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Our Quality Account 2011/12

Contents Page No

Executive summary 3

A brief overview of our Trust (what we do) 5

Part 1

An introduction to our Quality Account (your definitions of quality) 9

Board Assurance Statement 11

Chief Executive’s Quality Statement 12

Part 2

Priorities for Improvement (where we need to improve) 14

Quality Management Systems (how we will support improvement) 21

Our current quality performance (what we did and how we improved) 26

Our local improvement priorities (what we pledged to do) 34

Part 3

How we developed our Quality Account (what you said) 43

Review of quality performance (how we did last year) 45

Glossary 55

Contact details 57

We asked our Foundation Trust members to describe in one word how they view EMAS. The above shows

what they said - the size of each word is in proportion to the number of times members used it.

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Executive Summary This Quality Account reviews our performance in 2011/12 and sets out our key priorities for quality improvement for 2012/13. Last year’s Quality Account reflected quality developments from a Trust-wide perspective. It is our intention that next year’s Quality Account will provide County-based information to show how our improvement activities have benefited local health communities

In 2011/12, EMAS continued to improve the quality of care provided. Last year we identified the following quality improvement priorities against the 3 ‘domains’ of quality – patient safety, clinical effectiveness and patient experience.

Delivering against the above priorities has yielded a number of benefits for patients: Priority 1: Communication and Joint Working We introduced a structured communication tool to improve communications between staff and organisations during patient care handover processes. Improving the quality and comprehensiveness of clinical information communicated has enhanced our ability to care for patients effectively. We also continued to work with our staff to develop our mechanisms for sustaining compliance with Safeguarding and Infection Prevention and Control standards for optimum patient care. Compliance audits for safeguarding and infection prevention and control have consistently shown excellent results which demonstrates our staff are delivery high quality care in this respect. Priority 2: Developing Our Workforce We increased our paramedic numbers to ensure our patients receive high quality care from skilled and competent clinicians. We have made significant progress to achieve our desired staffing levels and skill mix ie a ‘relief rate’ of 27% against a target of 28% and our target skill mix of 60:40 (registered to non-registered). In addition, 92% of A/E and PTS staff had completed the EMAS Essential Education Programme. Priority 3: Effectiveness of treatment (Clinical Performance Indicators - CPI) We improved our performance against a number of national clinical performance indicators and implemented improvement plans to target areas where further improvement was needed. This has enabled us to continually improve the quality care we deliver to our patients.

Priority 4: Response to our patients (Accident and Emergency - A&E)

We introduced measures which led to improvements in our response times to patients with life-threatening conditions. The additional investment in our clinical assessment team has led to more appropriate management of non life-threatening calls via telephone-assessment and referral to local community services.

Priority Quality measure

Patient safety

Priority 1: Communication and Joint Working

Priority 2: Developing our workforce

Clinical effectiveness

Priority 3: Effectiveness of treatment (Clinical Performance Indicators - CPI)

Priority 4: Response to our patients (Accident and Emergency - A&E)

Patient experience Priority 5: Treating patients with dignity, respect, care and compassion

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Where we need to improve our response times to national targets, we have developed plans to improve our performance.

We have developed our services for service users with learning disabilities and implemented a Trust wide ‘Dignity in Care’ campaign. We now have over 400 ‘Dignity Champions’ across the Trust with over 80% of these in patient-facing roles. We also increased the number of staff attending learning disability training. This gave staff a greater understanding of how to care for patients holistically taking account of their individual needs and family relationships. Our engagement with service users and carers has enabled us to identify ways to make our service more accessible to all. In 2012/13 we will continue to drive forward our quality improvement initiatives to enhance patient safety, patient experience and clinical outcomes for patients. Our priorities have been developed with our staff, service users and the public and are shown below:

Progress against priorities identified in the Quality Account for 2012/13 will be regularly monitored by the Quality and Governance Committee, a sub-committee of the Trust Board. A mid-year Quality Account report will also be received by the Trust Board to provide additional assurance of delivery.

Priority 5: Treating patients with dignity, respect, care and compassion

Patient safety Priority 1: Improvements in response to staff survey key questions and

Performance Development Reviews (appraisals)

Clinical effectiveness

Priority 2: Continue to improve the processes for call handling, clinical

assessment and the deployment of resources

Priority 3: Existing clinical performance indicators to be improved and new

indicators to be developed taking into account regional priorities

Patient experience

Priority 4: Continue to engage with stakeholders across local communities to

enable patient experience to influence service improvement and development

Priority 5: Develop a training package linked to a new Domestic Violence Policy

to equip frontline staff with the knowledge to recognise and deal effectively with

victims and perpetrators of Domestic Violence

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A brief overview of our Trust (what we do)

Introduction

East Midlands Ambulance Service NHS Trust (EMAS) currently provides

Emergency and Urgent Care and Patient Transport Services for the six

counties of Derbyshire, Leicestershire, Rutland, Lincolnshire (including

North and North East Lincolnshire), Northamptonshire and

Nottinghamshire.

We employ over 3,200 staff at more than 70 locations, including two

Emergency Operation Centres at Nottingham and Lincoln, with the

largest staff group being accident and emergency personnel. Our

overall annual income budget for 2011/12 was £161 million.

Our accident and emergency crews respond to over 586,000 emergency calls every year, that is one call every

54 seconds, while our Patient Transport Service (PTS) and volunteer ambulance car drivers provide care and

transport on over 2,900 journeys to and from routine appointments each day - over 1 million journeys a year.

Following a competitive tendering exercise, from July 2012, EMAS will no longer provide PTS other than in

North and North East Lincolnshire.

We rely on our volunteer staff to help us provide a quality service. These include Community First

Responders, LIVES responders, Voluntary Care Drivers, St John Ambulance, The Red Cross and our own

staff who respond as Medical First Responders in their own communities. We also utilise EMICS (East

Midlands Immediate Care Scheme) doctors who respond to emergencies. All doctors in EMICS are

volunteers who attend emergency incidents at the request of and in support of staff from the EMAS. These

doctors are all very experienced and fully trained in trauma work and are equipped to perform life-saving

interventions at the scene of an incident such as an industrial or road traffic accident or a rail crash. They

carry with them a wide range of specialist equipment to deal with the serious trauma and other emergencies

that might be encountered in their day to day emergency work. The positive partnership EMAS has with

organisations such as LIVES and EMICS is particularly valuable in supporting timely responses to patient in

more rural areas.

We also work closely with three air ambulance charities: Lincolnshire & Nottinghamshire Air Ambulance,

Derbyshire, Leicestershire & Rutland Air Ambulance and Warwickshire & Northamptonshire Air Ambulance.

What can you expect from us when you call 999?

When you call 999 and ask for an ambulance, you will be immediately connected to one of our highly trained

ambulance control centre teams. They will ask you for your location, the telephone number you are calling

from and details of the main problem. While you are talking to our control team, appropriate help has

already started to be arranged.

If the illness or injury is life-threatening, we instantly pass the information we have been given to the nearest

available ambulance vehicle so that they can get to the location as quickly as possible. In many cases we

will send a fast response car or a community first responder, where they can get to the scene more quickly

than a conventional ambulance and start to provide care immediately.

Whilst help is on the way, our control team will offer advice on how to help the patient and they will usually

remain on the phone until the vehicle arrives.

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On arrival, the patient’s condition is assessed and treatment is given. Where necessary the patient is quickly

transported to a hospital A&E department or, where appropriate, to a centre which specialises in the

treatment of head injuries, heart attacks or stroke.

In non life-threatening cases, a ‘blue light’ emergency response from an

ambulance is not always needed but if we decide to dispatch an

ambulance, crews will often provide treatment at the scene. If we decide

an ambulance response is not needed (based on the information given to

us by the caller) an advisor will call back, carry out a full clinical

assessment of the patient’s condition over the phone and then suggest

the best treatment - such as being cared for at home, being referred to a

GP, pharmacy or community based care service.

On 1 April 2011, the Department of Health introduced new national targets for ambulance

services. The Category A life-threatening call target of responding to 75% of all cases within 8 minutes of the

call being received was unchanged. However, eleven new Clinical Quality Indicators were introduced for

non-life threatening calls. This means we are measured on how we treat patients and the outcomes of the

treatment rather than just on timeliness. By monitoring performance in this way, we are able to identify good

practice and any areas which need improvement. As an organisation keen to develop and improve, EMAS

welcomed this change. Examples of the new quality measures are:

� Outcome from cardiac arrest – survival to discharge rates

� Outcome following stroke

� Proportion of calls dealt with by telephone advice or managed without transport to A&E (where this is

clinically appropriate)

� Unplanned re-contact from the patient within 24 hours of discharge of care (i.e. where patient not

transported but has received telephone advice or treatment at the scene)

The following flow chart identifies how the timeliness of our response to 999 calls is measured:

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Patient Transport Services (PTS)

EMAS provides a non–emergency transport service for eligible patients across the East Midlands. This is for

patients whose medical condition is such that they cannot travel by public or private transport and their

needs are best served by non-emergency ambulance staff. Every year, our PTS staff transport about 1

million patients to hospital, treatment centres and other health related facilities within the area we serve and

to other specialised centres outside of the region.

Earlier this year the service was put out to competitive tender by the commissioners of the East Midlands.

Whilst a quality bid was submitted by EMAS the commissioners chose to award the business to 2 private

operators. The counties of Derbyshire, Northamptonshire and Lincolnshire (excluding North and North East

Lincolnshire) were awarded to NSL and the remaining Leicestershire and Nottinghamshire (including

Bassetlaw) were awarded to Arriva. North and North East Lincolnshire continue to be part of the EMAS

provision having gone through a similar tender exercise 18 months ago.

The new contract is due to commence on 1st July 2012 for the East Midlands. Until then, patients will

continue to be transported by EMAS resources. EMAS are working closely with the commissioners to ensure

a smooth transition for patients. All changes to booking arrangements and contact details will be

communicated to existing patients and the revised eligibility criteria will be stringently applied by the new

operators in an effort to reduce the number of patients accessing the service inappropriately.

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Our Quality Account 2011/12 Part 1

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An introduction to our Quality Account (your definitions of quality)

We have compiled this document to provide readers with information about EMAS’ past, present and future

activities in relation to the important subject of quality.

In 2010, the Department of Health (DoH) mandated that all NHS provider Trusts published a Quality Account

on an annual basis. The purpose of the Quality Account is to demonstrate our commitment to quality and for

others to hold us to account. Quality is broken down into three domains:

� Patient safety

� Clinical effectiveness

� Patient experience

This Quality Account reviews our performance for 2011/12 and sets out our key priorities for 2012/13.

To make our Quality Account useful to all readers, we asked a broad range of organisations and people how

we could make the three domains of quality meaningful to them. The table below summarises the responses

we received and these are updated annually:

What does quality mean to you?

Area We asked Respondents said

Patient

Safety What would make you feel safe?

� good and effective communication between

professionals, between care agencies and

others

� treatment in a clean environment

� being given reassurance, made to feel calm

and less anxious

� an appropriate response being provided

� Appropriate personal protection

� Ability to control wheel chairs safely

Clinical

Effectiveness

What would you expect from us

when we treat your ailment or

condition?

� prompt response times

� prompt and up-to-date care delivered by

knowledgeable, calm, capable staff

� well maintained vehicles, with up-to-date

equipment.

� Treatment is fast and effective

� Personal data is protected

� Resources are used effectively

� Staff are identifiable

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Patient

Experience

How would you like to be treated

by the Ambulance Service?

� with care, compassion and dignity

� polite, friendly and professional staff

� a service that focused on patients. � Staff who are knowledgeable, polite and

understand the needs of a diverse group of

patients.

� Patients are listened to

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Board assurance statement Every member of the EMAS Trust Board has been involved in identifying the quality indicators, agreeing the content and endorsing the content of this Quality Account. We took into consideration the feedback we received on previous quality accounts and in response this year we have developed our quality priorities and indicators with our stakeholders and our staff. Non-Executive Directors continue to play a pivotal role in providing challenge and scrutiny, assessing our performance and contributing to our future strategy. It is important to endorse our achievements in relation to compliance with the Care Quality Commission. We welcomed a visit from the CQC in October 2011 and were assessed against 4 outcomes as follows:

� Outcome 04 - Care and welfare of people who use services � Outcome 07 - Safeguarding people who use services from abuse � Outcome 12 - Requirements relating to workers � Outcome 16 - Assessing and monitoring the quality of service provision

All outcomes were found to be fully compliant with the exception of Outcome 12 because not all staff employed before the regulation requirements were introduced (in 2002) had been subject to a criminal record bureau check.

The organisation’s performance in respect of quality is closely monitored by Board members as an integral part of their overall responsibilities.

Statement of Directors' responsibilities in respect of the quality account

EMAS Directors are required under the Health Act 2009, National Health Service (Quality Accounts)

Regulations 2010 and National Health Service (Quality Account) Amendment Regulation 2011 to prepare

Quality Accounts for each financial year.

The Department of Health has issued guidance on the form and content of annual Quality Accounts (which

incorporate the above legal requirements).

In preparing our Quality Account, Directors are required to take steps to satisfy themselves that:

� the Quality Account presents a balanced picture of the Trust’s performance over the period covered;

� the performance information reported in the Quality Account is reliable and accurate;

� there are proper internal controls over the collection and reporting of the measures of performance

included in the Quality Account, and these controls are subject to review to confirm that they are

working effectively in practice;

� the data underpinning the measures of performance reported in the Quality Account is robust and

reliable, conforms to specified data quality standards and prescribed definitions, is subject to

appropriate scrutiny and review; and the Quality Account has been prepared in accordance with

Department of Health guidance.

EMAS Directors confirm to the best of their knowledge and belief they have complied with the above

requirements in preparing this Quality Account. By order of the Board.

Chief Executive Chairman

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Chief Executive’s quality statement

Welcome to East Midlands Ambulance Service’s (EMAS) third annual Quality Account which provides:

� a summary account of our performance against selected quality metrics (measures) for last year

� details of our quality priorities for the forthcoming year.

This report is for the public, it shows what we are doing well, where we need to make improvements and what our priorities are for the coming year. I am delighted to share with you our annual Quality Account. Quality Accounts are intended to show how NHS services are truly putting quality at the top of their agenda. Their introduction in 2010 marked an important step forward in putting quality on an equal footing with finance. NHS Trust Boards are ultimately responsible for quality of care provided and they must ensure that Quality Accounts:

� demonstrate commitment to continuous, evidence based quality improvement; � set out to patients where improvements are required; � receive challenge and support from local scrutiny; � enable Trusts to be held to account by the public and local stakeholders for delivering quality

improvements. After joining EMAS as Chief Executive in December 2011, I have spent a great deal of time visiting our committed and talented staff across the East Midlands and seeing how our many departments work. I continue to be impressed by the pride, professionalism and friendliness of everyone I meet and their determination to improve the quality of our services and care. In EMAS, our number one priority is to maintain and improve the quality and safety of the service. We strive to deliver the right care, in the right place, at the right time through being clinically-led and patient focused. Working in partnership with our service users ensures that improvements in care are not only evidence-based but are responsive to need, reflecting the issues that patients tell us are important to them. In 2011/12, EMAS has continued to make significant improvements in the quality of services we deliver. A major focus for next year will be the on-going implementation of quality improvement initiatives that enhance patient safety and improve the experience and clinical outcomes for patients. The priorities for the year ahead have been drawn from our staff, service users and the public. To the best of my knowledge, the information contained within this Quality Account is accurate and reflects a balanced view of EMAS’ current position and future ambitions. I hope you enjoy reading this report and share in the pride I have in the services we have been able to provide for our patients in the last year, and will continue to provide in the future. The Quality Account celebrates our hard work and achievements. I would like to congratulate staff for providing outstanding care to patients whilst ensuring the Trust remained financially sound. This would not have been possible without the hard work of everyone who works for and supports the Trust. Thank you.

Chief Executive

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Our Quality Account 2011/12 Part 2

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Priorities for improvement in 2012/13 (where we need to improve)

In association with patients, staff and other stakeholders (see Part 3 – How we developed our Quality

Account) we have identified a broad range of key priorities for 2012/13. These cover what are considered to

be the most relevant factors given the role EMAS performs in providing high quality patient care. These

priorities have been developed in line with the views of our stakeholders. Note that the priorities listed below

are of equal importance:

Priority Quality measure

Patient safety Priority 1: Improvements in response to staff survey key questions and PDR

Clinical effectiveness

Priority 2: Continue to improve the processes for call handling, Clinical

Assessment and the deployment of resources

Priority 3: Existing Clinical performance indicators to be improved and new

indicators to be developed taking into account regional priorities

Patient experience

Priority 4: Continue to engage with stakeholders across local communities to

enable patient experience to influence service improvement and development

Priority 5: Develop a training package linked to a new Domestic Violence Policy

to equip frontline staff with the knowledge to recognise and deal effectively with

victims and perpetrators of Domestic Violence

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Priority 1: Improvements in response to staff survey key questions and PDR

EMAS is committed to ensuring its workforce is competent and confident in practice; and that staff are appropriately supported to do their job effectively. Compliance with Care Quality Commission (CQC) Supporting Staff standards will demonstrate the Trust’s commitment to ensuring high quality safe patient care.

Quality measure Quality indicator measured by

Patient

Safety

Maintaining CQC Supporting

Staff Standards that ensure safe

recruitment processes;

supportive management

behaviour; and employee

assistance programmes.

• Maintaining compliance with CQC

Supporting Staff Standards

• Improved Staff Opinion Survey outcomes

and 45% response rate

Education and Development:

• Attendance on Essential

and Mandatory

Education

• Performance

Development Review

• 100% attendance on Essential Education

• 100% completion of PDRs on a 12 month

rolling basis

Priority 2: Continue to improve the processes for call handling, Clinical Assessment and the

deployment of resources Every patient counts and needs to be treated appropriately according to their individual needs. It is therefore necessary that we remain committed to providing a fast, safe and effective service from the moment the call is connected to the time of treatment, assuring that the patient’s needs are assessed and met in the most appropriate and timely manner.

Quality measure Quality indicator measured by

Patient Safety

Call pick up 95% within 5

seconds to improve overall

speed of response to patients

with life threatening conditions,

by June 2012.

Report of percentage of calls hitting the 5

second call pick up target.

Implementation of NHS

Pathways to ensure continuity of

clinical assessment across all

types of calls, so the patient

receives the most appropriate

response to meet their individual

needs, by October 2012.

An improvement in the number of calls that are

directed towards the right outcome, first time –

with an emphasis on Hear and Treat, See and

Treat and See and Convey, according to

requirement of patient.

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New deployment plan

developed utilising evidence

based Tactical Deployment

Points to improve speed of

response to patients with life

threatening conditions, by

October 2012

Performance in relation to national/local

standards benchmarked against the results

achieved by other UK ambulance services.

Report to compare performance prior to and

following implementation of new Tactical

Deployment Posts.

Priority 3: Existing Clinical performance indicators to be improved and new indicators to be

developed taking into account regional priorities

The National Clinical Performance Indicators (CPI) currently cover the areas of Heart Attack, Stroke, Asthma

and Hypoglycaemia. EMAS has shown continued improvement in these areas and many of these are now

business as usual with consistent performance at high level nationally. Due to the limited number of cases, it

is intended to produce a set of our own indicators on further areas to be measured and performance

managed increasing our scope of clinical effectiveness.

Quality measure Quality indicator measured by

Clinical

Effectiveness

Improvement to reach or

maintenance of standards for

existing CPIs in line with CQC

Quality Risk Profile standards.

Demonstrable improvement

from a Quarter 1 baseline in any

newly developed indicators.

Outcome for patients: consistent

high quality care, and improved

clinical outcomes across these

areas

Existing CPI areas measured against National

benchmarks. New Indicators reviewed by a

measure of improvement using an identical

methodology.

Priority 4: Continue to engage with stakeholders across local communities to enable patient

experience to influence service improvement and development

The Equality Delivery System (EDS) is the national performance framework for the NHS to demonstrate

progress on equalities; identify and improve equality performance and objectives that address inequalities

and deliver positive outcomes for patients. Implementation of the EDS and external engagement will enable

stakeholders to grade our current equality performance and influence the development of equality objectives

to support the Trust’s goal to improve equality performance.

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Quality Measure Quality indicator measured by:

Clinical

Effectiveness

Ensure stakeholder

engagement is representative of

seldom heard groups; and

members from protected

characteristics (identified in the

Equality Act) to ensure

meaningful grading activity is

conducted to measure current

equality performance.

One Annual EDS Grading Event to be held per county during the year.

Through the above stakeholder

engagement and influence,

develop relevant equality

objectives to support

improvements in the Trust’s

equality performance in line with

the priorities identified by

seldom heard groups and

members from protected

characteristics.

EDS objectives developed in conjunction with community groups by 6 April 2012 prior to Board submission

Priority 5: Development of a training package linked to a new Domestic Violence Policy to equip

frontline staff to recognise and deal effectively with victims and perpetrators of Domestic Violence The 2009 Government strategy “Together we can end violence to women and girls” recommended that the NHS improves its response to domestic violence (of all forms) against women and children. The development of a policy and education for all staff will demonstrate EMAS’ commitment to addressing Domestic Violence and Abuse through partnership working with key statutory, voluntary and private sector agencies.

Quality Measure Quality indicator measured by:

Patient

Experience

Implement a Domestic Violence

and Abuse Policy to ensure the

adoption of a safe, consistent

and quality approach.

To increase awareness and

improve staff confidence in

addressing Domestic Violence

and Abuse through a module

within our Essential Education

programme and a

Communications campaign

To ensure that lessons learnt

from Domestic Homicide

Reviews (DHR’s) are embedded

into practice

Domestic Violence and Abuse Policy to be

implemented by 30 April 2012

Disseminate education Trust-wide to EMAS staff.

100% staff will receive the education by 31 March

2013.

We will monitor the number of staff who have

provided individuals with appropriate signposting

material for support services.

We will monitor action plans from DHR’s within the

clinical governance framework

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EMAS captures patients’ experience in a variety of ways. One way is by inviting patients and carers into our

Trust Board meetings to tell their story. We have included 2 examples below – one where we have done well

and one which shows we need to improve:

Patient Story

We heard from an elderly lady who made a 999 call for an emergency ambulance after suffering what she

thought was a stroke. Mrs W had seen the public announcements on the television for what to do in the

event of having a stroke. She knew time was of the essence. However we failed Mrs W because we got it

wrong. We did not send a response in time and Mrs W called back a total of three times. The care she did

receive was excellent and she was transported directly to hospital. The staff were caring, calm and

compassionate.

When Mrs W wrote to complain, her complaint was acknowledged and an investigation was begun.

However, our complaints handling process was flawed. EMAS had failed Mrs W again. By this time, Mrs W

was anxious, distressed and unable to focus on getting better until the complaint had been resolved. Mrs W

was forced to complain again and this time senior management responded. Mrs W was visited in her home

and an apology was given. A full and open account of the investigation was provided and explanations were

detailed and honest. Mrs W was invited to present her story to the Trust Board. The Trust Board listened and

responded.

Mrs W was able to write again to EMAS, this time to say thank-you for the care and attention she had

received. Mrs W was now able to concentrate on recovering from her recent illness.

What we did:

We admit that we sometimes get things wrong, however, we need to acknowledge when this happens,

apologise and ensure we are open and compassionate at all times. Our staff have received additional

training and support. We offer local resolution meetings to ensure our complainants reach a satisfactory

outcome. We have robust monitoring systems in place and our performance is reported (through the quality

dashboard system) to our Trust Board.

Carer Story

We heard from a lady (Mrs H) who cares for her 40 year old sister, who has profound multiple learning

disabilities. Her sister, who lives in residential accommodation, makes frequent visits to family and friends

and has very limited ability to communicate, achieving this mainly via facial expressions and gestures. She

does however have good cognitive understanding and is aware of everything that is going on around her.

Caring for her sister when she is on a home visit means helping her do everything that most of us take for

granted. As a carer, her real concern is the challenges her sister faces:

• Many people talk over her sister, often talking to family members instead. This is very demeaning as

her sister is an adult.

• Dealing with other people’s embarrassment when they come into contact with her sister.

• Managing the pre-conceived ideas, stigma and discrimination about people with learning disabilities.

• Protecting her sister’s interests when she has to be admitted to hospital.

Until recently, Mrs H worked in the NHS as a liaison between patients with learning disabilities and hospital

staff, breaking down the communication barriers to ease anxieties. On Christmas Day 2010, Mrs H’s sister

was at home on a family visit when she suffered a significant and prolonged seizure, later diagnosed as

‘status epilepticus’. An ambulance was called to the house, arriving quickly. What impressed Mrs H was that

the first thing the crew asked for after they had introduced themselves was her sister’s ‘Traffic Light

Assessment’ - a colour coded document designed for people with learning disabilities, which gives essential

information about a patient’s medical history, routine, likes and dislikes etc.

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The crew directed their conversation to Mrs H’s sister debating whether or not to admit her on Christmas Day

when she would rather be at home with her family. The crew had a calming effect on the family and put

everyone at ease. After doing their clinical observations, explaining everything to her sister throughout, the

crew sought Mrs H’s opinion as her Carer with extensive experience of learning disabilities to determine the

best way to move and handle her sister. A testament to the way the crew treated Mrs H’s sister was that she

was not anxious when she finally came out of the seizure. She recovered so well she was able to be left at

home in the care of her family. .Mrs H was asked what it was that was so special about the way the crew

approached the situation that day. We asked ‘If you could reach all 3,000 staff across the Trust, what would

you say it was it about this crew that made the difference?’ Without hesitation she responded, ‘They

listened, they genuinely cared about my sister and our family and they understood about learning

disabilities’.

What we did

We shared this carer’s story with our Organisational Learning team for use in Essential Education because a

‘real-life’ story can convey a very powerful message to staff. Key messages from this story were also

included in our Chief Executive’s bulletin (a weekly bulletin sent to all staff). We will continue to act upon the

recommendations of key reports such as ‘Six Lives’ and ‘Dignity in Care’ to build upon the excellent care our

crews are providing for patients with learning disabilities.

EMAS also learns from complaints and compliments to make sure we are continuously improving our

services. The following gives examples of extracts from both complaint and compliment letters:

Extracts from letters of thanks sent to EMAS

Mrs D, Nottinghamshiree:

I was unfortunate to have a horse riding accident in the woods with no direct access to the scene. I would

just like to praise the ambulance personnel who attended to me. Both young men were very professional

and caring. They put me at ease at a frightening time. I can only imagine how difficult it was to transport me

out of the woods on a spinal board and they never once complained. They are a true credit to your service

and I cannot thank them enough.

Mr C, Northamptonshire

My son fell down his stairs last night and we needed to call an ambulance. The ambulance staff could not

have been more considerate, professional, ultra efficient and helpful in trying circumstances for us. I feel I

must give you this feedback. They are a credit to your ambulance service and their profession generally.

Mrs P, Lincolnshire

We made a 999 call for a student presenting with an asthma attack, within a few minutes a paramedic

arrived. Whilst dealing with the asthmatic, another student become non respondent, unaware of her

surroundings etc and went floppy. The paramedic was absolutely fantastic and if he had not been there I

would not have known what to do, he remained calm and professional at all times. Our thanks to him for his

help from the whole school and governors & parents of the student concerned.

Extracts from could do better letters sent to EMAS

Mrs C, Leicestershire:

My mother was discharged from hospital after being there for 11 weeks. I had continually told the hospital

how difficult it would be to get my mother back into the house - the occupational therapist had been out to

see herself and agreed. When the patient transfer ambulance arrived I went out to them and told them direct

of the problem. They didn’t come to see for themselves but brought my mother to the front door in a

wheelchair, lifted it over the threshold and proceeded to assist her out of the chair. Her legs were not strong

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enough to hold her so she began to slip to the floor. What was to be a simple task of looking after her on her

discharge with only a frame and one carer to come in has turned into needing a hospital bed, a hoist and two

carers four times a day to look after her. Something that wasn’t her fault and was due simply total lack of

assessment and care by the ambulance team that brought her home.

Mrs G, Northamptonshire:

I fully understand that the ambulance service is under pressure at times, but when a call is put through that is

obviously an ‘emergency’ call I feel that it is not too much to expect that at least a correct category be

applied to the information that is being relayed. I am registering this complaint in the sincere hope that this

kind of situation will not arise in future.

Mrs M of Derbyshire

Raised a concern that an ambulance on blue lights pulled out of a junction leading to them having to make

an emergency stop.

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Quality Management Systems (how we will support improvement)

Embedding quality within EMAS is crucial to ensuring high quality, safe, patient care and clinical

effectiveness. The support and commitment of our workforce is paramount to achieving this and to driving

continuous improvement across the services and care we provide. Developing our workforce to ensure staff

are appropriately skilled and supported to develop and improve their practice therefore remains a high

priority for the Trust.

Our priorities for improvement are already identified in Part 2, articulating what we intend to do to support the

continuing development of our workforce during 2012/13 to ensure our staff remain up-to-date and fit to

practice.

This section of our Quality Account provides a brief summary of how we intend to improve quality through

workforce and organisational development plans, systems and processes.

Planning and Developing the Workforce

Education and development

Ambulance services have experienced significant change and increasing diversification over recent years.

This has resulted in us moving away from being organisations which merely transfer patients to hospital into

a service which has direct responsibility for patient assessment, clinical treatment, managing patients at

home, and, when relevant, referring patients through alternative healthcare pathways ensuring patient care

is responsive and appropriate to their needs.

This highlights the changing role of ambulance service practitioners who now need a greater range of

competences, skills and underpinning knowledge whilst maintaining the vocational nature of their training.

The move towards a model of higher education and registration with the Health Professions Council (HPC)

provides consistency with the pre-registration programmes of other allied healthcare professionals and

ensures Paramedics are awarded equal status. This provides the foundations upon which we will continue to

further develop professional practice across EMAS.

We have already implemented systems and processes of workforce and education planning, involving staff

and clinicians within the Trust alongside local health community partnerships and regional workforce

planning and education commissioning systems. This has led to improved data quality and more systematic

education and recruitment planning to resolve workforce demand and supply factors.

In the last quarter of 2010/11, we implemented a new Education Planning Framework designed to ensure

the collation of EMAS’ Training Needs Analysis based on robust information systems including compliance

with national quality standards.

National Public Sector Strike 30 November 2011

We started our continuity planning work early with a cross functional workshop in June 2011to explore issues

and develop different responses in the event of a public sector strike . This workshop proved particularly

useful for designing our approach to communications. We also started early discussions with our Union

Leads and established an open and collaborative way of working with them.

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We had a small team of 3 people (HR, Communications and Continuity Planning) who worked together to

produce an integrated plan . The communications plan focused on personalised ‘neutral’ messages from the

Interim Chief Executive which recognised the strength of feeling that staff have about pensions. In particular,

the communications acknowledged that if staff chose to strike that, for many, this would not be an easy

decision. Letters to home addresses were supplemented with a dedicated site on our Intranet which was

updated regularly with latest Q and A’s. A phone help-line was created should staff have concerns they

wished to raise confidentially. All our communications were shared, in advance, with Union Leads. Our

communications plan, Q&A’s and letters to staff were shared with other Ambulance Trusts and Health

Partners in the East Midlands .These organisations were able to use some of our material, as appropriate for

them, saving them time and resources

We had regular discussion with Union Leads about leave arrangements, when the strike would start and

finish, working with third party providers, picketing etc which enabled early clarification and communication

about matters of payment. Our Operational teams were also able to complete timely, detailed continuity

plans and keep local hospitals and other health providers in touch with developments. Senior Operational

Managers devoted time to plan for the strike and to ensure that all areas had effective continuity plans in

place. There was strong leadership from the Director of Operations.

On the day of action, we had an 82% attendance and achieved a 78.46% performance standard for life-

threatening calls (Red1 and 2 calls requiring an ambulance attend within 8 minutes).. Overall, our

performance was ranked third highest against other UK ambulance services.

Staff support and wellbeing

Occupational Health services The Occupational Health service will provide or source, in each case referred to it, the appropriate levels of support within the terms of its contract with EMAS . Managers providing support to staff involved in traumatic or stressful incidents, complaints and investigations refer cases to Occupational Health through relevant referral channels. Employee Assistance Programme Confidential counselling is offered through our contract with the Employee Assistance Programme Provider, Care First. Care First counsellors are available to provide support for anything a staff member may wish to discuss. The services are available online at www.carefirst.co.uk, and via a Freephone number 24hrs a day 365 days of the year. Staff Support Network Support is available through a team of volunteers from across our Trust all of whom have extensive experience within the Ambulance Service. Volunteers in the Staff Support Network are there to help colleagues working in all sectors of the Trust to come to terms with things they have observed or dealt with over the phone such as traumatic incidents (cot deaths, serious road accidents, murders and serious injuries) and problems staff may have at work (training issues, relationships with colleagues). Specialist Harassment Advisors To assist EMAS in preventing bullying and harassment, Specialist Harassment Advisors have been trained to provide guidance, assistance and advice on the prevention and/or remedy of bullying and harassment. Contact details are available on our staff intranet site and Advisors can be contacted directly by staff members. Trade Union support and support through a named contact This support is of particular importance during the process of disciplinary, grievance, bullying and harassment and other internal investigations and hearings. Staff that are suspended from work during these processes are given a named point of contact who is responsible for keeping in touch with the individual and providing a link with the workplace during their time away. Staff who are trade union members contact their local trade union representative for details of support mechanisms available through their union.

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Access to a mentor/coach In certain circumstances and with agreement from the member of staff, arrangements can be made to link the person with a mentor or coach. A list of internal non-clinical mentors and coaches is available on the staff intranet site. . Clinical Mentors can be accessed through Clinical Education Departments and further advice on this can be sought from that team. . In exceptional circumstances, arrangements can be made for an independent mentor or coach from outside the organisation. Where such support is arranged, it is on a time limited basis with clear terms of reference for the provider. Mediation services There are a limited number of trained mediators available within the organisation. Mediation is appropriate in certain circumstances in particular when attempting to resolve grievances or claims of bullying and harassment. Mediation is only appropriate where all parties agree to this approach. If it is not possible to use an internal trained mediator, then EMAS may consider the use of a mediation service provider such as Advisory, Conciliation and Arbitration Service (ACAS). Advice on the use of mediation is provided by our Human Resources Department. Chaplaincy support Chaplains working for the Trust that are available to offer support to staff. Contact details are available on the staff intranet site and staff can contact chaplains directly for support. Legal support for staff If EMAS deems it appropriate, legal support is provided for support staff attending court as a witness. Further detail on support available for Coroner Court is available in our Coroner’s Policy. Managers should advise staff that they should get legal support if they are being interviewed under caution for any reason. For further information on support for staff attending an employment tribunal, is provided by our Human Resources Department. Informal support through line manager and colleagues It is often the case that talking through a problem with a colleague or with a manager will enable the individual to resolve their issues informally. This is often the most effective way of dealing with problems and can resolve issues early on before they escalate. Support for staff involved in a violent incident EMAS has a dedicated Security Management Specialist who works to protect staff from the threat of violence, reduce the risk of security breaches and to provide support following an incident. More information on support available through this role is available on the staff intranet site. In addition to the above, we have a wide range of policies and procedures to support staff – Sickness Absence Policy, Raising your Concerns policy, Supporting Staff & Management of Stress policy, Bullying and Harassment policy, Work-Llife balance policy and the Special Leave policy

Sickness absence The Trust is committed to the health and wellbeing of our workforce and to increase levels of attendance. A number of actions continue:

• Occupational Health provision supporting early intervention and access to physiotherapy and employee assistance programme

• Publishing consistent data within EMAS to highlight costs of sickness and areas of concern

• Specific targets set for each division and performance managed through the Performance Management Framework

• Monthly focus meetings with the Director of Workforce and Operations with each Assistant Director of Operations to scrutinize the management of sickness including unblocking barriers

• Increasing the due diligence procedures with Resource Management Centre, Human Resources and the Operational Directorate

• Increased case review and sharing of best practice within Human Resources

• Supportive Manager training to include skills for managing attendance

• New Attendance Management Policy

• Toolkits being developed to support managers

• Review of how the ’fit note’ is utilized to enable staff to return to work on alterative duties Absence management is a key focus with all managers and there has been a downward trend.

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Statistical information on sickness absence rates

Quarterly Performance

Q1 Q2 Q3 Q4 KPI Target

Average

6.62% 6.99% 7.35% 6.06% 5.50% 6.82%

Equality Delivery System

The Trust is implementing the NHS Equality Delivery System (EDS) to ensure equality, fairness and

improved access to services and opportunities. The EDS is a national framework designed to improve the

equality performance of the NHS and embed equality into mainstream business. The EDS is a tool for the

NHS to use in partnership with stakeholders, to review equality performance and identify equality objectives.

At the heart of the EDS are a set of 18 outcomes grouped into four goals. These outcomes focus on the

issues of most concern to patients, carers, communities, NHS staff and Boards. It is against these outcomes

that performance is analysed and graded to support development of equality objectives. EDS grading to

determine equality performance is undertaken by stakeholders, including patients and members of our local

communities.

Leadership

We are seeing a move away from a traditional command and control culture to one of localised, empowered

management teams working within the heart of their communities. The need to sustain this cultural shift is

recognised and we have been working hard to understand our current culture so we can develop plans to

ensure change is implemented, embedded and sustained.

Strong leadership is key to defining and driving EMAS’ culture and to

facilitate the on-going empowerment, management, and delivery of our

strategic aims. Differing strategic objectives such as financial

imperatives, service quality objectives or wider social and environmental

issues will require adaptive leadership styles and skills. Strategic

thinking, entrepreneurial leadership, influencing and partnership working

will be key skills in this area and will need to be delivered by

demonstrating a visionary, pacesetting and coaching style. As an

empowering organisation, we need leadership to be prevalent at all

levels, especially amongst those staff who deliver front-line services.

We are also developing our Talent Management Strategy which sets out our aims, objectives, systems and

processes to support an integrated approach to workforce planning, resourcing, education and development,

and succession planning. This will ensure we have the capacity and capability from Board to front-line to

deliver high quality, safe, patient care and services.

Innovation

We believe great ideas come from our staff. These ideas can then be turned into actions and result in

service improvement. The EMAS Staff Suggestion scheme was re-launched in 2010 as a result of staff

feedback gleaned from station visits carried out by our Foundation Trust and Organisational Learning

Teams. The same themes were also evident during a series of staff focus groups which were undertaken to

design a culture survey for all staff to complete which focused upon staff views across areas such as

innovation, quality, and the Trust Values.

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Since its re-launch in July 2010, we have received 1,663 ideas. The top ten key themes have been:

� Educating the public

� Equipment

� Recognition

� Fleet - Vehicles

� Internal communications

� Operations

� Resource Utilisation

� Training

� Staff engagement

� Uniform

� Control/EOC

� Human Resources

Many of the ideas put forward have been turned into action. Here are some examples of our successes: � Introduction of a staff recognition scheme

� Development of a five year Community Engagement Strategy and

five year Membership Strategy with a focus on educating the public

and looking to improve the service in response to the same

� Pilot schemes introduced to assess the functional viability of items of

new medical equipment

� Review of the Staff Engagement Strategy including a review of the

staff recognition scheme

� A continual review of internal communication channels from the

introduction of ‘EMAS Dialogue’ through to a Chief Executive’s

Weekly Bulletin to replace both 'EMAS Dialogue' and EMAS Matters

in response to the needs of the organisation

� Review of ‘light duty’ role for staff who cannot fulfil their normal duties

� Consideration of resource utilisation ideas leading to the introduction of the Resource Management

Centre

The Trust also has several examples of innovation supported by the Strategic Health Authority and Regional

Innovation Fund (RIF):

� Hope Exchange Programme

� Innovation Cell at Leicestershire and Northamptonshire Divisions

� Fallers Programme within Leicestershire and Northamptonshire Divisions

� Future consideration of internal Innovation Fund (linked to Charitable Funds)

� Ttwo RIF projects have been awarded to EMAS to improve hospital turnaround times and demand

management tecnhiques

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Learning

EMAS has an embedded system of sharing learning across the organisation through our established

Divisional and Strategic Learning Review Groups (SLRG). SLRG members review the feedback and take

steps to communicate the learning outcomes across the Trust. In 2011, we were able to identify the

following improvements:

Service Improvements

� Following a number of issues involving requests for ambulances from General Practitioners, we

reviewed our booking service and re-designed our internal processes.

� Following a number of patient stories, we recognised we needed to improve our complaints service.

We did this by re-structuring our team leading to improved response times and customer service.

� We introduced a telephone referral line for front-line crews who had safeguarding concerns to speed

up the referral times.

� A new system of managing patients’ property was introduced in response to claims for lost property.

� The introduction of a safety-netting leaflet for patients not taken to hospital. This gives patients

information about their condition, who to call should they need help and what symptoms to look for

should they deteriorate.

� The introduction of a structured communication tool for clinical information about patients (SBAR).

Staff Survey

In 2011, we conducted our annual NHS Staff Survey questionnaire. Our response rate was 36.6%.

Although we didn’t get our results until spring 2012, we held a Trust wide event in November 2011 to

commence an interactive approach to engagement using results and themes from previous staff survey’s

and the Zeal culture survey. The EMAS Big Conversation was the start of on-going conversations with staff,

which offered them the opportunity to get involved in service development, highlight how they feel, and

identify what matters to them most. This is currently being followed up by Local Conversations in

divisions/areas. The themes we are currently progressing are recognition, how to give staff a greater say in

the workplace, supportive management behaviours, team and interpersonal relations in the workplace and

how we can improve the way we work together as an organisation. We are also developing a Staff

engagement strategy to underpin everything we do.

Our current quality performance (what we did and how we improved)

We have reviewed all the data available to us on the quality of the care we have provided to our patients.

The following information identifies what we did during 2011/12 to monitor and assess our quality

performance outcomes.

The factors listed overleaf demonstrate that we have made good progress in many areas whilst

acknowledging that we can make further improvements in 2012/13.

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What Issue we addressed What we did and how we improved

A Theme emerged from serious untoward events

around the care of patients under the influence of

alcohol with possible spinal injuries.

Specific education on managing patients under

the influence of alcohol has been added to the

essential education programme to support staff

in correctly managing these patients

High numbers of requests for urgent transport to

hospital from Healthcare professionals going out of

time or being delayed due to high volume of 999

calls.

Following a consultation with primary care

clinicians, the 1 hour and 3 hour booking

options were removed. In cases where a patient

was very ill , the 999 system is used. This has

led to fewer calls going out of time and sicker

patients being dealt with more appropriately.

Poor recognition of sepsis and septic shock in the

pre-hospital environment (other than meningitis)

A clinical bulletin was issued to all staff to

improve the recognition of potential sepsis and

a trial is being undertaken using a specific

proforma to improve the recognition and care of

patients with this condition.

Need to ensure that our essential education and

supervision programmes reflected both external

and individual need.

Development and implementation of Clinical

Supervision framework and Essential education

programme including safeguarding and Infection

Prevention and Control, appropriate to the staff

role.

Need to ensure that our staff are developed to give

the highest quality of service across a range of

functions.

A range of learning interventions was provided

to support staff in their personal and

professional development including clinical

updates, post-registration continuous

professional development (CPD) opportunities,

management development, NVQs and

apprenticeship programmes.

Need to ensure visibility of senior managers and

opportunity for staff to raise issues directly with

them

A system of Chief Executive’s weekly bulletins

provide staff with direct information from the

senior leadership team along with a programme

of Directors tours and Patient safety visits

allowing opportunity for staff to raise issues of

importance directly with senior managers.

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Participation in Clinical Research

There is good evidence that health organisations which undertake effective research provide better care for their patients. This is because staff involvement leads to

them being given the opportunity to put into practice (through additional training) the knowledge and skills gained through the process. Research at EMAS involves

strong support from the executive team, managers and, importantly, the many front-line staff who participate in the studies undertaken.

EMAS is involved in a number of research projects some of which were completed in 2011/12. The table below shows the projects, the status and either the intended or actual outcomes of the studies. Funding organisations: The Health Foundation (HF), NIHR Programme Grants for Applied Research (NIHR), Research Design Service for the East Midlands (RDS). NIHR Health Technologies Assessment (HTA), NHS Policy research programme, (NHSPR), Department of Health (DH)

CURRENT STUDIES

PROJECT EMAS LED

OR HOST SITE

TYPE &

STATUS PROJECT SUMMARY

CHIEF INVESTIGATOR &

FUNDING ORGANISATION

Patient reported Outcomes for Vascular Emergencies (PROVE): Interview study of patients and practitioners for developing PROVE (IS-PROVE)

EMAS Led NIHR Portfolio Research

The study’s main objective is to develop an understanding about what aspects of care and outcomes are important to patients accessing the emergency services for stroke and heart attack. The completed study has shown features of pre-hospital care that improve outcomes and experience for patients. These include communication, holistic care, appropriate treatment and smooth transition from home to hospital. The results are being used to inform development of PROMS (Patient Reported Outcome Measures) and PREMS (Patient Reported Experience Measures)for stroke and heart attack.

Niro Siriwardena Funded by: HF

Developing new ways of measuring the impact of ambulance service care

EMAS led Research The programme aims to develop new ways of measuring the impact of care provided by the ambulance service to support quality improvement through monitoring, audit and service evaluation. The programme is currently in progress.

Prof Niro Siriwardena Funded by: NIHR

Pre hospital Pain Scoring and Linked

EMAS Led Research The aim of the study is to gain an understanding about pain assessment and management in the pre-hospital environment which

Funded by: RDS

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management System (PSALMS)

would be used to inform the development of a pain management tool. Phase 1 is complete with suggestions to improve pre-hospital pain management including addressing barriers, modifying the available drugs and developing a pre-hospital pain management protocol supported by training for staff. The second phase is expected to produce a pain management tool ready for validation and testing.

and EMAS

Barriers and facilitators to evidence based assessment of asthma: exploring the perceptions and beliefs of ambulance paramedics to the assessment of asthma

EMAS Led Research The aim of the study was to understand the factors which prevent or enable ambulance assessment guidelines for asthma being followed. The study has now been completed and has identified issues relating to clarity of ambulance guidelines, conflicts between training and guidance, misconceptions about the importance of objective assessment and over- reliance of non-objective assessment. Our findings have informed improved systems of care and training for asthma, and have led to improvements in asthma indicators.

Deborah Shaw Funded by: NIHR, RDS

Closing the Gap: Ambulance Service Quality Improvement Initiative

EMAS Led Quality Improvement

A two year funded study looking at the use of quality improvement initiatives to improve the delivery of the stroke and heart attack care bundle across all English Ambulance Services. Preliminary results show significant improvements in care for heart attack and stroke across ambulance services in England. We have also developed a model to improve pre-hospital care which is transferable to other conditions.

Niro Siriwardena Anne Spaight Funded by:HF

Engaging Ambulance Clinicians in Quality Improvement (QI) Initiatives

EMAS Led NIHR Portfolio Research

The study aims to achieve a measure of Quality Improvement (QI) leadership behaviour, culture and methods used in ambulance services in England. The study also aims to identify potential barriers to achieving and maintaining clinician engagement. Data is currently being collected and analysis will shortly begin.

Niro Siriwardena Funded by: HF

Strategic Reperfusion Early After Myocardial

Host Site Industry Research

The aim of the study is to compare the outcomes of pre-hospital patients presenting with a heart attack who receive either:

Prof Gershlick

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infarction (STREAM) Early (pre-hospital) thrombolysis (clot busting treatment) followed by cardiac catheterisation or; Primary Percutaneous Coronary intervention (immediate balloon and stent treatment to open the blocked artery in the heart). EMAS participation in the study has now finished and EMAS will await the final conclusion.

Funded by: Boehringer Ingelheim

Acute Medicine Interface Geriatrician Outcome Study (AMIGOS)

Host Site NIHR Portfolio research

The study’s overall aim is to conduct a randomised controlled trial based at Queen’s Medical Centre, Nottingham to assess the impact of the interface geriatrician compared to usual care of older people attending the acute medical unit. EMAS’ participation in the study involves gathering data about the ambulance resources used by patients who have consented and been recruited to the study.

Prof John Gladman Funded by: NIHR

Trial of a Medical and Mental Health unit for Older People

Host Site NIHR Portfolio Research

The aim of the study is to evaluate whether a specialist multidisciplinary Medical and Mental Health Unit for older people with confusion admitted to general hospital as an emergency is associated with better outcomes than standard care. EMAS’ participation in the study involves gathering data (with consent) about the ambulance resources used by patients recruited to the study.

Prof John Gladman Funded by: NIHR

Better Mental Health Development Study

Host Site NIHR Research The main objective of the study is to describe and measure the health problems of older people who are admitted as emergencies to general hospital and who additionally have mental health needs. The study also aims to measure the management of patients and their outcomes to facilitate the development and of a specialist in-patient unit for the management of such older patients. EMAS’ participation in the study involves gathering data (with consent) about the ambulance resources used by patients recruited to the study.

Prof John Gladman Funded by: NIHR

Care of older people who fall: evaluation of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community based care (SAFER 2)

Host Site NIHR Research The principle objective of the research is to assess the benefits and costs for patients and the NHS of new protocols allowing paramedics to assess and refer older people who have fallen to community based care. Patients who have suffered a fall are being assessed by paramedics and where appropriate are being referred to a community falls services reducing Emergency Department attendances

Prof Helen Snooks Funded by: HTA

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Evaluating High Quality care for All: Quality and Safety in the NHS (QSN)

Host Site Research (Portfolio Study)

The overall study aim is to identify clinical team processes and how these are linked to patient care. The study also aims to assess how the team working processes impact on decisions made about the quality and safety of patient care. All NHS trusts have been invited to participate in the study. Study in progress.

Professor Michael West Funded by: NHSPR

Rapid Intervention with GTN in Hypertensive Stroke Trial

Host Site Research The aim of the trial is to determine whether it is possible to conduct a trial in stroke patients in the first few hours after onset by using the ambulance service to assess, consent, randomise and administer medication. The trial is complete and has demonstrated the feasibility of pre-hospital invention studies in hyper-acute stroke. This is being used to inform future studies.

Professor Philip Bath Funded by: Nottingham University Hospital Trust

Evaluation of three digit number (3DN)

Host Site Research The learning outcomes of the project are expected to be around: (1) whether the three digit number simplifies the process of

accessing urgent care (2) whether the new service results in increased satisfaction of

service users; (3) the impact of the three digit number on other services; (4) the costs and consequences of the new service (5) The advantages and disadvantages of different models of

provision to identify lessons on the best ways of developing the service and rolling it out.

Janette Turner Funded by: DH

Avoiding Isolation: A study of relationships between NHS Commissioners and Providers

Host Site Student Research

This study will examine the relationship between commissioners and providers in the NHS and what can be done to improve this. This has recently been approved in the Trust and is yet to begin.

Peter Cross Funded by: Self funded

Investigating whether any barriers affect ethnic minority consumers’ (EMCs) take-up of Products or Services designed and delivered in UK

Host Site Student Research

The study aims to identify whether staff face or are aware of any barriers in the provision of services to ethnic minority consumers. The study is also looking at how an inclusive design solution could benefit stakeholders which may lead to time-cost savings. The study is at the analysis stage and an interim report is currently being written.

Shena Parthab Taylor Funded by: Loughborough University and self funded

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Participation in Clinical Audit 2011/12

During 2011/12, EMAS participated in several national clinical audits covered NHS services that we provide. There were no national confidential enquiries which we

were eligible to participate in. Additionally we are completing our own clinical audit programme, as described in the table below.

2011/2012 AUDIT TYPE TIME-SCALE/

STATUS NOTES

MINAP National Quarterly ONGOING

Check of data I MINAP (National Myocardial Infarction Audit Project) data is collected by hospitals to look at how quickly patients suffering with a heart attack receives clot busting drugs. This allows us to evaluate where

dealys occur and has led to improved processes for evaluation and alert of hospitals.

National Clinical Performance Indicators

National Continuous ONGOING

This reviews the care given to patients with STEMI (a group of heart attacks), stroke, hypoglycaemia (low blood sugar) and asthma. As well as reporting on these CPIs nationally every 5 months, data from the Electronic patient report form system has been collected within the Trust and validated local monthly reports have been produced from these allowing better tracking of progress. The results of these audits have been distributed to clinical staff and actions for improvement put into place which has improved care for patients

National Ambulance Quality Outcome

Indicators National

Continuous ONGOING

This is a group of new indicators which services report on nationally where data is collected and analysed for all patients with stroke, cardiac arrest, or STEMI. The outcomes are then reported and fed-back to clinicians and specific improvement work has been put into place to improve patient outcomes in these areas

PRF Compliance Local Quarterly ONGOING

This audit reports on the compliance of Patient Report form (PRF) completion. The results from the audit are fed-back to clinicians so that improvements on the recording of the patient’s assessment and treatment can be made ensuring that when care is passed to either a GP or hospital that they have all the information available to give the right on-going care.

Oxygen Guidelines Local Annual COMPLETE

Audit of the accuracy of oxygen guidelines being followed since they were changed nationally. Where the guideline was not followed, the most common point of failure was that the patient did not require, but had still received, oxygen (40 patients). This suggests that old practices of oxygen administration still persist and has led to discussion with staff to target those not complying to ensure the best care for patients.

Stroke Care Local Annual COMPLETE

This Audit was focussed around the times spent at the various stages of the patients journey when a call was made for a suspected stroke. It identified potentially prolonged on-scene times and this has been communicated to staff with work to try and improve this position.

STEMI Care Local Annual ONGOING

This Audit was focussed around the times spent at the various stages of the patients journey when a call was made for a suspected STEMI (type of Heart attack). It is yet to report

Intubation/use of supraglottic airways in

patients Local

Annual COMPLETE

This audit compared the rate of survival when a supraglottic (a type of airway management device) airway (LMA) was utilised compared to endotracheal intubation (ETT). During the five month period examined, far more intubations were performed using an ETT (88%) than using an LMA (12%). There was little or no

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difference found in survival between the two methods. With the introduction of a new LMA this will be reviewed again.

Evaluation of the Clinical Safety of downgrading

Red 2 calls Local

Quarterly ONGOING

This audit was designed to support the introduction of telephone assessment for some of the red calls (potentially life-threatening) where it was felt they may have been over-prioritised by the computer system utilised in the control room. This demonstrated a 93% safety and areas where safeguards could be put in place to further improve the process which have been implemented.

Following the publication of ‘Innovation, Health and Wealth, Accelerating Adoption and Diffusion in the NHS’ (Department of Health, 2011), EMAS developed an Innovation strategy .This strategy aims to promote the spread and adoption of innovation across the organisation to ensure transformational change and the delivery of quality and productivity improvement. The strategy also focuses on the need to strengthen the contribution of Health Research and Development to promote the Trust as a centre of excellence for health and healthcare-related research and development. EMAS’ Research and Development Strategy supports both regional and ambulance sector innovation. The approach aims to increase the quantity and quality of health and healthcare-related research and development through:

• Enhancements in collaborative working

• Innovative approaches between sectors (particularly health, universities and industry)

• Promoting continual improvement in everything that we do. The research community in EMAS is a key part of the innovation landscape and many joint initiatives are underway as a result of our partnerships.

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Our local improvement priorities (what we pledged to do)

A proportion of EMAS’ income in 2011/12 was conditional on achieving quality improvement and innovation

goals agreed between EMAS and Derbyshire County PCT (our lead commissioners) through the

Commissioning for Quality and Innovation payment framework. Further details of the agreed goals are

available on request (see the end of this document for contact details).

Through use of the Commissioning for Quality and Innovation (CQUIN) framework, the total value of our

CQUIN indicators was £1.9 million. Our CQUIN Goals for 2011/12 are provided in the following table.

Clin

ica

l E

ffective

ness

Stroke Improve the care for stroke patients

Hypoglycaemia (low blood sugar)

Improve clinical performance indicators for patients suffering with low blood sugar (hypoglycaemia)

Myocardial Infarction (heart attack)

Improve the care we give to patients suffering from a heart attack

Asthma Improve the care we give to asthma patients

Diabetes Improve the care given to patients with diabetes

Return of spontaneous circulation following cardiac arrest

Restore circulation after the heart stops

Patient

Experi

ence

Patient Experience Strategy

Improvement in three areas:

• safety-netting of patients not conveyed to hospital

• Explore the expectations of General Practitioners

• Staff attitude

Patient

Safe

ty Safeguarding training

Improve safeguarding procedures through safeguarding training Learning Disability level 1

Patient safety strategy

Improvement in three areas:

• The introduction of a Trigger Tool to improve safety

• The introduction of risk management audits

• The development of a work book which supplements Essential Education

EMAS achieved all 2011/12 CQUIN targets for patient safety and patient experience. In relation to clinical

effectiveness, we have improved on all of our CQUIN targets based on our baseline at the start of the

financial year; we have achieved significant improvement in the care given to asthma patients which was

highlighted by an improvement to over 80% on peak flow recording exceeding the performance target set.

This has been mirrored across the CPIs with care bundles which was a new approach for the ambulance

service. However, it was embraced by front-line clinicians and we have achieved all of these to date, the last

one being STEMI care which again we exceeded. The Clinical Quality leads in our divisions have looked at

innovative ways of raising awareness; these have ranged from developing stickers and posters prompting

care which have been placed in ambulances, to staff being sent letters highlighting good care given and

where appropriate highlighting shortfalls in performance. Whilst improving on all areas, we have fallen short

of our targets in a couple of areas – specifically oxygen saturation monitoring and recording of two pain

35

scores. These areas are subject to a detailed review to understand the reasoning and improve care in future.

We have also linked with our healthcare partners to set up pathways for referrals of patients in attempt to

provide the right care at the right time in the right place. This approach has been well received by front-line

staff. Engagement has remained a priority throughout 2011/12 and will continue as we look to enhance the

care given to patients.

What others said about us: Care Quality Commission (CQC)

On the 19 July, 2011, the Care Quality Commission undertook a responsive review and examined 4

Outcomes:

Outcome 04 - Care and welfare of people who use services

Outcome 07 - Safeguarding people who use services from abuse

Outcome 12 - Requirements relating to workers

Outcome 16 - Assessing and monitoring the quality of service provision

The CQC reviewed all the information they held about EMAS, checked records, looked at records of people

who use services and reviewed information from stakeholders. What people told the CQC

The patient survey results showed very high levels of satisfaction with our accident and emergency and

patient transport services. The vast majority of people said the service met or exceeded their expectations.

People said the staff had explained their treatment, involved them in decisions and assessed their pain. They

felt reassured and safe with the staff and most people said the staff were caring and professional. We found

that the Trust took action when things went wrong and stood down staff so that the matters could be

investigated and the public and staff protected. However, we found that the Trust had work to do to make

sure that recruitment processes were in line with legal requirements and that patients were fully protected.

What we found out about the standards we reviewed and how well Trust was meeting them

Outcome 04: People should get safe and appropriate care that meets their needs and supports their

rights

People receive safe and appropriate care treatment and support which meets their needs.

Outcome 07: People should be protected from abuse and staff should respect their human rights

People are protected from abuse or the risk of abuse because staff know how to identify and respond in

accordance with local procedures.

Outcome 12: People should be cared for by staff who are properly qualified and able to do their job

People are not fully protected because not all staff employed before the regulation requirements in 2002

have been subject to a criminal record bureau check. Some staff files of staff and volunteers employed

before 2005 are not well organised making it more difficult to find information relating to staff members

recruitment history and performance.

Outcome 16: The service should have quality checking systems to manage risks and assure the

health, welfare and safety of people who receive care

The Trust takes steps to try and ensure that people receive safe, quality care and treatment.

Action taken by EMAS

36

A risk assessment was carried out and an action plan developed to ensure staff were CRB checked

according to the level of risk. This included:

� All staff within the same role prior to CRB processes being introduced in 2002.

� Re-checking all staff who were solo responding, where no tracking data was available.

� Re-checking all other staff in patient facing roles (including bank) appointed to role prior to end of

September 2008.

� The Department of Health Self Declaration form was introduced for staff whose CRB checks were

outstanding

� A project commenced in April 2011 to carry out retrospective CRB checks for all staff for whom the

Trust could not evidence a check being carried out (1,671 staff in total) as set out above.

What others said about us: Local Involvement Networks (LINKs)

Leicester, Leicestershire and Rutland Local Involvement Networks Joint Response to East Midlands Ambulance Service’s Quality Account 2011/12 Leicester, Leicestershire and Rutland LINks welcome the opportunity to comment on the East Midlands Ambulance Service’s Quality Account. The LINKs have continued to have a strong working relationship with EMAS and are very grateful for the cooperation and openness from officers at EMAS. This has been very helpful in relation to the work of the Joint LINks EMAS Task Group. The group has been able to develop a better understanding of the pressures that EMAS experience in many areas and the actions that they have put in place to resolve the issues. We also recognise that some of the issues highlighted in our response to the 2010/2011 Quality Account have been positively incorporated in this year’s account. We would like to express our disappointment that EMAS lost the PTS contract to Arriva but recognise that they had done everything in their power to retain the contract. We are sure that they will continue to maintain a quality service until the end of the contract and facilitate a smooth transition to the new provider. We also recognise that EMAS has a new management team in place. This has resulted in a much more open and transparent approach to communicating with the stakeholders, a very positive and welcome development. This is particularly important as the Trust is about to start a major ‘Change Programme’ designed to ensure that they can provide high quality care that is financially sustainable in an effectively managed organisation We agree and commend, in principle, the priorities highlighted in the Quality Account. We note that there have been improvements in certain areas of the Trusts performance, for which they too are commended. These include meeting essential education targets, reducing sickness rates, responding to adverse and serious incidents and improvements in the Clinical Performance Indicators. However we note that EMAS is still not meeting all targets whether they are aspirational targets set by the Trust or those set nationally. We do however note that the Trust recognise these areas of poor performance and have been very proactive in seeking solutions, with their partners, to improve their performance in all areas where problems still exist. These plans are clearly included in the Integrated Board Reports presented at the Public Board meetings and are summarised in the Quality Accounts. In conclusion, The LINks recognise the significant changes that have occurred within EMAS over the last year and their potential impact on the way the service will be structured and delivered in the future. We feel that it is imperative for EMAS to continue to work with all stakeholders, including LINKs, so that we can support the development of the proposals contained in the Quality Account designed to improve the quality of services provided to the people of Leicester, Leicestershire and Rutland. Derbyshire LINk’s comments to East Midlands Ambulance Service NHS Trust Quality Accounts 2011/2012 EMAS has clearly established themselves with the regional LINks, including Derbyshire, and it is through our own relationship with them that we are easily able to feed in the voice of the Derbyshire community in

37

respect of the services provided by EMAS. Through our engagement activities, comments collated regarding EMAS are fed back through their involvement as a Derbyshire LINk Stakeholder. These comments are provided by way of a formal and confidential report, on a bi-monthly basis. Attendance by EMAS at LINk’s quarterly Stakeholder meetings continues to show their willingness to maintain an open communication channel. However, in addition to this, Derbyshire LINk has also exercised their power to formally write to EMAS concerning an individual issue which was identified as having the potential to impact on the wider population of Derbyshire. We are pleased to report that a satisfactory response was received from EMAS within the obligatory response period of 20 working days. It is reassuring to us, as LINk, that each and every user experience of the EMAS service highlighted by Derbyshire LINk will be taken seriously, responded to and acted upon (where necessary). Influencing service providers through collating patient experience is at the core of the LINk remit and it is therefore encouraging to read of EMAS’ commitment to delivering Priority 4: Continue to engage with Stakeholders across local communities to enable patient experience to influence service improvement and development. Derbyshire LINk was pleased to be invited to participate in the regional LINk EMAS/EDS event. This enabled a further opportunity for LINk to represent and provide input from the patient perspective, which further evidences that EMAS is receptive towards gaining intelligence on the issues of most concern to the Derbyshire public. It is interesting to read that one of the ways in which EMAS capture patient experience is by inviting patients and carers to their Trust Board meetings, where participants are encouraged to share their experiences. Although recent media publicity has, at times, been somewhat damning, the content of these Quality Accounts, in Derbyshire LINk’s opinion, demonstrates that EMAS is committed to continually improving patient satisfaction.

Northamptonshire LINks comments on EMAS’ Quality Account LINk is very concerned with the on-going poor performance of category A, 8 minute responses. We recognise however that a large part of this relates to ‘stacking’ at the acute trusts beyond the statutory 15 minute handover target. We further recognise following the NCC Scrutiny Committee review which involved all of the health partners involved in the County, that a substantial investment has been approved in order to address this problem. We now await the final outcome of all the corrective action. The improvement to date is slower than we had expected, influenced we believe to a large degree by the on-going problem of slow patient handover at the acute trusts. In other regards LINk's experience of EMAS has been good and we are able to see a substantial increase in their endeavours to assess public and patient involvement and reactions to their services." We have worked well with the engagement leads at EMAS, organising a successful event at the Northampton Saints where we were able to bring a large and diverse range of individuals and groups from across the ability, age and ethnic spectrum. We have an on-going dialogue with EMAS to input the issues and concerns of the community, which has involved some specific activity around working with the traveller and gypsy community. We look forward to developing with EMAS in the development of a joined up engagement model for Northamptonshire which will involve EMAS, to ensure that all organisations and communities across the County have a common understanding of involvement and engagement and can support each other to enable services to be even better”

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What others said about us: Overview and Scrutiny Committees (OSC)

Health Scrutiny Committee for Lincolnshire Priorities for 2011/12 The Lincolnshire LINk and the Health Scrutiny Committee for Lincolnshire are disappointed that EMAS has failed to meet the response time targets for both Categories A8 and A19 in the county of Lincolnshire. We note that EMAS acknowledges that falling short of national response targets provides the potential for an adverse impact on patients. However, we are surprised that the Quality Account refers to measures introduced during 2011 leading to “improvements in response times to patients with life-threatening conditions”, as Category A19 performance for 2011/12 is recorded at 92.3%, compared to 93.5% in 2010/11, which represents a decline in performance. Our concerns with response time performance have been raised at a national level. We are pleased with the progress reported on Priority 5 (Treating Patients with Dignity, Respect and Compassion) and we would not like to see this progress lost. Priorities for 2012/13 Improving ambulance response times is not stated explicitly as one of EMAS’ priorities for 2012/13. We believe that this is a serious omission by EMAS, as the Operating Framework for the NHS in England 2012-13 states that the Categories A8 and A19 targets should be met or exceeded. This is particularly pertinent given EMAS’ decline in Category A19 performance during 2011/12. We recognise the further development of clinical performance indicators during 2012/13, but would like to see clarification on who sets the “regional priorities” for these indicators. We look forward to benchmarking EMAS with other ambulance trusts on the clinical indicators. Care Quality Commission – Criminal Record Bureau (CRB) Compliance The Care Quality Commission’s compliance report (October 2011) referred to the fact that not all staff employed prior to 2002 had a current CRB disclosure in place. We have been concerned that whilst most of the outstanding CRB disclosures were in place by 31 December 2011, a small number of disclosures remained outstanding several months after that date, which represented a risk to the patients. The Health Scrutiny Committee for Lincolnshire continues to pursue this. The Patient Experience – Complaints and Compliments The inclusion of a selection of complaints and compliments in the Quality Account is welcomed and provides a voice for patients. However, we would like to see some information on the overall number of complaints and compliments received by EMAS, and any general lessons learned from these complaints. Engagement on the Development of Quality Account We would like to see engagement on the development of the content of the Quality Account broadened to include all LINks and health scrutiny committees in the region. Inclusion of More Local Performance Information EMAS serves eleven upper-tier council areas. Whilst we acknowledge that there are constraints on the length of the Quality Account, the absence of local information on areas such as Lincolnshire does not necessarily serve readers well, who might be expecting some local information on performance, complaints and compliments, to provide some local context to a regional service. Conclusion At a time of change in the NHS, we look forward to EMAS delivering its local and national priorities, so that ambulance services not only improve in Lincolnshire, but throughout the region as a whole.

39

Leicestershire Adults, Communities and Health Overview and Scrutiny Committee The Adults, Communities and Health Overview and Scrutiny Committee welcomed the opportunity to comment on the Quality Account for the East Midlands Ambulance NHS Trust (EMAS) at its meeting on 24 April 2012. The Committee would like to thank officers for their helpful and open attitude when attending Overview and Scrutiny Committee meetings. The Committee is not aware of any major issues that have been omitted from the Quality Account. However, the Committee has made comments on a number of areas included in the Quality Account and these are set out below. The Committee welcomes EMAS’ commitment to the training and development of its staff. The clinical development evening sessions, with a focus on a single topic, appear to be particularly valuable for front line staff. The Committee is pleased to note that EMAS participates fully in the national initiative to introduce dignity champions. The Committee suggests that EMAS undertakes further work to manage public expectations. The work with local media outlets around this is welcomed, as is the intention to develop measurable benchmarks for communications. Finally, the Committee is of the view that the report is readable and easy for a lay person to understand. The timelines used are sometimes too short to enable the identification of trends; however they give a flavour of EMAS’ performance. In conclusion, based on the Committee’s knowledge of the provider, the Committee is of the view that the Quality Account provides a fair reflection of the healthcare services provided. Nottinghamshire City and Nottinghamshire County joint Overview and Scrutiny Committee Representatives from five healthcare providers attended the Joint City and County Health Scrutiny Committee’s May 2012 meeting last week to present for comment their organisation’s Quality Account – this followed on from discussions at the Committee’s January 2012 meeting. The Committee appreciates the opportunity to comment on your Quality Account, and its formal response for inclusion in the Quality Account is appended to this letter. However, and in keeping with Department of Health guidance, the Committee would request that all presenting organisations check that their Quality Account so that it avoids overly-technical, unexplained medical language, and provides a range of quotes about the patient experience, where available. At the meeting, the Committee requested that next year’s Quality Account provide information on work with NEMS on social care referrals. The Committee is conscious that presenting and commenting on Quality Accounts is becoming a more cumbersome exercise, as the numbers of organisations required to produce them increases. We will be giving consideration to how we might revise our arrangements for next year, and any comments or observations you have to inform this would be very welcome. Comment for inclusion in Quality Account – East Midlands Ambulance Service NHS Trust

The Joint Health Scrutiny Committee believes that the Quality Account 2011-12 is a fair reflection of the services provided by East Midlands Ambulance Service NHS Trust, based on the knowledge the Committee has of EMAS. The information contained in the Quality Account is well presented and we are pleased to see the use of clear and accessible language and layout. The use of case studies makes the document more accessible to the public, and we commend the inclusion of numerous examples of actions taken in response to service user feedback, both positive and negative. The document clearly demonstrates the involvement of key stakeholders in determining priorities and reflecting what quality means to them. We are pleased to note that EMAS has achieved all 2011/12 Commission for Quality and Innovation

40

(CQUIN) targets for patient safety and patient experience. We welcome the inclusion of a priority on training front-line staff to recognise and deal effectively with victims and perpetrators of Domestic Violence in support of the introduction of the organisation’s Domestic Violence Policy, and look forward to hearing more about the impact of the Policy in the coming year. The Committee recognises that the EMAS service covers both major urban centres of population and more isolated rural communities. We therefore welcome the tailoring of performance indicators more closely to the needs of the communities served by EMAS, and the provision of performance information on a County by County basis, from next year.

The Committee looks forward to continuing to develop its relationship with the Trust over the coming year.

What others said about us: Our Lead Commissioners

Statement from our Lead Commissioner - NHS Derbyshire County (on behalf of associate commissioners):

General Comments The Trust’s Quality Account is well written with clearly defined priorities for 2011/12. Views from a wide range of patients, staff and groups have been used to evaluate the priorities. Data contained within the report reflects the information received through contract monitoring arrangements. Overall the report is well presented, and is written in language that should be accessible to the general public. Measuring & Improving Performance The organisation has worked hard to improve the quality of services, and the various initiatives that have been introduced to improve the quality of services are encouraging. The Trust has had regular clinical quality review meetings with the commissioners where progress against an agreed quality schedule is monitored. In its 2010/2011 Quality Account report, the Service identified five priority quality measures which were matched against the three domains of quality (Patient Safety, Clinical effectiveness and Patient experience). The Trust has made significant progress in Infection Prevention and Control and safeguarding. In 2011, Care Quality Commission undertook a responsive review of the organisation and inspectors raised concerns regarding criminal record bureau checks for staff employed before 2005. The trust has implemented a detailed action plan to address the concerns raised and this was monitored by the commissioners through regular quality meetings. The report reflects the loss of the Patient Transport Service contracts following the competitive tendering process to 2 private operators (NSL & Arriva). The new contract is due to commence on 1 July 2012. Sickness absence continues to be an issue within EMAS. The Trust has developed a revised action plan supported by Directors within Workforce and Operations. Implementation of the action plan and reducing sickness levels will be monitored by the commissioners. EMAS had agreed a number of quality measures with the PCT, some of which attract a quality incentive payment. Over this last year EMAS achieved all CQUIN targets for patient safety and patient experience. The Trust has improved on targets based on baseline at the start of the financial year for clinical effectiveness. These achievements showed improved care for patients, for example an improvement to over 80% on peak flow recordings for asthma patients. However, additional work is required to improve oxygen saturation monitoring and the recording of two pain scores. The report contains ‘patient stories’ which have been heard at the Board. One of the accounts relates to a patient who suffered a stroke and did not initially receive a response. The follow up details the failings in responding the patient but does not outline how the Trust were going to prevent a similar occurrence for stroke patients in the future. Although the report outlines the criteria for the new national targets (introduced 1 April 2011) for ambulance

41

Data Quality

Good quality information underpins the effective delivery of patient care

and is essential if improvements in quality of care are to be made.

EMAS relies upon quality information to undertake its various duties and

responsibilities allowing us to deliver the highest possible level of patient

care. EMAS’ Business Intelligence Unit (BIU) plays a key role in allowing

the Trust to achieve these aims.

Accordingly, the A&E activity performance data provided in this

Quality Account has been provided by the BIU and data relating to ‘other’ activity areas within EMAS has

been validated by experts in each subject area for relevance and accuracy prior to inclusion within this

document.

Based on proper checks and controls we have in place relating to data collation and reporting, the BIU can

confirm data accuracy and surety and also that data compiles with the Department of Health’s KA34

guidelines and our Ambulance Services Annual Return for period 2011/12.

EMAS was not subject to the Payment by Results clinical coding audit during 2011/12 by the Audit

Commission.

Information Governance Toolkit attainment levels

EMAS’ Information Governance Assessment Report overall score for 2011/12 was 88% and was graded

satisfactory. The Information Governance Manager is responsible for maintaining the evidence to support the

information governance toolkit for the Trust. Assurance on the process to collect the evidence is overseen

by the Information Governance Group which is accountable to the Audit Committee.

services, there is no indication to show how the Trust measured up to them. Following on from the previous year it would have been positive to show that that the organisation achieved the A8 target but failed to meet the A19 target. A priority for the coming year is to continue to improve the processes for call handling, Clinical Assessment and the deployment of resources but there is no indication how this is going to be achieved. The Trust has continued to work hard to engage and support its staff. The Quality Account outlines the many staff support and wellbeing initiatives available to the workforce. Engagement with the NHS Staff Survey showed an increase from last year (a score of 3.35, average when compared with trusts of a similar type). However, according to the survey, the number of staff receiving appraisals has fallen since last year and is below the national average for ambulance trusts. In 2012/13 the trust will continue to drive forward their quality improvement initiatives with priority’s linked to the three safety domains. Progress will be monitored through the Quality and Governance Committee, of which the commissioners attend. Further quality measures have been agreed through quality incentive payments on both national (safety thermometer) and regional (Independent review) areas of safety that the Trust has agreed and where it can make a real difference.

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Our Quality Account 2011/2012 Part 3

43

How we developed our Quality Account (what you said) How we developed our Quality Account (what you said) Last year’s Quality Account featured a strong contribution from community groups. This took in the process we followed in compiling the Quality Account and also the content of the finished document. The creation of a summary document - a ‘first’ for an ambulance trust – our use of plain language and the use of an appropriate title (we selected Our pledge to you because it is more accessible than Quality Account 2010/11) were all prompted by our contact with community groups. As a consequence, last year’s edition was well received and we therefore set out to build upon this solid foundation as we created the 2011/12 edition. That foundation included workshops with six of our Local Involvement Networks (LINks) last year. They encouraged us to engage with people other than themselves during 2012 and so we gained the perspectives of carers at two workshops in April 2012. We also gained views from 5 focus groups held for people under the Trust’s Equality Delivery System. We have not overlooked LINks this year, as their contributions last year helped us greatly. We have carried out a questionnaire survey, plus attend one LINks by invitation. This approach allowed EMAS to talk to other groups to gain their perspectives on quality. We have also approached our Health Overview and Scrutiny Committees to gain their views on the content of this Quality Account and the approach that we have taken in compiling it.

Staff Engagement In 2010/11 we invited staff to comment on our Quality Account through a number of mechanisms. We set up a web based dialogue, we invited comments though in-house media and we delivered a presentation through the Essential Education programme with responses obtained via a short survey. EMAS published a summary document and sent this to all staff with their pay slips. We also launched the Quality Account internally through our internal media, a screen saver on all laptops and through local engagement in divisions. This year we have issued an updated survey to staff through the Clinical Quality Managers in Divisions and through Essential Education. The Quality Account survey also featured at the ‘Local Conversations’ events led by the Clinical quality managers.

Feedback from staff

A range of thoughts have been put forward by staff. They have told us they would like to see:

� Shorter handover times at hospital Emergency Departments

� Public education about EMAS and when to call 999

� Increase education/training opportunities

� Greater emphasis on staff welfare

� Improved use of our resources

� A review on the use of some equipment

What we have done as a result of the feedback we have received

We have listened to the views received and as a result we have:

44

� Identified Hospital turnaround as a key priority. We have a designated Director for turnaround and

have been working with hospital Directors and Commissioners to develop plans to work together to

improve times.

� We have included a communications campaign as one of our key priorities. This also includes

promoting our service to other healthcare professionals.

� 2012/13 will be our third consecutive year for delivering a comprehensive essential education

programme. This is included again as a key priority for next year.

� EMAS continues to address the feedback from staff in a variety of ways. For example there is an

equipment working group where issues regarding equipment are discussed.

45

Review of quality performance (how we did last year)

EMAS is required to achieve a range of performance outcomes specific to the nature of the services we

provide to the public. In addition, we are required to achieve many other organisational responsibilities as

laid down by the Department of Health.

The following information provides evidence that EMAS is performing very well in relation to certain quality

measures and that, compared to other ambulance trusts, we are making significant progress in the areas

where further improvement is necessary for EMAS to achieve its aims.

Our priorities in 2011/12 were:

Priority 1:Communication and Joint Working

Aim What we did What we have

achieved Quality Indicators

We committed to

improve communication

between staff and

between organisations.

We introduced a

structured

communication tool

SBAR (Situation,

Background,

Assessment and

Recommendation) to

improve the way we

communicate patient

information within

EMAS and to other

organisations.

SBAR: Checklists produced for staff to ensure a structured handover Forms produced using the SBAR principle to be left with the patients when managed at home.

Priority Quality measure

Patient safety

Priority 1: Communication and Joint Working

Priority 2: Developing our workforce

Clinical effectiveness

Priority 3: Effectiveness of treatment (Clinical Performance Indicators - CPI)

Priority 4: Response to our patients (Accident and Emergency - A&E)

Patient experience Priority 5: Treating patients with dignity, respect, care and compassion

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Sustain Infection

Prevention and Control

(IPC) compliance

against policies,

procedures and

practices.

We have a robust

audit process in place

to monitor cleanliness

of our vehicles and

premises. We also

rigorously assess

compliance with IPC

policy through our

observed practice

audits.

Excellent alignment of

IPC practice with best

practice guidance

(Hygiene Code, DH

2008) to maintain our

compliance with Care

Quality Commission

standards.

Audit results for

vehicles

staff

premises

against a target of

85% compliance

Sustain compliance

against Safeguarding

Vulnerable Adults and

Children policies,

procedures and

practices.

We have a robust audit

process to ensure that

frontline practice

reflects best practice

guidance and meets

statutory requirements.

An increased number

of referrals of ‘at risk’

patients to EMAS’

safeguarding team.

Full compliance with

safeguarding

standards in Care

Quality visit in October

2011. Several areas of

best practice were

identified with EMAS

receiving regional and

national recognition for

its work with

vulnerable adults.

Audit results for policy

and practice

compliance against an

85% target

EMAS Observed Practice: Divisional Percentage Compliance

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0.00%

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Derbyshire Leicestershire &

Rutland

Lincolnshire Northamptonshire Nottinghamshire Air Ambulance HART Training Centres HQs EMAS %

Compliance

47

>= 85%: Compliant with acceptable practices >= 75.1-84.9%: Partially Compliant, requires action

<= 75%: Minimal Compliance, URGENT ACTION / ORGANISATIONAL PRIORITY The Infection Prevention and Control (IPC) audit outcomes show that IPC is well embedded in clinical practice. Consistently high compliance rates for premises, vehicles and observed practice audits show that there is close alignment of IPC policy to practice. This ensures that the risk of acquiring health care associated infections is minimised. The IPC Team maintain a high visibility in the field to provide specialist

EMAS Station Premise: Divisional Percentage Compliance

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r 2

01

2

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Derbyshire Leicestershire &

Rutland

Lincolnshire Northamptonshire Nottinghamshire Air Ambulance HART Training Centres HQs EMAS %

Compliance

EMAS A&E Vehicle Cleanliness: Divisional Percentage Compliance

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q2

Ju

l -

Se

p 2

01

1

Q2

Ju

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Se

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Q2

Ju

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1

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1

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Oct

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20

11

Q3

Oct

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ec

20

11

Q3

Oct

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ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Derbyshire Leicestershire &

Rutland

Lincolnshire Northamptonshire Nottinghamshire Air Ambulance HART Training Centres HQs EMAS %

Compliance

EMAS PTS Vehicle Cleanliness: Divisional Percentage Compliance

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q2

Ju

l -

Se

p 2

01

1

Q2

Ju

l -

Se

p 2

01

1

Q2

Ju

l -

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01

1

Q2

Ju

l -

Se

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01

1

Q2

Ju

l -

Se

p 2

01

1

Q2

Ju

l -

Se

p 2

01

1

Q2

Ju

l -

Se

p 2

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1

Q2

Ju

l -

Se

p 2

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1

Q2

Ju

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Se

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1

Q2

Ju

l -

Se

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1

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Derbyshire Leicestershire &

Rutland

Lincolnshire Northamptonshire Nottinghamshire Air Ambulance HART Training Centres HQs EMAS %

Compliance

48

IPC advice and support. They conduct regular validation audits to provide additional assurance of compliance with required standards for optimum patient care.

>= 85%: Compliant with acceptable practices >= 75.1-84.9%: Partially Compliant, requires action

<= 75%: Minimal Compliance, URGENT ACTION / ORGANISATIONAL PRIORITY Safeguarding audit results provide evidence that staff are able to recognise and respond appropriately to safeguarding concerns. The audits show that staff have an awareness of appropriate communication methods, are able to manage allegations and understand how to deliver care with dignity and respect. The safeguarding team completed validation audits during the year which reiterates Trust compliance with statutory requirements.

Priority 2: Developing our workforce

Aim What we did What we have

achieved Quality Indicators

Increase staff numbers

to ensure a paramedic

on every frontline

vehicle.

Increase our

paramedic workforce

through education and

training and HEI

commissions

At the end of March

2012, our relief rate is

27% and we have

achieved a skill mix of

60:40

Achieve Workforce

Plan targets of 28%

relief element in staff

rotas and a 60:40

(Paramedics to

Ambulance

Technicians or Care

Assistants) skills mix

ratio in all A&E

divisions.

EMAS Safeguarding: Divisional Percentage Compliance

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q1

Ap

r -

Jun

20

11

Q2

Ju

l -

Se

p 2

01

1

Q2

Ju

l -

Se

p 2

01

1

Q2

Ju

l -

Se

p 2

01

1

Q2

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l -

Se

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01

1

Q2

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l -

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01

1

Q2

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l -

Se

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01

1

Q2

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l -

Se

p 2

01

1

Q2

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l -

Se

p 2

01

1

Q2

Ju

l -

Se

p 2

01

1

Q2

Ju

l -

Se

p 2

01

1

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec 2

01

1

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec

20

11

Q3

Oct

- D

ec 2

01

1

Q3

Oct

- D

ec

20

11

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

Q4

Ja

n -

Ma

r 2

01

2

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

Derbyshire Leicestershire &

Rutland

Lincolnshire NorthamptonshireNottinghamshire Air Ambulance HART Training Centres HQs EMAS %

Compliance

49

Implement year 2 of our

Essential Education

programme with its

underpinning theme of

patient safety.

Implemented year 2 of

essential education

which included 3 days

face to face training for

A&E staff and 2 days

for PTS staff.

At the end of March

2012, 92.35% of A&E

staff and 92.51% of

PTS staff have

completed the

programme.

Number of staff

attending Essential

Education programme.

Implement year 2 of our

Clinical

Supervision/Observed

Practice framework to

provide staff with

appropriate support and

development to

maintain their practice.

Implemented year 2 of

clinical supervision

framework

At the end of March

2012, 73.29% of A&E

staff and 45.94% of

PTS staff have had

clinical supervision.

Number of staff

receiving Clinical

Supervision.

The above interventions have ensured that the Trust is resourced in line with the workforce plan and that patients receive care from skilled and competent clinicians. It also ensures that our staff receive ongoing supervision to support their continued development and assure that essential standards of quality of safety are met. In order to strengthen the number of staff who receive clinical supervision in 2012/13, we have further developed the clinical supervision framework to ensure it is more comprehensive, accessible and user-friendly.

Priority 3: Effectiveness of treatment

Aim What we did What we have

achieved Quality Indicators

EMAS will improve our

performance against the

Clinical Performance

Indicators (CPI) are

national indicators

developed to allow

clinical skills and patient

outcomes to be

measured rather than

timeliness of response

alone.

The measures cover:

� STEMI (ST

elevation

myocardial

Improved scrutiny via monthly validated reports from the Electronic Patient Report Form Scrutiny at individual practitioner level and feedback on areas of concern Checklists on vehicles to remind staff of the elements Clinical Bulletins to promote the care bundles Targeted interventions to support staff in

EMAS has delivered

improvement across

all areas of the Clinical

performance Indicators

although seeing little

change in the results

for Return of

Spontaneous

Circulation (ROSC) in

Cardiac arrest.

EMAS uses monthly

performance data from

the electronic patient

report form to monitor

progress, recognising

there will be some

variation month on

Measured from

ambulance patient

records and submitted

to a national database

for comparison with

other UK ambulance

services.

We will benchmark our

performance against

the results achieved by

other UK ambulance

services.

50

infarction)

� Coronary care

(heart attack)

� Stroke

� Diabetes

� Cardiac Arrest and

ROSC (return of

spontaneous

circulation,

following

resuscitation)

Asthma care.

understanding the rationale for the changes Deep dives into areas of concern to get to the root cause Quality indicators: Decreased incidents occurring at the point of handover

month but looking to

improve the average

over time. The latest

results for the care

bundle performance

are shown below (note

scale variation).

Delivery of improvement across the Clinical Performance Indicators has been a very positive story for EMAS

demonstrating the commitment to high quality care. There are a couple of areas of lower performance as

highlighted in the Narrative for the Clinical Quality Indicators, however, specific work is being undertaken to

review and manage these areas of care. The success has been down to application of robust Quality

Improvement methods and the involvement of front-line staff in supporting care delivery.

Cardiac Arrest remains an area of huge variation nationally and due to this was removed from the clinical

performance indicator set in- year (although it remains as part of the ambulance quality indicators). A

National Cardiac Registry is being set up to try and understand the variation but in the meantime, EMAS is

looking at ways to continually review this area to try and improve clinical outcomes.

Care Bundles are a series of indicators for a clinical area e.g. Stroke. For a complete care bundle each of the

individual elements must be present, failure to achieve one is a failed care bundle. On the charts below the

green line is the EMAS average and the blue dots show our monthly performance. Once we get 7 blue dots

above the green line we adjust the green line and call this a step change in performance. The Red lines

show the limits of normal variability around the average as you expect variation month on month around any

average figure.

All Divisions Stroke Care bundle

80

82

84

86

88

90

92

94

96

98

100

Apr

-11

May

-11

Jun-

11

Jul-1

1

Aug

-11

Sep

-11

Oct

-11

Nov

-11

Dec

-11

Jan-

12

Feb

-12

Month

% c

om

plia

nce

F

F

F

51

All Divisions STEMI Care bundle

0

10

20

30

40

50

60

70

80

90

100

Apr

-11

May

-11

Jun-

11

Jul-1

1

Aug

-11

Sep

-11

Oct

-11

Nov

-11

Dec

-11

Jan-

12

Feb

-12

Month

% c

om

plia

nce

F

F

All Divisions Hypoglycaemia Care bundle

80

82

84

86

88

90

92

94

96

98

100

Apr

-11

May

-11

Jun-

11

Jul-1

1

Aug

-11

Sep

-11

Oct

-11

Nov

-11

Dec

-11

Jan-

12

Feb

-12

Month

% c

om

plia

nce

52

Priority 4: Response to our patients

Aim What we did What we have

achieved Quality Indicators

Provide a timely

response to Category A

Red and Category

Green emergency calls.

Implemented new

demand sensitive rotas

across all divisions

Strengthen our

Category A response

times through the

implementation of the

new rotas.

Performance in

relation to

national/local

standards.

All divisions - Return of spontaneous circluation (ROSC) at

hospital all patients

0

5

10

15

20

25

30

35

40

45

50

Apr

-11

May

-11

Jun-

11

Jul-1

1

Aug

-11

Sep

-11

Oct

-11

Nov

-11

Dec

-11

Jan-

12

Feb

-12

Month

% R

OS

C

Special Cause Flag

All Divisions Asthma Care Bundle

0

10

20

30

40

50

60

70

80

90

100A

pr-1

1

May

-11

Jun-

11

Jul-1

1

Aug

-11

Sep

-11

Oct

-11

Nov

-11

Dec

-11

Jan-

12

Feb

-12

Month

% c

om

plia

nce

AE

E

E

53

Introduce a new

telephony solution that

streamlines the call

answering process.

Increased the capacity

within the Clinical

Assessment Team to

enable EMAS to ensure

the patient gets the

most appropriate

response.

A virtual telephony

environment was

implemented in May

2011 which has

strengthened our call

answering standards

and resilience

A third of our Green 3

& 4 incidents are dealt

with through telephone

advice without the

need for a resource to

be sent.

We will benchmark our

performance against

the results achieved by

other UK ambulance

services.

The data shows that the measures EMAS introduced during 2011 have led to improvements in our response

times to patients with life-threatening conditions. The additional investment in our clinical assessment team

has also led to more appropriate management of non life-threatening calls via telephone assessment and

referral to local community services.

EMAS recognises that where we fall short of meeting national response targets there is potential for adverse

impact on patient experience and patient safety. In 2012 EMAS will build on the measures introduced in

2011 to ensure continuous improvement against all national performance targets.

Priority 5: Treating patients with dignity, respect, care and compassion

Aim What we did What we have

achieved Quality Indicators

EMAS will comply with

health inequalities

policies, procedures and

guidance which apply

across the NHS.

Developed our

services for service

users with learning

disabilities and

implemented a Trust

wide ‘Dignity in Care’

campaign

We received a national

Innovation Award for

Emergency Services

as well as recognition

in Department of

Health guidance for

our pioneering work

with patients with

learning disabilities

At the end of March

2012, EMAS had over

400 Dignity champions

from every level. Over

80% of these staff

have direct patient

contact.

Number of Dignity

Champions

54

Number of staff

attending learning

disability level 2

module training (within

Essential Education

programme) during

2011/12.

At the end of March

2012, 92.35% of A&E

staff and 92.51% of

PTS staff have

completed Learning

Disability level 2

training

Safeguarding training

figures

Through the above interventions, EMAS staff have greater understanding of how to care for patients

holistically taking account of their individual needs and family relationships. Our engagement with service

users and carers has enabled us to identify ways to make our service more accessible to all.

Conclusion

This quality account is intended to set out our ambitions for improving and sustaining quality during the

2012/13 performance year, we hope that readers will see that we have kept quality as our main priority and

have taken action to improve where we can. We hope that we have been able to tell you that we know where

we have further improvements to make and where we have not been able to make the progress that we had

planned.

In producing this report, it has involved contributions from a wide range of stakeholders and I would like to

pay tribute to their input, this has helped us to ensure that our ambitions for quality improvement match those

who use, observe and/ or commission our services. Next year we will continue to work with our stakeholders

so that we can ensure that our approach to quality is grounded in their expectations.

Chief Executive

East Midlands Ambulance Service NHS Trust

55

Glossary

A&E

Accident and Emergency – Accident and Emergency (A&E) is a hospital or primary care department that

provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be

life-threatening and require immediate attention. Also referred to as ED, Emergency Department.

AMPDS

Advanced Medical Priority Dispatch System – is a medically-approved, unified system used by EMAS to

dispatch appropriate aid to medical emergencies including systematized caller interrogation and pre-arrival

instructions.

Audit

A continuous process of assessment, evaluation and adjustment.

Board

EMAS Trust Board of Directors made up of Executive and Non-Executive members responsible for all that

EMAS does.

CQC

Care Quality Commission – The Care Quality Commission (CQC) regulates all health and adult social care

services in England, including those provided by the NHS, local authorities, private companies or voluntary

organisation. It also protects the interests of people detained under the Mental Health Act.

CQI

Clinical Quality Indicators - These are a set of eleven indicators introduced to the ambulance service by the

Government from April 1st, 2011 as measures of clinical quality.

CPI

Clinical Performance Indicator – A way to measure quality.

Commissioners

The NHS organisations who effectively purchase services from EMAS, based on the identified health needs

of their local population. Derbyshire County PCT is the ‘lead commissioner’ for EMAS. That is, they (on

behalf of all the PCTs in our area) negotiate what level of income EMAS will receive – and, alongside this,

what quality measures we are expected to achieve as set out in our service level agreement.

CQUIN

Commissioning for Quality and Innovation (CQUIN) – The CQUIN payment framework makes a proportion of

NHS service providers' income conditional on quality and innovation. Its aim is to support the vision set out in

High Quality Care for All of an NHS where quality is the organising principle. The framework was launched in

April 2009 and helps ensure quality is part of the commissioner-provider discussion everywhere.

CAD

Computer Aided Dispatch – Software used for ambulance dispatch.

DIVISION/S

Operational areas with autonomy to make decisions about the provision of local services under the umbrella

of EMAS’ corporate vision, goals and objectives. Our divisions are aligned to the counties we serve (see

below)

56

EMAS

East Midlands Ambulance Service – East Midlands Ambulance Service (EMAS) is part of the NHS and

provides emergency and urgent care and patient transport services for the six counties of Derbyshire,

Leicestershire, Rutland, Lincolnshire (including North and North East Lincolnshire), Northamptonshire and

Nottinghamshire.

EMICS

East Midlands Immediate Care Scheme – Made up of a group of volunteer doctors who assist the

Ambulance Service on emergency call-outs.

ECA

Emergency Care Assistant – Respond to emergency calls as part of an accident and emergency crew or at

times as a first responder, using skills and procedures that they have been trained and directed to do.

ECP

Emergency Care Practitioner – The role of emergency care practitioners (ECPs) utilises the skills of

paramedics and other professionals (such as specialist nurses with additional skills) to support the first

contact needs of patients in unscheduled care. They are employed primarily by ambulance service trusts.

HPC

Health Professions Council – A UK health regulator. It was created by the Health Professions Order 2001 to

protect the public by setting and maintaining standards for the professions it regulates.

IPC

Infection Prevention and Control – Provides specialist infection prevention and control support and advice for

all clinical and support services.

IG

Information Governance – The way by which the NHS handles all organisational information - in particular

the personal and sensitive information of patients and employees. It allows organisations and individuals to

ensure that personal information is dealt with legally, securely, efficiently and effectively, in order to deliver

the best possible care.

JRCALC

Joint Royal Colleges Ambulance Liaison Committee - its role is to provide robust clinical speciality advice to

UK ambulance services and other interested groups

NHS

National Health Service - Established in 1948 to provide free state primary medical services throughout the

United Kingdom.

NICE

National Institute for Health and Clinical Excellence – The health technology assessment body in the UK

providing guidance to clinicians relating to authorised treatments, devices, diagnostics and techniques.

NHS Institute for Innovation and Improvement

Supports the NHS to transform healthcare for patients and the public by rapidly developing and spreading

new ways of working, new technology and world-class leadership.

PALS

Patient Advice and Liaison Service – Offers confidential help, advice, support and information and are

responsible for any compliments and complaints.

57

PPI

Patient and Public Involvement – Aims to support patient, user, carer and public involvement in health care.

PTS

Patient Transport Services - Conveys patients to and from their homes to out-patients’ appointments, clinics,

physiotherapy or non-urgent inter-hospital transfers.

PCT

Primary Care Trust – Part of the NHS responsible for the planning and securing of health services and

improving the health of a local population.

ROSC

Return of Spontaneous Circulation - Following a period when the heart stops, providing life support is aimed

at restoring the body’s circulation.

SBAR

Situation, Background, Assessment, Recommendation - A structured communication tool used to share

clinical information

SHA

Strategic Health Authority – Responsible for developing plans for improving health services in its local area

and increasing the capacity of local health services so they can provide more services.

STEMI

ST Elevation Myocardial Infarction - heart attack.

VCS

Voluntary Car Service – A group of volunteers within our Patient Transport Service who use their own car to

provide a door to door service to medical appointments.

58

Our Quality Account 2011/2012 We welcome your comments about our Quality Account.

Please contact us using the details below:

East Midlands Ambulance Service NHS Trust

Trust Headquarters

1 Horizon Place

Mellors Way

Nottingham Business Park

Nottingham

NG8 6PY

Call 0115 884 5000

Email communications@emas.nhs.uk

Visit www.emas.nhs.uk

communications@emas.nhs.uk

To receive this information in

large print, audio or in another

language, please call us on 0845 299 4112.