to new opportunities with strong engagement from service users, staff and stakeholders.

Delivering quality The new Health & Care Standards Framework for Wales will set out the expectations for the people of Wales either receiving health care or providing

it. The standards used alongside the Framework for Assuring Service User Experience will be an integral component in the Trust demonstrating the provision of quality services to patients.

We will continue to proactively seek out patient experience and align our work to Health Standards to drive continuous improvements in quality and service improvement. Improving clinical auditWe will improve on our audit and recording procedures. We will capture and log patient care records electronically to improve the quality and accuracy of patient information which will enhance our clinical audit capability and ultimately drive improvements in patient care and reported outcomes.

So some of our key priorities for 2015/16 will be:◆◆ Safeguarding

◆◆ Infection Prevention & Control

◆◆ Mortality reviews

◆◆ Strengthening the Putting Things Right (PTR) process

◆◆ Developing a 3 year Quality Improvement Strategy and Plan

◆◆ Evidence learning throughout the organisation

◆◆ Introducing new clinical models in EMS and NEPTS

Gove

rnance, Leadership and Accountability

Governance, Leadership and Accountabili

ty

Staying Healthy

SafeCare

EffectiveCare

DignifiedCare

Timely Care

IndividualCare

Staff andResources

PersonCentred

Care

24 Welsh Ambulance Services NHS Trust Annual Quality Statement 2014-2015

Follow the links below to find out more about the work of the Welsh Ambulance Services, see people’s feedback and hear patient stories.

Welsh Ambulance Services websitewww.ambulance.wales.nhs.ukFor committee papers and reports: http://bit.ly/1OwGa7F To hear patient stories: http://bit.ly/1RPDOpP

NHS Direct Wales - for self-care, information and advicewww.nhsdirect.wales.nhs.uk

Social Media Channels:

Welsh Ambulance YouTube channelhttp://bit.ly/1DrLZgb

Facebook: Welsh Ambulance: www.facebook.com/welshambulanceservice NHS Direct Wales: www.facebook.com/nhsdirectwales

Twitter: @WelshAmbulance

@NHSDirectWales @WelshAmbPIH

How was your experience with us?

If you would like to give feedback on this document or any aspect of your experience of using the Welsh Ambulance Service email us at [email protected] or visit the ‘Have your Say’ section on the website http://bit.ly/1EpUR93

more inFormAtion ABout tHe welSH AmBulAnCe SerViCe And itS deVelopmentS

annual quality statement 2014-15

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