so far, so good by odl20037

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									so far, so good




                  5 year strategic plan




                    review and update
                                                introduction
  Helicopters should not only be                The Kent Air Ambulance Trust implemented its first ever 5-year Strategic Plan in 2005. In the summer of 2007,
                                                (the half-way point), trustees of the charity held a “visioning” day, to review progress to date against this plan and
considered as a mode of transport,
                                                to see what adjustments needed to be made, so as to take full advantage of the fast moving and ever-changing
     but also a system of care                  pre-hospital care environment. This document is the result of that meeting, measuring as it does, successes against
                                                objectives to date and encapsulating agreed aspirations for the remainder of the Strategic Period, which concludes
                                                in December 2010.
Trauma: Who Cares?
A report of the National Confidential Enquiry
into Patient Outcome and Death (2007)
                                                       1
                                                       OBJECTIVE



                                                       It is the intention of
                                                           this Trust to
                                                                                Following a successful fundraising campaign linked
                                                                                to a robust business plan, air ambulance flights into
                                                           commence             those counties commenced in the autumn of 2006.
                                                       operations in those
                                                                                A completely new and additional HEMS service, from
                                                       counties served by
                                                                                our own purpose-built airbase, was launched from
                                                         the Surrey and
                                                                                Dunsfold Park in Surrey on 8 June 2007.
                                                           Sussex NHS
                                                       Ambulance Trusts




how are we doing?
In 2005, the charity adopted 6 strategic objectives.

Each of these are listed on the following pages
with an analysis of progress to date, or otherwise.
 2
OBJECTIVE



It is the intention of
this Trust to ensure
                         In 2005, the charity trialled the introduction of specialist pre-hospital care doctors on the Kent Air Ambulance,
                         based at Marden. The initial pilot scheme was supervised by Brighton and Sussex University Hospital.
that there is always
                         Anecdotal evidence as to the efficacy and benefits of this medical upskilling was so overwhelming that the
 the best available
                         initiative was rolled out on a permanent ongoing basis, but under the supervision and governance of doctors
 medical skills mix
                         linked to the Royal London Hospital in Whitechapel.
deployed along with
the air ambulance,       Doctors are now employed directly by the charity, but hold honorary contracts with Barts and the London
  so that the best       NHS Trust.
possible care can be
                         Additionally, working in partnership with the South East Coast Ambulance Service NHS Trust (SECAmb), the charity
given at the scene of
                         has agreed to participate in the new Critical Care Paramedic programme. This will see 12 traditional paramedics
    the incident
                         undergo a graduate course at the University of Hertfordshire, following which, they will be qualified and capable
                         of enhanced medical interventions, so as to complement the doctors’ skills. This is regarded as the strongest
                         possible team that can be delivered.
3
OBJECTIVE



It is the intention
  of this Trust
                      In 2005, the charity increased the number of hours the Marden based helicopter operated during the summer
                      months to 12 hours a day. Now both aircraft operate these hours during British Summer Time.
   to keep the
                      It is postulated that, since the charity has 2 helicopters at its disposal, consideration will be given to staggering
helicopter online
                      summer shift patterns, so that a greater time period is covered, possibly 6am to 9pm, with each aircraft covering
for the maximum
                      a 12 hour shift within that time frame. The advantages of such a plan are self evident, since it would mean the
   number of
                      population in the total area we serve, would have access to pre-hospital care for up to 15 hours a day. However,
 daylight hours
                      it would mean that for 6 of those hours, one helicopter would be covering 6,500 square miles.
4
OBJECTIVE



This Trust desires to
equip the helicopter
                        The charity wasted no time in fitting moving map satellite technology to the Kent based aircraft, and this is
                        also incorporated in the design fit of the new helicopter at Dunsfold, although there are ongoing software
 with all available     compatibility problems. Similarly, both aircraft have satellite phone communications systems and carry portable
 new technology,        ultrasound technology, in addition to standard air ambulance medical kit.
 to ensure that it is
                        We continue to explore new technology and adapt accordingly.
  operating in the
safest possible way
and is able to offer
 the best available
  care to patients
5
OBJECTIVE



 It is the intention
    of this Trust
                       This is an area where we have only had limited success. Our confrontation with the East Kent Hospitals Trust,
                       over the summary closure of the helipad at Canterbury, has yielded a much better working relationship with
                       that organisation, following the acquisition and building of our own helipad on land immediately next door to
  to campaign to       the hospital.
ensure that hospital   Behind the scenes, ongoing discussions with the Maidstone and Tunbridge Wells Hospital Trusts, has won us no
   helipads are        more than a reprieve on the Maidstone hospital site. The Queen Victoria Hospital at East Grinstead closed its
    not closed         helipad in 2006. There are planning problems regarding helipad usage at the Royal London Hospital in
  unnecessarily,       Whitechapel, which is our main trauma receiving hospital. The Strategic Health Authority seem resolutely
   and wherever        committed to make Brighton Hospital the main Level One Trauma Hospital for the region, but it has no appropriate
 possible, to work     landing facilities and, because of its location, is never likely to have one without millions of pounds being spent
with hospitals and     on creating a rooftop landing site.
   others for the
   creation and        We continue to bring pressure to bear through national forums to make helipad provision a matter for national
maintenance of new     joined-up thinking at a strategic level. Our own Operations Manager, has participated in a joint review of hospital
     helipads          helipads by the Civil Aviation Authority and the Department of Health, which is due to publish
                       in December 2007. This will give definitive guidance to Hospital Trusts and is aimed at clarifying
                       and simplifying the build of new hospital helipads (HBN 15-03).
6
OBJECTIVE



Wherever possible,
for the greater good
                       Surprisingly, this was perhaps our most radical and resisted objective. The Ambulance Service in particular, has
                       not been keen on seeing other agencies involved in the 999-dispatch system.
  of patients, this
                       On a positive note however, the Ambulance Service and the charity have forged a compromise, which in our view
 Trust will explore
                       provides the best tasking protocol deliverable, whereby our air crews man the helicopter dispatch desk in the
  and implement
                       ambulance control room.
procedures whereby
agencies other than    This innovation has been welcomed by all and led to a much more effective and targeted use of the
  the Ambulance        air ambulances.
Service, can request
  air ambulance
    deployment
    for medical
   emergencies,
    trauma and
 patient transfers
                                                                                                                         the pre-hospital care environment
                                                                                                                         – in general
                                                                                                                         The last 3 years have seen unrelenting change going on in the NHS. In our region, the separate Strategic Health Authorities serving
                                                                                                                         Kent & Medway and Surrey & Sussex were combined in 2006, to become NHS Southeast. The number of Primary Care Trusts has more
                                                                                                                         than halved and the 3 Ambulance Trusts serving our region were merged to form SECAmb.
                                                                                                                         The NHS itself has been absorbed with its “Fit for the Future” 1 consultation and under the guidance of Professor Sir George Alberti,
                                                                                                                         the Department of Health has been conducting the Acute Services Review2. More recently, Professor the Lord Darzi of Denham,
                                                                                                                                                                                                                      ,
                                                                                                                         Parliamentary Secretary of State for Health, has launched the “NHS Next Stage Review” as part of the “Our NHS Our Future”
                                                                                                                                     3
                                                                                                                         consultation .
                                                                                                                         In his own words, Lord Darzi states that he hopes this consultation “will form the basis for a vision for a world class NHS, to be
                                                                                                                                                                                           .
                                                                                                                         published in June 2008 in time for the 60th anniversary of the NHS”
                                                                                                                         One hopes that Lord Darzi’s optimism is not misplaced. A recent survey by the Brussels based “think tank” – The Health Consumer
                                                                                                                         Powerhouse – rated the British Healthcare system as 17th out of 29 in Europe, by using a basket of indicators, which puts it on a par
                                                                                                                         with Hungary and Slovenia.



the next steps
Having reflected on these achievements and the ongoing challenges, the trustees and executive team have                  1   The Fit for the Future programme considers why change is needed and sets out some ideas for discussion on future provision of health and social care services.

considered a number of options and opportunities for the remainder of the Strategic Period, and these are set out        2   Most UK hospitals follow the ‘district general hospital’, or DGH model that was set out in the National Hospital Plan in 1962, more than 40 years ago. This envisaged hospitals providing a full
                                                                                                                             range of A&E, emergency medicine and surgery, elective care, maternity and outpatient services to a population of between 250-300,000. However, a number of major issues have caused
as aspirations at the end of this document. However, for them to make any sense, it is important to understand the           commentators to question the sustainability of this DGH model. These include clinical standards, medical staffing and financial sustainability, and it has been suggested that specialist level one
                                                                                                                             trauma hospitals, need to serve larger populations of up to 500,000 each, thereby causing the closure or downgrading of local A&E services.
pre-hospital environment that exists today, which is very different to that which existed in 2005, just 36 months ago.   3   Nationwide consultations at SHA level through 8 work streams are currently in progress. Our Charity sits on the Acute Care Group for the South East region.
the pre-hospital care environment
– air ambulance specific
Whilst the NHS has been involved in all the reorganisation and consultation outlined previously, the air ambulance industry in the
UK has made unprecedented advances.

The formation of the Association of Air Ambulance Charities (AAAC)4, under the chairmanship of David Philpott, Kent Air
Ambulance CEO, enabled the 16 independent funders of our service to gain credibility through joint lobbying. Consequently, a
cohesive approach has been made to government on how our charities should be recognised and developed in the future. This has
culminated in the establishment of the Department of Health initiated Air Ambulance Working Group (AAWG), which is now
advancing a common agenda. The first major piece of work of this group was an independent “Situation Audit” on the state of the
air ambulance industry, the findings of which have been helpful to all concerned in developing a national strategic overview.
Simultaneous to, and in parallel with the AAWG, those charities committed to flying with doctors on board have developed and
adopted the UK HEMS Charter5, a competency based benchmark for excellence in pre-hospital care delivery.
During the past 3 years, Kent Air Ambulance Trust has also opened a European dimension to its service by joining the
European HEMS and Air Ambulance Committee (EHAC)6, and the Charity’s CEO and the Operations Manager, now sit on the
Scientific and Operations sub committees respectively. This has allowed European best practice to be assimilated into UK protocols
where, it has to be said, we have lagged behind by some 10 years in terms of service delivery and clinical effectiveness.

4   The Association of Air Ambulance Charities (AAAC) exists to support the work of the UK's Independent Air Ambulance Charities. The Association acts as a conduit between the charities, policy
    makers, regulators and other industry bodies. The Association is a national umbrella organisation that recognises the autonomy of each individual charity.
5   The purpose of the UK HEMS Charter is to promote clinical excellence and uniformity of clinical care delivered by HEMS operations throughout the UK. It aims to provide a benchmark for all
    aspects of clinical governance.
6   EHAC strives to create and promote a public perception in Europe, to the effect that air rescue and air ambulance services are necessary and that they have certain requirements. EHAC
    represents the interests of its members with the European regulatory authorities. EHAC makes the expertise of its members available to the bodies involved, in drawing up or reviewing
    regulatory acts (for instance the EU Commission, EASA, JAA). Furthermore, EHAC is devoted to further developing air rescue services and to maintaining high standards of service quality.
    The primary criteria include flight safety and medical efficacy.
ongoing aspirations
In recognition of the fact that healthcare policy is fluid, and that in such an environment the only thing that is constant is change,
the trustees have agreed to explore and develop the following opportunities, if they present themselves.
Patient Transfers
The Trustees agreed to explore the possibility of inter-hospital patient transfers within the NHS, as a paid-for, or chartered service,
so long as it does not compromise our primary HEMS function.
Organ Transplants
The Trustees agreed to explore possibilities for organ, or organ team transport, particularly if we could assist life-critical transplant
dependent patients from our area of benefit.
Critical Care Transfers
The Trustees agreed to explore opportunities for critical care transfers, including night transfer (lit helipad to lit helipad), again, as a
paid for, NHS commissioned service, once the demand for such a service was proven and safety considerations had been satisfied.
Broadening Our Objectives
The Trustees agreed to explore whether the charity should offer training in first aid or CPR, so as to broaden our appeal and the
good-will that the public has towards us, and make full use of our expanding clinical staff.
Membership Schemes
The Trustees agreed to explore membership models, such as the Norwegian model of membership supporters with affinity and
membership bonuses, possibly linked to the insurance industry or motoring organisations.
Move to an Independent Operator Status
The Trustees were advised that Air Ambulance Trusts may follow the way of Police helicopter operators, who had in recent years,
increasingly sought to obtain their own Air Operators Certificates (AOC). There were risks associated with this but also benefits,
which might become more attractive with the passage of time.
Collaboration/Partnership
We already have a strong relationship with Barts and the London NHS Trust, who provide recruitment, screening of doctors, HR
support and the honorary contracts they operate under. Additionally, we have a strong partnership arrangement with SECAmb.
There is an increasing likelihood that these kinds of collaborative partnerships will be ever more necessary in future, especially if we
are successful in securing some direct NHS commissioning.
We continue in dialogue with Hotel 900, the Sussex Police Helicopter, and the Assistant Chief Constable has indicated that the police
are interested in offering that aircraft for pan-regional (Kent, Surrey Sussex) air ambulance support through the night, in exchange             A medical emergency is no respecter of time and the need for the service does not diminish
for funding. These developments will be kept under review.
                                                                                                                                                 with either the onset of darkness, or the end of a shift, but continues 24 hours of the day. Our
Territorial Expansions
                                                                                                                                                 challenge is to continue to expand the availability of our service towards the 24 hour goal, the
The Trustees are aware that since ambulance service reorganisation in 2006, (reducing the number of NHS ambulance trusts from 31
to 12), some charities were moving towards merger. This would lead to fewer, but therefore more powerful/influential charities being             holy grail of all air ambulance services.
formed. The Trustees view was that although we should not be actively seeking territorial expansion or mergers, we should keep our
ear to the ground and consider any opportunity that might better serve the people of Kent, Surrey and Sussex on its merits.                      We may not be able to achieve this on our own, as an isolated charity, but there is clearly scope

General Aspirations                                                                                                                              to develop. Our industry still has a lot of catching up to do, and experience elsewhere suggests
The core of our objectives are straightforward. We do not exist to subsidise, or replace the NHS service, but to enhance it by the               that operationally, economies of scale and best practice may well come from a collaborative
provision of an air ambulance service. We can do this in two parts;                                                                              effort by the air ambulance world as a whole. We need to continue to play a leading part to
1. The rapid delivery of enhanced specialist skills to the scene.                                                                                find the way forward. Our challenge is to do all of this, without losing sight of the fact that our
2. Delivery of the patient to the best (not necessarily nearest) specialist hospital, that most meets their needs. This can include an           air ambulances belong to the communities they serve. We therefore recognise that the
   emergency transfer from a District to a Specialist hospital.                                                                                  moment the Kent, Surrey or Sussex Air Ambulances lose their county-specific identity, not
Some challenges are outside of our control, such as where the specialist hospitals are located. We can, however, focus upon those                only will the funding dry-up, but the charity may well lose its soul.
areas that are within our control, that we have the ability to develop and improve. We already have the gold standard of care on board
the aircraft with the physician/critical care paramedic partnership, and this is world class.
The future requires an aircraft capable of delivering an ever increasing amount of technical equipment and clinical specialist staff to
support the patient in need. This is a major challenge to the industry and a new generation of larger aircraft is needed. It needs to be small
enough to safely drop in to the high street, yet large enough to carry the patient, clinical team and equipment without compromise.
                Wheelbarrow Park Estate, Pattenden Lane, Marden, Kent TN12 9QJ
                Tel: 01622 833833 Fax: 01622 833448 Email: admin@kaat.org.uk
Web: www.kentairambulance.co.uk www.surreyairambulance.co.uk www.sussexairambulance.co.uk




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