Future Focus: Right Care Right Time Right Place

Future Focus: Right Care Right Time Right Place

Who we are... The North West Ambulance Service NHS Trust (NWAS) provides emergency and patient transport services to the North West population, covering the counties of Greater Manchester, Merseyside, Cumbria, Cheshire and Lancashire. The Trust was formed in 2006 as part of a national realignment of county based ambulance services. The Trust responds to over one million 999 calls a year and undertakes 2 million non-emergency patient transport journeys. The largest ambulance service in England, NWAS covers a total area of 5,400 sq m and serves a population of over seven million people. Message from the Deputy Chief Executive The aim of the North West Ambulance Service is to provide a first class urgent and emergency care and patient transport service to the people of the North West. This is by providing the right care, at the right time, in the right place, either via the physical presence of an emergency vehicle or by referral to another health care provider. It would be wrong of any organisation in today s financial and technology driven society to ignore the prospect of change. In such a relatively short space of time, ambulance services have dramatically evolved and as clinical skills advance, we learn more about emergency and trauma treatment and hospitals take on specialist status for various conditions. The scoop and run days, where ambulance crews just picked up a patient and drove as quickly as possible to the nearest hospital have long gone. Treatment now begins before the patient is even moved into an ambulance and paramedic crews can perform procedures and administer drugs that not that long ago, could only happen in hospitals. As clinical practices must change, we must also look now at the logistical way in which we locate our vehicles. With the increase in population and the development and expansion of new towns and communities in the region, we are finding that the traditional setting of ambulance stations is no longer best suited to effectively serve the community. We must also look at the requirements of our patient transport service which also utilise our stations. This document sets out how we plan to modernise our estate and create new state-of-the-art hub stations which will host larger numbers of vehicles and serve wider communities. We will also explain our intention to create new ambulance deployment points in the heart of our communities and work in partnership with our emergency and NHS colleagues with the siting of ambulance bases within shared facilities. NWAS has two main priorities, one being to provide an efficient, timely, clinically safe service for our patients, and the other to ensure our staff have safe and comfortable bases to work from. The review of our estates portfolio takes both of these factors into account and a great deal of exploratory work has, and will continue to be, undertaken to formally establish where demand has changed, what local activity is and what resources are required. What we know for certain is that the way we logistically place our resources must change. Call vb 2. to ask to come DID YOU KNOW? In total, the North West Ambulance Service s annual budget is 253m NWAS has 351 emergency ambulances and 134 rapid response vehicles responding to emergencies 999 emergency calls are dealt with by emergency control centres across the North West, based in Manchester, Liverpool and Preston. Each call centre consists of a call taking suite in which the 999 calls are answered, and a dispatch centre, from which the most appropriate and nearest vehicle to the incident is dispatched. If the reason for the call is not categorised as immediately life-threatening, it may be passed to our Urgent Care Desk. This is manned by Advanced Paramedics who will ask further questions and then decide on the most appropriate response. While each of the control centres will primarily take calls from those people in the surrounding areas, if the nearest control centre is receiving an excessive number of 999 calls, the call will be taken by the first available operator across the region. The ambulances or response cars, however, are always dispatched by the local dispatch centre. The centres have a call pick-up target which is set nationally and aims to answer 95% of all 999 calls within five seconds. NWAS has one of the best pick-up rates in the country. 999 calls The Trust is commissioned to respond to 75% of life-threatening cases in 8 minutes, last year we achieved a response level of 76.7% Depending on the condition of the patient, the response may be an ambulance, a rapid response vehicle (RRV), a doctor, an air ambulance, a nonemergency patient transport service (PTS) ambulance crew, or a community first responder (CFR) who lives within the community and is trained to deal with life threatening situations such as heart attacks. The CFR s role is to provide immediate care while the ambulance is en route. If the patient doesn t require a physical response, we may refer them to their local GP, walk-in centre or ask someone from NHS Direct to call. All information about the patient is entered into a computerised priority dispatch system and the nearest appropriate available resource is sent. It is a common misconception that an ambulance from the nearest ambulance station will be sent in all cases. Our ambulances are generally on the road from the start of their shift and apart from a meal break, the majority of crews rarely go back to the station to await their next job. Most ambulances are sent to an incident while they are on the road or leaving a hospital, so when someone rings 999, the nearest ambulance will be sent regardless of where it is based. NWAS employs 5,130 people, with 84% of those on the public facing frontline 02 North West Ambulance Service North West Ambulance Service 03

Our Stations NWAS currently operates from 109 stations throughout the North West, located in small villages, medium sized towns and large diverse cities. Many of the stations have been in operation since the 1960s and since then, have been enveloped by new developments, new road infrastructure and increased traffic. Some are also in a poor state of repair. Our entire estates portfolio costs approximately 1.8m a year to maintain. Considering that ambulances are on the road for the majority of their shifts, this means that the Trust is paying for utilities, rates, security, groundskeeping and maintenance for properties which for a great proportion of time, are vacant. Add to this, the age of these buildings means that the majority of them are not environmentally sound and do not meet Trust energy efficiency targets. It is time for an over-haul of the estates portfolio. It is time to think beyond the traditional station and look at how we can continue to serve the population while responsibly spending the money they give us as tax payers. Spokes - community deployment points How the Hub Model Would Work A Hub station would act as a base for a large number of vehicles, where they can be cleaned and fully stocked Spokes n 2. the radial projection from the rim of a wheel Deploy vb 2. to redistribute forces within a given area Staff would start their shift on a Hub-based ambulance station and take it to a deployment point where it will serve the surrounding area Barnoldswick Ambulance Station Time for change Hub n 2. the focal point 3. centre of interest or activity or importance A number of ambulance services across the country are looking at a station model which we call a hub. These are purpose built properties which will have the potential to host dedicated teams of staff who will stock, clean and make vehicles ready for their next shift. Currently this is what our skilled clinicians do before they can go to their first patient. The hubs will have modern, comfortable break facilities kitchens and a mess room for when staff return for a meal break and quiet areas if they wish to study. Hygiene and cleanliness is of paramount importance to every NHS trust and hubs will provide shower and changing facilities. Hub stations will include garages and facilities, to accommodate larger numbers of ambulances which can then be despatched at the start of their shift to the second part of our proposal - the spokes. As a pilot, we are currently looking at a possible three hub stations, Prescott in Merseyside a possible colocation with Merseyside Police and Merseyside Fire & Rescue Service, one on the current site of Blackpool station on Waterloo Road and the third in North East Manchester at a site yet to be decided. A further phase will involve a review of the whole North West region and the possible siting of hub stations in other areas. Case Study: Blackpool Ambulance Station Blackpool station is in a prime location, just off one of the main arterial routes to the heart of the resort and promenade, and the outlying areas of Lytham and Fleetwood are easily accessible. It occupies a large area and currently has an ambulance workshop (mechanic s garage) on site. There is plenty of scope for redevelopment on the site which could accommodate vehicles and staff from Fleetwood, Thornton, Lytham and Wesham which could then be served by spoke deployment points. Blackpool Ambulance Station Deployment points could be shared premises with other emergency services, existing ambulance stations or NHS partners Hub stations will cover a wider area The hubs will act as an off duty base for ambulances and a focal point for restocking, general maintenance and cleaning, while the spokes or deployment points, will be strategically placed in communities and where the ambulances will respond from. An ambulance crew will travel to a hub station, collect a prepared vehicle and take it to one of these points where it will serve the local community for the remainder of its shift. These will be sited according to where they are best able to respond to emergencies and can be flexible according to demand or need. Where possible they will be located within other emergency service or NHS sites, providing staff with bathroom and refreshment facilities. They would replace old stations which are no longer fit for purpose, or can be located in existing stations. We have successfully utilised NHS sites as deployment points for some time. We have an ambulance based at Rossendale Health Centre in Lancashire which serves the local area and provides our crews with rest facilities. We are planning to replicate this in Wardle in Greater Manchester, within the grounds of the refurbished hospital. The decisions on where to locate spoke deployment points and hubs, will be made on a case by case basis with major input from our leading clinicians, our staff and our trade unions, in order to ensure that the resources provided are suitable for the demand and activity in each area. Areas will not lose ambulance or emergency service provision and everyone who calls 999 and needs an emergency ambulance response will still get one. 04 North West Ambulance Service North West Ambulance Service 05

Our blue light colleagues Colleague n 2. fellow worker or member of a profession In many incidents and behind the scenes in support services, you will find us working closely with Police and Fire Services we even have the same phone number for emergencies! Like ourselves, many police forces and fire services are reviewing their estates portfolio and looking at whether their properties are well located and still fit for purpose. Where opportunities arise, all three organisations are looking at ways in which we can help each other and whether sharing premises is a viable option. There are a number of NWAS stations which are shared with our blue light colleagues already, for example, Altrincham station in south Manchester has been shared by both the fire and ambulance service since the 1960s. More recently, NWAS has moved into Merseyside Fire and Rescue Service s newly built community fire stations in Formby and Newton-le-Willows. NWAS has also recently signed an agreement to share premises with Greater Manchester Police and Lancashire Police. The Trust will dispose of Stretford ambulance station which is poorly sited within the grounds of a hotel, and relocate staff to the Police station 750 yards away. In Barnoldswick, Lancashire, ambulance crews will share premises with police in the newly extended police station. The Trust believes that co-locating is a positive step forward in collaborative working and benefits our staff, who can forge improved working relationships and enjoy a modern and comfortable base. Like ourselves, Police and Fire services also locate their stations where they know they can easily access all areas of the community so by colocating with them, we know we are well placed to respond to patients. Is this about money? To a certain extent yes. The appropriate and efficient use of our budget is an important factor of the review, however it is not the only one. NWAS is funded by the British tax payer and every penny we spend is accountable. We are a responsible public sector organisation and like everyone else in today s financial climate we have to use our money wisely. We exist to serve the North West population in the best way we can with the funds that we have. What our estates review has shown us is that we are not spending as wisely as we could be. We are spending money repairing buildings that are no longer suitable for their original purpose. We are spending money keeping empty buildings warm and secure. The majority of the stations we own are not environmentally sound and so our utility bills are high. This is not right and is certainly not financially viable. We would rather spend the money on more ambulances, more clinical staff, properties which are kind to the environment and provide our hardworking staff with comfortable break, rest and training areas. We fully intend to reinvest any funds made from station sales back into the frontline which ultimately benefits the tax payer our patients. When will this happen? Happen vb 1. To come about or take place We are already making great progress with the review and have made great strides in our collaboration with our emergency service and NHS colleagues. The Trust has such a large and diverse estate portfolio, that the review will be ongoing for the next five years. With regard to the hub stations, we envisage that decisions will have been made and work will commence within the next 12 months. The new models we are proposing still require a great deal of planning and consideration and in some cases, we are still in the process of searching for appropriate sites or premises. However, as you will have seen in this document, some co-location options have already taken place. Altrincham Ambulance Station 06 North West Ambulance Service North West Ambulance Service 07

We like to talk Talk vb 1. To express one s thoughts, feelings or desires by means of words The initiatives we have described in this document are not going to happen overnight. This is a long term plan and will be done in stages throughout the region. There is a great deal of preparatory work yet to be done and at the forefront of this work is patient care. Whatever decisions we make in terms of ambulance bases and locations, will be made in the best interest of the communities we serve and to ensure that everyone who needs an ambulance response will get one within the most appropriate time frame. Your views are important to us and we understand that as key representatives of the community, we have a duty to keep you informed of developments within your community. We welcome your feedback and are always happy to discuss individual projects with you. NWAS prides itself on being an open and honest organisation and we recognise that the subject of local stations is of real importance to you. As we examine each station, we have written, and will continue to do so, to stakeholders with a vested interest in that area to inform them of our plans. If you would like to talk to one of our project team regarding what you have read in this document or in response to a correspondence you have received now or in the future concerning your local resource, please do not hesitate to contact us either by post to our head office address or via communications@nwas.nhs.uk Trust Headquarters Ladybridge Hall, Chorley New Road, Bolton, BL1 5DD Tel 0845 112 0 999 (local rate) Minicom 0151 260 8628 Email communications@nwas.nhs.uk Website: www.nwas.nhs.uk