OUR-FUTURE,-OUR-HEALTH,-OUR-SAY by sdaferv

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									               South Western Ambulance Service NHS Trust

                           Trust Board Meeting
                               September 2008


Title:                 Feedback to NHS South West on the Draft Strategic
                       Framework for Improving Health in the South West
                       2008/09 to 2010/11


Purpose:               Achieve key steps to fulfil the requirements of Lord
                       Darzi’s Interim Report, Our NHS Our Future, published in
                       October 2007.


Content/Summary:       Paper outlines general principles, the needs of the public,
                       patients and staff, target areas for improving care and
                       begins to consider how the South Western Ambulance
                       Service NHS Trust may contribute to these goals.


Recommendation:        Information Strategic


Prepared By:           Dave Beet, Acting Service Development Manager


Presented By:          Norma Lane, Director of Urgent Care and Clinical
                       Services


This report covers:


Assurance              AF/06/08         Standards for Better Health      C18
Framework              AF/15/08         (specify)                       C22a&c
*(specify)             AF/18/08                                           C5
                       AF/20/08


Corporate              Corporate        Auditors’ Local Evaluation
Objective(s)          Objective: 6      (ALE) – specify by Key Line
                      Equality and      of Enquiry (KLOE)
                       Diversity




                                     Page 1 of 24
Statutory/Legal                          Information/Other
(specify)


*If Assurance Framework, please give details:


AF/06/08 To embed Equality and Diversity in the Trust so that the patient
experience and employee satisfaction improves.
AF/15/08 Sustain compliance with Core Standard Clinical and Cost Effectiveness
Domain of S4BH.
AF/18/08 Sustain compliance with Core Standard Accessible and Responsive
Care Domain of S4BH.
AF/20/08 Sustain compliance with Core Standard Public Health Domain of S4BH.


The Company Secretary will be responsible for updating the Assurance
Framework following each Board meeting.

Please consider the impact of the paper presented and complete the
sections below as applicable:

Impact:

Number of WTE
provide number affected or state ‘All’                       All

£ cost
State cost or ‘No Value’                                     No Value

Geographical Coverage
State area affected or ‘Whole Trust’                         Whole Trust

Activity
State any impact on operational activity                     None




Board Paper September 2008         Page 2 of 24
                             FEEDBACK TO NHS SOUTH WEST


INTRODUCTION
This paper is based on the Draft Strategic Framework for Improving Health in the South West
2008-2011, published by NHS South West on 15 May 2008. Specifically, this paper outlines
general principles, the needs of the public, patients & staff, target areas for improving care and
begins to consider how the South Western Ambulance Service NHS Trust may contribute to these
goals.


GENERAL PRINCIPLES
Lord Darzi‟s Interim Report, Our NHS Our Future, was published in October 2007 and outlined the
requirement for all care to be:
     FAIR – equally available to all, taking full account of personal circumstances and diversity.
     PERSONALISED – tailored to the needs and wants of the individual (Especially those who
         are vulnerable and have the greatest need) providing access to services at a time and
         place of their choice.
     EFFECTIVE – focusing on delivering outcomes for patients which are amongst the best in
         the world.
     SAFE – giving patients and the public confidence in the care they receive.




Board Paper September 2008                Page 3 of 24
In order to achieve this there are key steps which we need to take:
    o Move beyond just expanding the capacity of the NHS and focus relentlessly on improving
        the quality of care patients receive.
    o Be ambitious, responding to the aspirations of patients and the public for a more
        personalised service by challenging and empowering NHS staff and others locally.
    o Change the way we lead change. Effective change needs to be animated by the needs
        and preferences of patients, empowered to make their decisions count within the NHS;
        with the response to patient needs and choices being led by clinicians, taking account of
        the best available evidence.
    o Support local change from the centre rather than instructing it, providing that the right
        reformed systems and incentives are in place.
    o Make best use of resources to provide the most effective care efficiently.


WHAT THE PUBLIC WANT
In order to produce a framework for the future, NHS South West consulted widely with the public
and our patients. What matters most to the public is:
     Access – Getting prompt GP appointments and reduced waiting times for hospital
        treatment.
     Quality – Getting the most effective treatment and drugs.
     Safety – Providing cleaner facilities and safer systems.
     Health – More focus on prevention of disease.
     Fairness & Equality.
     Services within local communities.
     Making it easier to get involved locally.
     Seeing value for money.
     Being able to say „my choice would be the NHS‟.


WHAT STAFF WANT
     To deliver excellent services to patients, users and carers.
     Treating people as participants in care.
     Having time and skills to listen.



Board Paper September 2008                Page 4 of 24
     Working together across organisational boundaries.
     Being trusted and enabled to provide services.


CHALLENGES IN THE SOUTH WEST
Our area is one of the healthiest in the UK; however, there are specific challenges which we must
face:
    o Lowest population density in England – difficulty in reaching rural settings.
    o Highest proportion of people aged over 65 years (21% in 2002 but expected to rise to 45%
        by 2021).
    o Above the national average for binge drinking, drug misuse, smoking in people under 25
        years, teenage pregnancy and skin cancer.
    o Increasing levels of obesity amongst children.
    o Large variation in life expectancy, in some areas this is as much as 10 years for men and 7
        years for women.


STRATEGY IN THE SOUTH WEST
The Strategic Health Authority has reviewed national strategy and responded by publishing the
Draft Strategic Framework for Improving Health in the South West. This document sets targets for
improvement in the key areas laid out in national strategy:
    1. Staying Healthy.
    2. Maternity & Newborn Care.
    3. Children & Young People.
    4. Long Term Conditions.
    5. Mental Health.
    6. Learning Disability.
    7. Planned Care.
    8. Emergency Care.
    9. End of Life Care.




Board Paper September 2008                Page 5 of 24
WORKFORCE
In order to develop the NHS of the future and achieve the aims and targets above we need to
ensure:
    o Staff with the necessary skills, support and training.
    o Effective leadership to maintain our low staff turnover.
    o Development of a workforce which positively promotes good health.
    o Greater integration of health and social care services.
    o Reputation of the NHS as a good employer by improving staff opportunities, engagement,
          health and wellbeing.


OUR OPINION

The Draft Strategic Framework for Improving Health in the South West 2008-2011 sets out an
ambitious vision and one which all members of the NHS community in the South West would
expect for its residents and transient population. The vision can and will be achieved with
collaboration and partnership working and we welcome the challenge.


Our specific opinion relating to ambulance services is as follows:

„Consideration will be given to establishing a single point of call for urgent care so that patients are
channeled to the appropriate service in the first place – general practice, Minor Injuries Unit, walk-
in centre, NHS Direct, ambulance or hospital depending on the nature of the problem, time of day
and local geography.‟


     This is welcomed and we suggest that our Clinical Hubs are ideally placed to
          accommodate the Single Point of Access and also the Capacity Management System
          which would draw together services in the health and social care economy. It would also
          provide a gap analysis for the commissioning of future services. South Western
          Ambulance Service is piloting nationally the passing of patient data electronically across
          the two organizations in management of low priority cat C calls.
     The East Division Clinical hub currently acts as a single point of contact for 999, Urgent
          Care / GP OOHs and Emergency Dental calls.



Board Paper September 2008                 Page 6 of 24
     Ambulance Services are also best place to identify frequent users of the urgent
        /emergency care services and trigger a more appropriate and collaborative management
        plan to be set into place for vulnerable patients.


„Better services will continue to be developed locally in general practices, primary care centres,
minor injury units and through ambulance staff so that people can be treated nearer to home.‟


     We agree with this approach and intend to work with our PCTs and service providers in
        order to maximise the services which may be provided. We are also keen to develop our
        own staff in order to ensure that they play an active role within the community.


„Major focus will be on implementing rapidly the requirements for stroke services, not only in
hospitals but also in ambulance services and in primary and community services.‟


     This is a key area for us and we support it. But we also highlight the need for the impact
        on ambulance transport to be both carefully considered and progressed.


„Primary Care Trusts will work with hospital and ambulance service NHS Trusts, cardiac networks
and patients, the public and other stakeholders to agree how primary angioplasty services will be
made available in the South West. Because of the rural nature of much of the South West it is
important that hospital and ambulance services work together to ensure that residents across the
region can access safe and effective primary angioplasty for heart attack or thrombolysis for stroke
at all times within recommended timescales.‟


     Again this is a key area for us and we support it. But we also highlight the need for the
        impact on ambulance transport to be both carefully considered and progressed.


„Delivery of care outside hospital which will be enabled by new communication systems including
telecare, assistive technology and telemedicine, allowing mobile technologies to assist in delivering
care in the homes of patients, at the road-side or even en route to hospital in an ambulance; The
development of more convenient care closer to home, including telephone advice, local pharmacy,


Board Paper September 2008                Page 7 of 24
mental health and social services, treatment on the spot by ambulance paramedics, local minor
injury units and rapid access to diagnostic tests and senior medical opinions without the need for
hospital admission.‟


     Connecting for health and SPR will be key components for delivering the above.


„On-the-spot treatment for patients to reduce the 30% of ambulance journeys that do not need an
ambulance.‟


     This will require increased education and training particularly around skills in non medical
        prescribing and direct referral pathways for patients with complex pathology and long term
        conditions. Ideally it will be backed by the Capacity Management System in order to
        maximise our resources.


„Clinical triage by the South West Ambulance Services NHS Trust to speedily route patients to
appropriate care and advice.‟


     This is in line with our current operations and future plans.


„Rapid response services to Category C calls to the ambulance service in North Somerset that has
helped to maintain good ambulance response times. Category C calls are those that do not require
an immediate response and may be suitable for alternative pathways of care.‟


     Again the Capacity management System would provide a cogent approach across the
        whole NHS South West Area.


„During the years 2001 to 2006 calls for emergency ambulances have increased by 6.8%, while
emergency incidents have increased by 7.4%. In each case these increases are well above the
national position (6% and 2.9% respectively).‟


     This is recognised by SHA and must also be factored in to our future commissioning.


Board Paper September 2008               Page 8 of 24
„Many ambulance calls and ambulance journeys are unnecessary and in the best examples local
services have been developed so that people can be treated locally without the need to go to
hospital.‟


     We will continue to work with partners in order to provide a cogent approach.


„If a specialist service is not available in the local hospital, ambulance paramedics have the
authority to take the patient direct to a more distant service providing specialised treatment.‟


     This will increase the need for clinical education (perhaps the advent of the Critical Care
         Practitioner). It will also have resource implications which will need to be considered.


OUR QUERIES


     One of the visions in Acute Care is that all PCTs will achieve upper quartile emergency
         ambulance response times by 31 March 2010. We would be grateful for clarification
         regarding this. Does it mean that targets will be delivered on a PCT rather than a Trust
         basis? We would need a more detailed evaluation of what this would mean regarding
         service delivery costs and the degree of commissioner support.
     A reduction of A&E Targets from 4 hours to 2 hours is broadly welcomed; however, we are
         mindful that the current target is challenging and would be concerned that the new target
         may have a negative impact on ambulance services. Our view is that handover delays
         would need to be rectified before any reduction in the target times could be implemented.
         In view of this we fully support the vision that handover delays will not exceed 15 minutes.
         The successful implementation of this target would improve utilization of the Ambulance
         Services resources in the community and reduce the clinical risk to patients needing
         immediate care.




Board Paper September 2008                 Page 9 of 24
      HOW SWAST MAY CONTRIBUTE TO DRIVE CHANGE


      The table below lists the nine high level clinical areas and the associated vision set out by NHS
      South West for achieving improvements in those high level clinical areas. I have then suggested
      what our role might be and begun to identify the impact on our organisation. In addition, we are
      currently in the first phase of our application to become a Foundation Trust. In view of this we have
      formed Task Groups to review each area of our business and to develop our future strategy. The
      work of these Groups to date is also reflected in the table below along with the results of our
      Service Development Day in July:


CLINICAL AREA     VISION               OUR POTENTIAL ROLE                              IMPACT

STAYING           Reduce smoking            Smoke Stop Promotion by                   Plan for ECP/Nurse
HEALTHY           levels in the              ECPs/Nurses in Walk-in Centres,           deployment.
                  South West to              Health Centres, MIUs and GP
                  equal the best in          Surgeries.
                  Europe by 2013.
                                            Smoke Stop promotion by
                                             ambulance crews.                          Development of Promotion
                                                                                       Literature.
                                           Health Bus
                                       Market research.
                                       Advertising.                                    Purchase of Bus.
                                       Schedules.                                      Developing partnerships
                                                                                       with PCTs, Councils, bus
                                            Community Paramedics/ECP                  company, private sector
                                              (RRV).                                   and voluntary sector.
                  Reduce the           As above.                                       As above.
                  prevalence of
                  smoking in           Specific targeting/market research.
                  manual workers
                  to that of non-
                  manual workers
                  by 2013.
                  Halt the rise in          Information on safe levels.               Plan for ECP/Nurse
                  hospital                                                             deployment.
                  admissions for            ECPs/Nurses to promote in Walk-
                  alcohol related            in-Centres, Health Centres, MIUs
                  harm and                   and GP Surgeries.                         Development of Promotion
                  achieve a                                                            Literature.
                  downward trend            Promote voluntary services to


      Board Paper September 2008                Page 10 of 24
          by 2013.                   those with alcohol dependency.

                                  Vulnerable Adult/Children reporting
                                   to Social Services.

                                 Health Bus.                            Currently undertaken.
                             Market research.
                             Advertising.
                             Schedules.                                  Purchase of Bus.
                                                                         Developing partnerships
                                  Community Paramedics/ECP              with PCTs, Councils, bus
                                   (RRV).                                company, private sector
                                                                         and voluntary sector.

                                                                         Capacity management
                                                                         System.
          Achieve a               Information on safe sex.              Plan for ECP deployment.
          minimum                                                        Promotion Literature.
          reduction of 50%        ECPs/Nurses to promote in Walk-
          in under 18              in-Centres, Health Centres, MIUs
          conception rates         and GP Surgeries.
          for each PCT
          area.                   Vulnerable Adult/Children reporting
                                   to Social Services.                   Currently undertaken.

                                 Health Bus.
                             Market research.
                             Advertising.                                Purchase of Bus.
                             Schedules.                                  Developing partnerships
                                 Community Paramedics/ECP               with PCTs, Councils, bus
                                     (RRV).                              company, private sector
                                                                         and voluntary sector.
          Reduce the year    As above                                    As above
          on year rise of    Provide testing kits for Chlamydia
          sexually           screening for patients given treatment in
          transmitted        Urgent Care
          infections.
          Achieve uptake          ECPs/Nurses to promote in Walk-       Development of Promotion
          rates for breast         in-Centres, Health Centres, MIUs      Literature.
          and cervical             and GP Surgeries.
          screening of at         Health Bus.
          least 80% in all
          areas.




Board Paper September 2008           Page 11 of 24
Note: vision          Promotion of         ECPs/Nurses to promote in Walk-      Development of Promotion
outlined in blue is   healthy eating        in-Centres, Health Centres, MIUs     Literature.
additional to the     and regular           and GP Surgeries.
SHA Vision but        exercise.            Health Bus.
may complement                             Community Paramedics/ECP
our future work.                            (RRV).
                      Promotion of         ECPs/Nurses to promote in Walk-      Commissioning for all of
                      health for            in-Centres, Health Centres, MIUs     the above.
                      minority groups       and GP Surgeries.
                      and those who do     Health Bus.                          Development of Promotion
                      not normally         Community Paramedics/ECP             Literature.
                      access Primary        (RRV).
                      Care                                                       Form a Health Promotion
                                                                                 Team to plan and deliver
                                                                                 all of the above.

Maternity &           Choice about         Provision of transport when          Consider in
Newborn Care          where to give         appropriate.                         commissioning.
                      birth.
                                           Provision of information (health bus
                                            & ECPs/Nurses in Walk-in-            Development of Promotion
                                            Centres)                             literature.

                                           Educate mothers in the appropriate   Single Access Point and
                                            use of the ambulance service when    Capacity Management
                                            requiring transportation to          System.
                                            maternity units for normal
                                            deliveries
                      Increase the         Appropriate skills for staff.        Consider in
                      number of babies     Development of obstetric policies    commissioning.
                      born at home          and provision of further training
                      from 4% to 10%        and development for the workforce    Education & Training.
                      by 31 March
                      2011.
                      Reaching and         ECPs/Nurses to promote in Walk-      Development of Promotion
                      supporting            in-Centres, Health Centres, MIUs     Literature.
                      mothers who do        and GP Surgeries.
                      not contact their    Health Bus.                          Form a Public Health
                      community            Community Paramedics/ECP             Team to plan and deliver.
                      services.             (RRV).




                      Maternity            ECPs/Nurses to collaborate with      Work programme for each
                      services should       their local teams.                   ECP team.


         Board Paper September 2008          Page 12 of 24
                work in close
                collaboration with
                other services –
                ambulances,
                A&E, ITU, HDU
                and social
                services

CHILDREN &      Reverse the           ECPs/Nurses to promote in Walk-     Development of Promotion
YOUNG PEOPLE    trend of               in-Centres, Health Centres, MIUs    Literature.
                childhood obesity      and GP Surgeries.
                and achieve a                                              Form a Public Health
                downward trend        Health Bus – target schools.        Team to plan and deliver.
                by 2013.
                Achieve a             ECPs/Nurses to promote in Walk-     Development of Promotion
                minimum of 90%         in-Centres, Health Centres, MIUs    Literature.
                immunisation for       and GP Surgeries.
                MMR in all PCT                                             Form a Public Health
                areas with a          Health Bus.                         Team to plan and deliver.
                regional average
                of 95%.
                Make available a      Engage with PCTs and local          Work programme for local
                range of               teams.                              managers and our Urgent
                community based                                            Care Service.
                child and
                adolescent            Coordinate services.                Single Access Point &
                mental health                                              Capacity Management
                services in every                                          System
                PCT area by
                2011.                                                      Develop Clinical Hubs and
                                                                           Triage Systems.
                Reduce                Coordinate services.                Single Access Point &
                admissions to                                              Capacity Management
                inpatient mental                                           System.
                health services       Appropriate referral by ambulance
                by 20% by 31           staff.                              Staff education & training.
                March 2011.
                                                                           Develop Clinical Hubs and
                                                                           Triage Systems.




                Ensure that same      Coordinate services.                Single Access Point &


      Board Paper September 2008        Page 13 of 24
          day urgent                                                    Capacity Management
          assessments for                                               System.
          acute care are           Appropriate referral by ambulance
          available to all          staff.                              Staff education & training.
          children to halt
          the rise in              Community Paramedics/ECP
          emergency                 (RRV).
          hospital
          admissions by 31
          March 2010.
          By 31 March              Coordinate services.                Single Access Point &
          2010 ensure that                                              Capacity Management
          every child                                                   System.
          needing long
          term support will
          have an identified
          care coordinator.
          Ensure that by           Promote staff awareness.
          2013 there are no
          predictable child        Collaborate with community
          deaths in the             services.                           Staff education & training.
          acute hospital
          setting unless           Coordinate services.
          this is the stated                                            Single Access Point &
          preference of the                                             Capacity Management
          parents.                                                      System.
          Single point of                                               Single Access Point &
          access to help                                                Capacity Management
          both in and out of                                            System.
          hours
                                                                        SPA work to continue
                                                                        through Urgent Care
                                                                        Networks.
          Child should be          Coordinate services.                Single Access Point &
          seen promptly by                                              Capacity Management
          a healthcare                                                  System.
          professional with        Appropriate referral by ambulance
          appropriate skills        staff.                              Staff education & training.
          related to                                                    Develop Clinical Hubs and
          children                                                      Triage Systems.
          Electronic           Awaiting EPR                             Work through national
          records available                                             networks.




Board Paper September 2008            Page 14 of 24
                Parents feel able     ECPs/Nurses to promote in Walk-     Development of Promotion
                and confident to       in-Centres, Health Centres, MIUs    Literature.
                deal with minor        and GP Surgeries.
                illnesses                                                  Form a Public Health
                                      Health Bus.                         Team to plan and deliver.

                                                                           Develop Clinical Hear &
                                                                           Treat.

LONG TERM       Promotion of          ECPs/Nurses to promote in Walk-     Development of Promotion
CONDITIONS      disease                in-Centres, Health Centres, MIUs    Literature.
                prevention.            and GP Surgeries.
                                                                           Form a Public Health
                                      Health Bus.                         Team to plan and deliver.

                                      Community Paramedics/ECP
                                       (RRV).

                Fast track            Deliver services via 999 and        Staff education & training.
                services to            Urgent Care.
                prevent
                conditions            Facilitate appropriate referrals.   Capacity management
                deteriorating.                                             System.
                                      Community Paramedics/ECP
                                       (RRV).                              Develop Clinical Hubs and
                                                                           Triage Systems.
                Reduce                Deliver services via 999 and        Staff education & training.
                avoidable              Urgent Care.
                admissions to
                hospital by           Facilitate appropriate referrals.   Single Access Point &
                making services                                            Capacity management
                and technology                                             System.
                available in
                patient‟s homes
                and the
                community
                setting.
                Ensure that crisis    Deliver services via 999 and        Develop Clinical Hubs and
                services are           Urgent Care.                        Triage Systems.
                available day and
                night.                Facilitate appropriate referrals.   Staff education & training.

                                      Community Paramedics/ECP            Single Access Point &
                                       (RRV).                              Capacity management
                                                                           System.


      Board Paper September 2008        Page 15 of 24
          Ensure that all        Deliver services via 999 and            Develop Clinical Hubs and
          people with a           Urgent Care.                            Triage Systems.
          long term
          condition have an      Facilitate appropriate referrals.       Staff education & training.
          action plan that
          supports their self
          management by                                                   Single Access Point &
          31 March 2010.                                                  Capacity management
                                                                          System.
          Have a single          Deliver services via 999 and            Develop Clinical Hubs and
          point of access         Urgent Care.                            Triage Systems.
          and
          multidisciplinary      Facilitate appropriate referrals.       Staff education & training.
          team approach
          for long term          Community Paramedics/ECP
          conditions by 31        (RRV).                                  Single Access Point &
          March 2010.                                                     Capacity management
                                                                          System.
          Ensure that at         ECPs/Nurses/Paramedics/ECA to           Commissioning.
          least 75% of            deliver in community setting.
          people who have
          an MI, bypass          Community Paramedics/ECP
          surgery or              (RRV).
          angioplasty
          receive Cardiac
          Rehabilitation by
          31 March 2010.

          Reduce                 Health promotion.                       See above.
          emergency
          admissions as a        Liaison with/referral to falls Teams.   Staff education & training.
          result of a fall by
          30% by 31 March        Vulnerable adults referral and
          2010.                   referral to GP                          Currently undertaken.

          Self assessment          Health Promotion.
          and self care            Health Bus.
                                   Hear & Treat.                         Continue to develop
                                   Community Paramedics/ECP              Clinical Hubs and
                                    (RRV).                                collaboration with NHS
                                                                          Direct.




Board Paper September 2008          Page 16 of 24
MENTAL HEALTH Promote positive           Health Promotion.                     Health Bus, Walk-in-
              mental health                                                     Centres, MIUs, GP
              and responsibility                                                Surgeries etc.
              for personal
              wellbeing.                 Liaison with Community Mental         Single Access Point &
                                          Health Teams.                         Capacity Management
                                                                                System.
                                         Community Paramedics/ECP
                                          (RRV).                                Staff
                                                                                Education/Training/CPD
                 Improve access          Liaison with Community Mental         Single Access Point &
                 to advice and            Health Teams.                         Capacity Management
                 support in early                                               System.
                 stages.
                 Improve support         Liaison with Community Mental         Single Access Point &
                 in home setting.         Health Teams.                         Capacity Management
                                                                                System.
                 Provide 24/7            Liaison with Community Mental         Single Access Point &
                 services within          Health Teams.                         Capacity Management
                 the community.                                                 System.
                                         Community Paramedics/ECP
                                          (RRV).                                Staff
                                                                                Education/Training/CPD.
                 Provision of high       Health Bus, Walk-in –Centres,
                 quality                  MIUs, GP Surgeries.
                 information for
                 patients

LEARNING         Ensure that             Health Bus.                           Staff education & training.
DISABILITY       people with
                 learning                ECP/Nurse outreach or liaison with
                 disabilities             specialist teams.
                 receive the same
                 opportunity to          Ensure that patient information and
                 lead healthy lives       equitable access to Urgent and
                 and avoid                Emergency Care is appropriate
                 discrimination at        and full fills the needs for those
                 all stages of life.      with learning disabilities
                 Support people          Health Bus.                           Staff education & training.
                 with learning
                 disabilities to live    ECP/Nurse outreach or liaison with
                 safe lives.              specialist teams.




       Board Paper September 2008          Page 17 of 24
                Ensure                 Community Paramedics/ECP             Staff education & training
                personalised            (RRV).
                services.
                Make service           ECP/Nurse outreach or liaison with
                users and carers        specialist teams.
                central to
                discussions
                regarding care.
                People with            ECP/Nurse outreach or liaison with
                learning                specialist teams.
                disabilities will
                have the same
                access to breast
                and cervical
                screening and
                the same uptake
                as the general
                population (80%)
                will be achieved
                by 2013.
                Staff training in      Community Paramedics/ECP             Staff education & training
                working with            (RRV).
                people with LD
                Disability equality
                impact
                assessment to be
                carried out by all
                health care
                organisations
                Voices of people                                             PPI
                who have LD

PLANNED CARE    Achieve a no           For information                      Single Access Point &
                waiting culture.                                             CMS in acute/urgent
                                                                             setting.
                Deliver services       Darzi Health Centres
                closer to home.
                                       Community Paramedics/ECP
                                        (RRV).
                Diagnostics            Darzi Health Centres
                closer to home.
                Better access to       Darzi Health Centres
                GP services.
                Self assessment        Health Bus                           Hear & Treat.
                and self care


      Board Paper September 2008         Page 18 of 24
                                                                            NHS Direct.

                Diagnostics            Possible business opportunity for
                /testing                SWAST
                Medical Gas
                Testing

ACUTE CARE      Simplified access      Capacity management System          Development of Clinical
                to Urgent Care                                              Hubs & triage systems.
                Services to
                ensure that                                                 Single Access Point &
                people receive                                              Capacity Management
                the most                                                    System.
                appropriate care.
                Support for            ECP/Nurse home visits.              Commissioning.
                people known to
                be at risk in order    Community Paramedics/ECP
                to avoid crisis.        (RRV).
                Ensure that the        Capacity Management System.         Single Access Point &
                most effective                                              Capacity Management
                response               Community Paramedics/ECP            System.
                services are            (RRV).
                available 24/7.
                A&E attendances        Capacity Management System.         Single Access Point &
                will reduce by                                              Capacity Management
                10% per annum          Development of Community based      System.
                over 5 years.           services.
                                                                            ECPs & RRV Paramedics.
                                       Community Paramedics/ECP
                                        (RRV).
                95% of patients        Appropriate level of staffing &     Single Access Point &
                who attend A&E          training in Minor Ailments/Minor    Capacity Management
                Departments,            Injuries.                           System.
                Minor Injuries
                Units, Walk-in         Effective local triage.             ECPs & RRV Paramedics.
                Centres, General
                Practices and          Community Paramedics/ECP (RRV
                Community               & MIU based).
                Settings for
                urgent care will
                receive treatment
                within 2 hours of
                arrival by 31
                March 2011.




      Board Paper September 2008         Page 19 of 24
          95% of eligible       Effective deployment of emergency Reduction of inappropriate
          patients suffering     resources to ensure rapid transport admissions to redeploy
          Myocardial             to Primary Angioplasty.             resources to these key
          Infarctions will                                           patients.
          receive Primary
          Angioplasty                                                     Continued development of
          within 3 hours of                                               Clinical Hubs and
          onset by 31                                                     technology.
          March 2011.
                                                                     Integrated plan with
                                                                     commissioners in each of
                                                                     our PCT areas to ensure
                                                                     that Primary Angioplasty is
                                                                     available and that we have
                                                                     appropriate ambulance
                                                                     resources to provide rapid
                                                                     transport to each location.
          95% of people         Effective deployment of emergency Reduction of inappropriate
          who have               resources to ensure rapid transport admissions to redeploy
          suffered a stroke      to Primary Angioplasty.             resources to these key
          will receive brain    Develop data and information        patients.
          imaging within 30      around mapping of Isochrones that
          minutes of arrival     identify the additional recourses   Continued development of
          7 days per week        required to transport, transfer     Clinical Hubs and
          by 31 March            patients to the specialist centres  technology.
          2010.
                                                                          Integrated plan with
                                                                          commissioners in each of
                                                                          our PCT areas to ensure
                                                                          that brain imaging is
                                                                          available and that we have
                                                                          appropriate ambulance
                                                                          resources to provide rapid
                                                                          transport to each location.
          Patients with a       To be aware.                             Capacity Management
          fractured neck of     Include the urgency of early             System has the potential to
          femur to have a        intervention of fallers and onward       smooth all aspects of
          best practice          referrals for patients with obvious      community based care;
          length of stay         fracture to reduced associated           therefore, assist with best
          (including             risks by effective assessment at         practice stay in hospitals.
          community              pont of contact in the clinical hub in
          hospital) within       the face to face setting


Board Paper September 2008         Page 20 of 24
                 the top 25% in
                 England by 2010.
                 Full
                 implementation of
                 all Quality
                 Markers of the
                 National Stroke
                 Strategy in all
                 PCT areas by 31
                 March 2011.
                 24/7 access to                                                 Capacity Management
                 falls services,                                                System.

                                                                                ECPs and RRV
                                                                                Paramedics.
                 Improved              Development of MIUs and „Darzi‟ Health   Work with PCTs and local
                 services in MIUs,     Centres.                                 providers to ensure that we
                 LTC’s, psychiatry                                              have MIUs and LTCs
                 and intermediate                                               which are able to accept
                 care                                                           patients from ambulance
                                                                                crews.

END OF LIFE      Ensure that               Staff awareness.
CARE             everyone has a            Training and education around the
                 choice of where            Liver Care Pathway and Last Days
                 to die, that their         of Life best practice principles.
                 wishes are                Participation in programmes such
                 respected and              as “Delivering Choice” and
                 their dignity is           supporting more care in the in
                 preserved.                 community.
                                           ECPs becoming members of Rapid
                                            Response Teams linked with
                                            palliative care and hospice teams
                 Stop                      Staff education & training.
                 unnecessary
                 admissions to             Appropriate referral to community
                 hospital in the            services.                           Capacity Management
                 final days of life.                                            System.
                                           Community Paramedics/ECPs
                                            (RRV).

                                           Use of Flag file and special
                                            messages in both the Urgent Care
                                            Service and the A/E 999 record




       Board Paper September 2008             Page 21 of 24
          Help people be        Staff education & training.
          free of pain and
          fear at the end of    Appropriate referral to community   Capacity Management
          life.                  services.                           System.

                                Community Paramedics/ECPs
                                 (RRV).

                                Development of Non Medical
                                 Prescribing and Patient Group
                                 Directives to support workforce
                                 delivering care
          All health            Staff awareness.
          communities
          identify the
          number of
          patients with a
          plan for their
          death and the
          percentage of
          patients where
          this plan has
          been delivered by
          31 March 2011.
          People can            Community Paramedics/ECPs           Capacity Management
          access the basic       (RRV).                              System.
          building blocks of
          effective care at
          all times (e.g.
          community
          nursing
          equipment and
          drugs) by 31
          March 2011.
          Through                                                    Capacity Management
          responding to                                              System.
          individual
          preferences
          reduce the
          number of adult
          deaths in acute
          hospitals by 10%


Board Paper September 2008        Page 22 of 24
            in each of the
            next three years.




            Through                   Staff education & training.               Capacity Management
            providing support                                                    System.
            at home reduce            Community Paramedics/ECPs
            unplanned                  (RRV)
            admissions in the
            final 12 months of
            life by 10% in
            each of the next
            three years.
            Co-ordination of                                                     Capacity Management
            care                                                                 System & Clinical Hubs.
            Ambulance                                                            Ongoing.
            services ensure
            that national
            clinical guidelines
            on resuscitation
            and terminal
            illness are being
            followed


SUMMARY

We support the draft strategy and look forward to working towards these goals in order to ensure
that our patients receive high quality care. Key areas of development suggested by us are:


    1. A Health Bus – to provide flexible local care with the ability to address local health
        inequalities.
    2. Single Access Point – hosted by our Clinical Hubs.
    3. Capacity management System – hosted by our Clinical Hubs.
    4. Consistency in MIUs – ensuring that ambulance services are able to access.
    5. Development of our ECP teams – to address local health inequalities and work within the
        community as part of the wider health and social care team.
    6. Continued focus and development of care for patients with acute stroke and myocardial
        infarction.


Board Paper September 2008               Page 23 of 24
   7. Develop and implement the role of the Critical Care Practitioner – to support patients with
       serious conditions.
   8. Develop our staff through education and training – in order to be responsive to the
       changing requirements of healthcare, integrate them further into the community, and
       maximise our resources.
   9. Continuation of high level broadcasting and issuing of communication initiatives which
       support the South West NHS reputation and brand building work underway which is
       showcasing the partnership working with the health and social care community; in parallel
       with key stakeholders such as Overview and Scrutiny Committees, Local Involvement
       Networks and others.




Board Paper September 2008             Page 24 of 24

								
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