service agreement - nsw · pdf file2013 /14 service agreement an agreement between:...

2013 /14

Service Agreement

An Agreement between:

Director-General

NSW Ministry of Health

and

Chief Executive

NSW Ambulance

for the period

1 July 2013-30 June 2014

This Agreement supports the devolution of decision making, responsibility and accountability for the provision of safe, high quality, patient centred care to NSW Health Services* by setting out the service and performance expectations and funding for NSW Ambulance.

NSW Ambulance agrees to meet the service obligations and performance requirements outlined in this Agreement.

The Director-General agrees to provide the funding and other support outlined in this Agreement.

Parties to the Agreement

NSW Ambulance Ray Creen Chief Executive NSW Ambulance

Date: -2-*13 Signed:

NSW Ministry of Health Dr Mary Foley Director-General NSW Ministry of Health

Date:

/ Signed:

*In this Agreement, the term Health Services refers to NSW Local Health Districts (LHDs), Specialty Health Networks (SHNs), Statutory Health Corporations (SHCs), Affiliated Health Organisations (AH0s), NSW Ambulance, HealthShare NSW the Cancer Institute NSW and any other organisations that come to fall within the NSW Health Performance Framework within 2013/14.

Contents

1. Objectives of the Service Agreement

2. Strategic Context

3. Regulatory and Legislative Framework for this Agreement

4. The NSW Health Performance Framework

5. Variation of the Agreement

6. Summary of Schedules

SCHEDULE A: Strategic Priorities

SCHEDULE B: Services and Facilities

SECTION 1 Service Planning and Provision

SECTION 2 — Services and Facilities

SECTION 3 — Affiliated Health Organisations (AH0s), Non-Government Organisations (NG0s) and other services supported by the LHD

SECTION 4— Community Based Service Streams

SECTION 4 — Population Health Services provided by the LHD

SECTION 5 — Aboriginal Health

SECTION 6 — Teaching, Training and Research

SECTION 7: NSW Kids and Families

SCHEDULE C: Budget

SCHEDULE D: Service Volumes and Levels

SCHEDULE E: Performance Measures

SCHEDULE F: Governance Requirements

1. Objectives of the Service Agreement

The objectives of the Service Agreement are:

• To enable NSW Ambulance to deliver a coordinated, high quality ambulance service to the communities it serves and to support its teaching, training and research roles.

• To clearly set out the service delivery and performance expectations for the funding and other support provided to NSW Ambulance.

• To promote accountability to Government and the community.

> To ensure NSW Government and national health priorities, services, outputs and outcomes are achieved.

• To establish with NSW Ambulance a Performance Management and Accountability System that assists in achievement of effective and efficient management and performance.

• To provide the framework for the Chief Executive to establish service and performance agreements within NSW Ambulance.

• To outline NSW Ambulance roles and responsibilities as key member organisations of a wider NSW public health network of services and support organisations.

> To facilitate the progressive implementation of a purchasing framework.

2. Strategic Context

The key goals of the NSW public sector health system are to help people stay healthy and to provide access to timely, high quality, patient-centred health care.

Achieving these goals requires clear priorities, supportive leadership and staff working together, underpinned by the core values of:

> Collaboration — Improving and sustaining performance depends on everyone in the system working as a team.

• Openness — Transparent performance improvement processes are essential to make sure the facts are known and acknowledged, even if at times this may be uncomfortable.

• Respect — The role of everyone engaged in improving performance is valued.

• Empowerment — There must be trust on all sides and at all levels with responsible delegation of authority and accountability.

One important way the CORE values can be realised is through active engagement of NSW Ambulance with the NSW Health Performance Framework.

NSW Ambulance operates as part of a broader statewide Health System and statewide network of services.

The recommendations and findings of a number of key State and Commonwealth initiatives inform the strategic directions of the NSW public health system. These include: • NSW 2021: A Plan to Make NSW Number One: NSW Health is the lead agency for the

goals of — Keeping people healthy and out of hospital — Providing world class clinical services with timely access and effective infrastructure.

• The NSW State Health Plan 2013, which will be developed during 2013 • Keep Them Safe • The National Partnership Agreement on Closing the Gap in Indigenous Health

Outcomes (Closing the Gap) • Reform Plan for NSW Ambulance.

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The Service Agreement operates within the NSW Health Performance Framework (see below) and in the context of NSW Health Funding Reform, Purchasing and Commissioning Frameworks.

NSW Ambulance represents a core part of the NSW Health System and is fundamental to the delivery of key goals and outcomes. Collaboration with other entities of the NSW health system, NGOs and other Government agencies is essential for NSW Ambulance to achieve these goals.

Appropriate consultation and engagement with patients and communities in relation to the design and delivery of health services is also a NSW Ambulance responsibility, including consideration of how best to support the needs of carers in the design and delivery of their services.

NSW Ambulance is also part of the NSW Public Sector and its governance and accountability framework.

The NSW Health Corporate Governance and Accountability Compendium outlines the governance requirements that must be completed by those organisations that are established as part of NSW Health, and sets out the roles, responsibilities and relationships of those organisations. Requirements under the Service Agreement appear at Schedule F. The Strategic and Services Planning section of the Compendium provides additional perspective on strategic context.

3. Regulatory and Legislative Framework for this Agreement

Health Services Act 1997 Under Part 5A of the Health Services Act 1997, the Director-General, on behalf of the Crown, has wide ranging functions in relation to the provision of ambulance services. Staff of NSW Ambulance are part of the NSW Health Service. The NSW Ambulance Advisory Council is established under s67C of the Health Services Act 1997. In the exercise of the functions under Part 5A of the Act, the Director-General has established NSW Ambulance as part of the Health Administration Corporation which is constituted under the Health Administration Act 1982.

The Director-General has, on behalf of the Crown, the following functions: (a) to provide, conduct, operate and maintain ambulance services; (b to cooperate with or provide assistance to any person or organisation for the purposes

of providing, conducting, operating and maintaining ambulance services; (c) in connection with ambulance services referred to in paragraph (a), to protect persons

from injury or death, whether or not those persons are sick or injured.

The primary role of NSW Ambulance is to provide quality, evidence-based time-critical emergency and urgent pre and out-of-hospital care. This includes care provided at the scene, transport to a hospital or other health facility and time-critical transport between health facilities.

NSW Ambulance is not a non-emergency patient transport service. Utilisation of emergency ambulances for this purpose has the potential to reduce emergency response performance and is at times inefficient as emergency ambulances are redirected to emergency patients leading to delays in the arrival for non-emergency transport.

Over the course of this Service Agreement NSW Ambulance will withdraw from the provision of the delivery of a non-emergency patient transport service in metropolitan NSW and further work will be undertaken to ascertain if the same may occur across rural NSW.

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4. The NSW Health Performance Framework

The Service Agreement is a key component of the NSW Health Performance Framework for NSW Ambulance. The Framework: > has the over-arching objectives of improving service delivery, patient safety and quality > provides a single, integrated process for performance review, escalation and

management > provides a clear and transparent outline of how the performance of NSW Ambulance is

assessed > outlines how responses to performance concerns are structured to improve

performance > operates in conjunction with the Purchasing Framework.

5. Variation of the Agreement

The Agreement may be amended at any time by agreement in writing by all the Parties.

The Agreement may also be varied by the Director-General or the Minister as provided in the Health Services Act 1997.

Any updates to finance or activity information further to the original contents of Schedule C will be provided through separate documents that may be issued by the Ministry in the course of the year.

6. Summary of Schedules

Requirements for the period of this Agreement are set out in the Schedules summarised below.

A: Strategic Priorities This Schedule outlines key priorities of NSW Health, including those arising from NSW 2021: A Plan to Make NSW Number One, NSW Health plans, and other relevant State and Commonwealth initiatives. A new 10 year NSW State Health Plan (2013-23) with a focus on the first three years (to 2016) is being developed during 2103. The priorities should be reflected in NSW Ambulance Strategic and Services Plans and in operational delivery.

Additional local priorities are detailed under the five strategic directions in the Reform Plan for NSW Ambulance.

1. Integrating NSW Ambulance within the broader health system 2. Separating non-emergency patient transport (NEPT) from urgent medical retrieval

services 3. Developing new models of care and investing in new providers to effectively manage

demand, have a positive impact on response time, reduce paramedic fatigue and improve the operating costs of NSW Ambulance

4. Ensuring that NSW Ambulance has effective infrastructure and has a funding model that will ensure financial sustainability in the future

5. Strengthening the leadership, workforce and governance structure of NSW Ambulance and embracing the CORE values of Collaboration, Openness, Respect and Empowerment

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B: Services and Facilities under governance of, or supported by, NSW Ambulance

1. Service Planning and Provision Outlines NSW Ambulance responsibilities to annually develop a strategic plan and implement an operational plan, for processes to be consistent with NSW Health Corporate Governance and Accountability Compendium planning principles and stakeholder engagement principles.

2. Services and Facilities Documents the services and facilities to be commissioned within the period of the Agreement, as they appear on the Capital Project Key Milestone Date Report

3. Community Education - Lists NSW Ambulance community education programs.

4. Aboriginal Health - Lists NSW Ambulance services specifically targeting Aboriginal people.

5. Teaching - Teaching and training to be provided by NSW Ambulance.

C: Budget This Schedule outlines the operating and capital budget allocated to NSW Ambulance for the provision of its services, operations and capital works (including where applicable subsidies to Affiliated Health Organisations or other services). These budget allocations may be varied in light of other approved variations throughout the financial year.

The Schedule is a summary only, and NSW Ambulance will also need to refer to the details contained in the service schedule, conditions of subsidy (government grants), NSW Health Funding Guidelines, other relevant policies, correspondence and other financial information.

NSW Ambulance is to publish the budget on the website within two weeks following the initial budget allocation.

D: Service Schedule This Schedule provides a list of services that NSW Ministry of Health will purchase from NSW Ambulance.

E: Performance Measures This Schedule lists: > Key Performance Indicators (KPIs) that, if not met, may contribute to escalation/de-

escalation under the Performance Framework processes. Performance against these KPIs will be reported regularly to NSW Ambulance in the Health System Performance Report prepared by the Ministry.

> Service Measures that assist NSW Ambulance to improve provision of safe and efficient patient care and to provide the contextual information against which to assess performance.

A companion document to the Service Agreement is the Data Dictionary — Key Performance Indicators and Service Measures, which provides definitions that enable the calculation and interpretation of Service Performance Measures.

A range of other monitoring measures are used for a variety of reasons, including monitoring the implementation of new service models, reporting requirements to NSW Government central agencies and the Commonwealth, and participation in nationally agreed data collections.

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F: Governance Requirements This Schedule outlines the structures and processes NSW Ambulance is to have in place to fulfil its statutory obligations and to ensure good corporate and clinical governance. The NSW Health Corporate Governance and Accountability Compendium outlines the governance requirements for organisations that are established as part of NSW Health, and sets out the roles, responsibilities and relationships of those organisations.

In regard to Clinical Governance, the Patient Safety and Clinical Quality Program provides an important framework for improvements to clinical quality.

Schedule F also outlines NSW Ambulance roles and responsibilities as key member organisations of the wider NSW network of public health system organisations.

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SCHEDULE A: Strategic Priorities

This Schedule outlines key priorities of NSW Health, including those arising from NSW 2021: A Plan to Make NSW Number One, NSW Health plans, and other relevant State and Commonwealth initiatives. The Strategic and Services Planning section of the NSW Health Corporate Governance and Accountability Compendium provides additional perspective on strategic context.

The following priorities should be reflected in the NSW Ambulance Strategic and Services Plans and in operational delivery. Additional local priorities are detailed in the Reform Plan for NSW Ambulance.

A new 10 year NSW State Health Plan (2013-23) with a focus on the first three years (to 2016) is being developed during 2103.

The new State Health Plan will outline the context for health services for the next 10 years, and strategies to deliver on health priorities and improved health outcomes over that period. It will provide the strategic direction to inform a longer term funding and budget setting process for the NSW Health system.

Consultation with senior members of the health system and stakeholders has commenced and will include consultation with Commonwealth Department of Health and Ageing and relevant NSW Government agencies.

Whilst the strategic priorities have not been finalised, key strategies for NSW Health include:

• Integrated models of care. The Ministry, in conjunction with the Agency for Clinical Innovation (ACI) and the Clinical Excellence Commission (CEC), are providing leadership for the design of models of care that better integrate and coordinate patient care across health care settings; reduce hospitalisation; and, improve both quality of care and patient experience, especially for complex and chronic conditions.

Key elements of integrated models of care are using e-health and strengthening community and home-based services. The delivery of more appropriate and innovative models of care will impact on the nature of capital investments, requiring repurposing and reconfiguring some assets. These changes will also offer opportunity to reduce the rate of growth in demand for hospital based care. Key to this will be the implementation of specific strategies including palliative care, pain management and dementia management

• Clinical Service Planning for Effective and Efficient Service Delivery. NSW Health planning is based on population demographics and health status and the health characteristics of the communities being served. The outcome of these analyses provided the profile of health services which need to be delivered. The gap analyses undertaken provide the basis for responding to changing demand over time.

Role delineation describes the complexity of services required to meet the identified needs of the population and is therefore part of the service and capital planning at a facility level. To reconfigure services based on revised role delineations is a necessary process to ensure that NSW Ambulance use their limited resources as efficiently and effectively as possible and are able to operate within their allocated funding. The process will often require reconfiguration of services across a network.

• Appropriate provider mix. NSW Health is developing strategies for the improved engagement with the not for profit and private sectors.

• Clinical Services Redesign (CSR). The Ministry has driven CSR across the continuum of patient care with the aim to reduce unwarranted clinical and process variation and to

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promote the adoption of good practice. CSR initiatives contribute to standardising care and reducing both inpatient lengths of stay and avoidable hospital admissions. This results in improved patient outcomes and reduced costs.

• Wellness Promotion, Illness Prevention and Improved Access to Primary Care. An important strategy for NSW Health to achieve significant efficiencies and savings is through preventive health initiatives which will mean that unnecessary hospitalisations are avoided, as well as through better out-of-hospital and in-the-community healthcare options. This will be assisted through the establishment of effective partnerships and joint planning processes between NSW Ambulance and Medicare Locals.

• Workforce Development for Sustainable Services. The NSW Health 10-year Health Professionals Workforce Plan 2012-2025 aims to build a sustainable health workforce by addressing the long-term projected workforce needs. The Plan outlines new models of care that will involve interdisciplinary teams undertaking varied roles in different settings, with the aim of achieving a balance between cost-efficient rosters and the right composition of skills. Annual reports on achievements in meeting outcomes of the plan are required and will be coordinated the Ministry.

• More Effective Use of Information and Communication Technology.

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SCHEDULE B: Services and Facilities under governance of, or supported by NSW Ambulance

SECTION 1 - Service Planning and Provision

NSW Ambulance is to annually develop a strategic plan and implement an operational plan. These requirements may be met by the Services Plan and Business Plan respectively.

Planning and service development processes should be consistent with the Strategic and Services Planning principles outlined in the NSW Health Corporate Governance and Accountability Compendium and any other requirements that may be advised by the Ministry from time to time.

Also, consistent with the Stakeholder Engagement principles set out in the Compendium, effective and meaningful stakeholder engagement is fundamental to achieving NSW Ambulance objectives in the planning, development and delivery of improved services and outcomes.

The Services set out below and in the services listed in Schedule D, including the volume or level of each service, shall not be varied without the agreement of the Ministry.

SECTION 2 - Service & Facilities

NSW Ambulance provides timely and safe access to appropriate care for each resident of NSW as part of an integrated network of clinical services. No variation to these service provisions should occur without prior agreement with the Ministry of Health.

NSW Ambulance will continue to provide, as part of an integral network. > Emergency pre and out of hospital care • Delivery high quality clinical care, and coordination of referral, transport and retrieval

services for emergency and time critical patients • Emergency management services and multi-agency operations • Develop and support staff to lead, manage and deliver pre-hospital care • Develop community safety and prevention programs

NSW Ambulance is to ensure continued provision of the following services: • Triple zero call and dispatch • Emergency services and emergency response capacity (including primary aeromedical) • Medical retrieval services (excludes aeromedical but includes all medical staff) • Non-Emergency Patient Transport* • Health related transport: services (including secondary aeromedical) • Health related transport: booking, scheduling and dispatch • Clinical Emergency Response Assistance (CERS Assist) • Emergency management services and multi-agency operations • Health Emergency Management Unit

* Over the course of this Service Agreement, NSW Ambulance will withdraw from the provision of the delivery of a non-emergency patient transport services in metropolitan NSW and further work will be undertaken to ascertain if the same can occur across rural NSW.

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3.1. Services and Facilities to be commissioned within the period of the Agreement

The following will require review following the release of the State Budget

Service

Milestone date

Bundeena Ambulance Services

ICEMS

Electronic rostering and Stafflink

Rural Ambulance Stations Refurbishments

Bega Ambulance Station

Albury Ambulance Station

Ambulance Technology Infrastructure Upgrade

Radio Network Infrastructure

Ambulance Infrastructure ICT Technology Infrastructure

Ambulance Services

InterCAD Emergency Messaging System (ICEMS) to facilitate exchange of recorded mission critical information between emergency service organisations in an accurate and timely manner.

Implementing Healthroster to replace manual rostering systems, implementing Stafflink in accordance with Health Shared Services requirements.

Various Ambulance Rural Stations Refurbishments

Replacement Ambulance Station

Replacement Ambulance Station

Technology Infrastructure Upgrade

Continuation of rolling program of works to maintain and upgrade the Ambulance radio network including replacing outdated or obsolete equipment

Continuation of rolling program of works to upgrade or replace ambulance ICT infrastructure including computer aided dispatch.

Aug 2013

Sept 2013

July/October 2013

June 2014

June 2014

June 2014

June 2015

June 2020

June 2020

3.2 Statewide Services NSW Ambulance is statewide service to which all residents of NSW have access.

3.3 Cross District Referral Networks NSW Ambulance is part of a referral network with other Districts and Health Services. These include Aeromedical & Medical Retrieval Services and the Health Emergency Management Unit

> Aeromedical and Medical Retrieval Service (AMRS) consists of the Aeromedical Operations Centre, Medical Retrieval Services, fixed and rotary wing and road transport services. The AMRS manages all requests for aeromedical transport and adult medical retrieval.

> Health Emergency Management Unit ensures NSW Health is prepared to respond effectively to major health emergencies and disasters as well as support the health aspects of major events within NSW.

SECTION 3 — Community Education

NSW Ambulance community education programs include:

• Newborns - First Steps Program

• Pre-school Children - Emergency Helpers Program • School Children - Be An Ambulance Hero Dial Zero Zero Zero Program

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• School children - Triple Zero Kids Challenge Game • Learn & Live — Year 10 students program • Non-English speakers - Calling an Ambulance program • Adults - Access for Life Program

• Retirees - Life Live It Save It Program

SECTION 4 — Aboriginal Health

NSW Ambulance will work collaboratively with the Ministry of Health, Pillars and Aboriginal Community Controlled Health Services to achieve the targets for "Closing the Gap" in Aboriginal Health. Services specifically targeting Aboriginal people include:

• Aboriginal Cardiac Awareness Program in selected small communities • The Aboriginal recruitment program • Calling triple zero cardiac care

NSW Ambulance will continue to work towards achieving the target of 2.6% Aboriginal and Torres Strait Islander employment in the health system by 2015.

SECTION 5 — Teaching, Training and Research

The functions of NSW Ambulance include:

• To establish and maintain an appropriate balance in the provision and use of resources for health protection, health promotion, health education and treatment services;

• To undertake research and development relevant to the provision of health services.

Teaching and training functions are to be undertaken in the context of the NSW Health Workforce Plan and the Workforce Development requirements of the NSW Health Corporate Governance and Accountability Compendium.

Teaching and Training To be informed by the implementation of relevant NSW Health strategies and the work program of the Health Education and Training Institute (HETI).

• Grow and support a skilled, competent and capable workforce - Maintain the NSW Ambulance Education, foundational, certification and credentialing

program. - Work in partnership with HETI to develop NSW Ambulance nominated education/training

needs. - Support online education and training throughout NSW Ambulance within the available

bandwidth and infrastructure. - Monitor expenditure and take-up of TESL across specialties and facilities. - Enhance the provision of training and education for Allied Health Professionals in

external education and training courses relevant to the particular allied health specialty.

• Recognise the value of generalist and specialist skills — Expand medical registrar training opportunities in line with current and future service

requirements.

• Develop effective health professional managers and leaders — Work in partnership with HETI to implement leadership programs (including Executive,

General Manager and Clinical Leader Programs) and the HETI Leadership Framework. - Implement the Statewide People Skills Management Framework and the NSW Health

Financial Management training program.

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Research To be informed by the implementation of the NSW Health and Medical Research Strategic Review as it applies to research conducted within NSW Ambulance. NSW Ambulance should work with the Office for Health and Medical Research and be responsible for:

Encouraging the translation and innovation from research by: - fostering a dynamic and supportive research culture through strategic leadership and

governance - attracting clinical trials by removing the barriers to undertaking clinical trials in NSW

Ambulance • Establishment of appropriate governance structures for research.

NSW Ambulance controlled entities - responsible to and governed by NSW Ambulance > NSW Ambulance Research

Affiliated with NSW Ambulance - Universities and other large entities • In accordance with the recommendations of the NSW Health and Medical Research

Strategic Review, establish new and continue current collaborative research arrangements that exist with:

- NSW Ministry of Health Pillars and appropriate departments - representatives of Local Health Districts, Medicare Locals, Specialty Health Networks

or other service providers within the NSW Ministry of Health

- project-specific experts within universities and research institutes.

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Base Adjustments Include:

Award Costs 7,943

Goods & Services Escalation (incl. RMR) 4,525

New Initiatives (annualised) Include:

Additional cost of electricity 122

HealthShare ICT Charges 334

NETS 5,400

Extended Care Paramedics - continued funding for ceasing NPA 3,809

Ambulance Service Review & Growth *"

Ambulance Service Review (Note: protected funding) 10,200

General growthr 3,000

Balance of funding pending further advice 1,600

14,800

Ambulance mobile data network 1,100

Total Expense Increase 38,033

New Revenue Initiatives include:

User Charges

Improved revenue capture' (7,000)

Other user charges (5,566)

Government Contributions

Recurrent Subsidy (24,717)

Capital subsidy (858)

Crown Acceptance (750)

Total Revenue Increase (38,891)

al Ambulance Service Review and Growth - is inclusive of D &D employer contribution.

#2 Program savings initiative - Total annual impact is $13M and is expected that improved revenue. Improvements are to reduce the level of bad debt write-off resulting in

an increase in actual revenue retained.

SCHEDULE C: Budget NSW Ambulance Service - Budget 2013/14

2013/14 INITIAL 2012/13 ANNUALISED

BUDGET BUDGET

Increase %

SOCO' s $000's

Including SP&T

Expenditure Employee Related 489,925 481,232 1.81%

Goods & Services (incl RMR & Grants) 216,309 186,969 15.69%

Depreciation and Amortisation 19,901 19,901 0.00%

Expense budget 726,135 688,102 5.53%

Total Expense Budget 726,135 688,102 5.53%

Revenue Government Grants

Recurrent Grants (485,627) (460,910) 5.36%

Capital Grants (incl RMR > $10k) (27,729) (26,871) 3.19%

Crown Acceptance (19,058) (18,308) 4.10%

Other Revenues

Revenue (220,384) (207,818) 6.05%

Sub-Total Other Revenues (220,384) (207,818) 6.05%

Total Revenue Budget (752,798) (713,907) 5.45%

Other Items Doubtful Debts 16,829 16,829 0.00%

Gain Loss Sale of Asset (1,074) (1,074) 0.00%

Total Other Items 15,755 15,755 0.00%

Total - Net Result (10,908) (10,050) 8.54%

2013/14 Budget -Supplementary Information

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SCHEDULE D: Service Volumes and Levels

NSW Ambulance provides timely and safe access to appropriate care for each resident of NSW as part of an integrated network of clinical services.

No variation to these service provisions should occur without prior agreement with the Ministry of Health. The outcome of Strategic Review: NSW Ambulance will further inform this section and may require amendment to implement recommendations.

NSW Ambulance will continue to provide, as part of an integrated network. • Emergency out of hospital care • Delivery high quality clinical care, patient transport, rescue and retrieval services • Emergency management services and multi-agency operations • Develop and support staff to lead, manage and deliver pre-hospital care • Develop community safety and prevention programs

NSW Ambulance is to ensure continued provision of the following services:

Service Code Service Name Notes .

-

Teaching Training and Research

Capacity purchased

TT-001 Teaching and Training — Ambulance Education Centre — Emergency Management and Counter Terrorism

Training — Learning & Development

— During 2013/14 base line to be established and agreed for 2014/15

Other Services

Triple zero call and dispatch — Answering triple zero calls, identifying location of patient, determining and coordinating response

— Identifying, allocating and dispatching resources to emergency patients

— Providing pre-arrival/first aid instructions — Secondary triage — Monitoring and managing welfare of paramedics


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Service Code Service Name Notec Capacity purchased

responding to incidents

— Monitoring and managing resource availability- re- allocating resources where appropriate

— Managing the dispersal of patients across the health system

— Operational liaison with other emergency agencies

Emergency services and emergency response capacity (including primary aeromedical)

— Emergency transport — Responses to triple zero calls

o Treating patients including where patient is discharged or referred to non-ED care

o Transporting patients to ED o Transfer of care to ED

— Specialist and secondary responses to emergency patients o ECP o ICP o Rural Paramedic (primary care model) o SOT o Rescue

— Primary aeromedical responses (rotary wing/fixed wing)

— Station infrastructure, vehicles, equipment, rostered paramedics on duty and on-call across NSW


Medical retrieval services (excludes aeromedical but includes all medical staff)

— State-wide retrieval service coordination (MRU); specialist advice and ICU bed finding

— Medical services for primary and retrieval services


Non-Emergency Patient Transport

— Patient transport services; low acuity patients - admissions, treatments, discharges subject to Health Check: NSW Ambulance outcomes


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Service Code Service Name Notes Capacity purchased

Health related transport: services (including secondary aeromedical)

— Emergency inter-hospital transport (where the patient is acute and transport is required in <30 minutes)

— Inter-hospital transport; high acuity but not emergency (i.e. > 30 mins where ambulance and paramedic or nurse escort is required)

— Aeromedical (fixed and rotary wing) transport of patients (includes road transfers at start and finish of journey)


Health related transport: booking, scheduling and dispatch

— Booking, scheduling and dispatch services for road transport services

— Booking, scheduling and dispatch service for aeromedical (fixed wing transport and rotary wing retrievals)


CERS Assist — Paramedics are authorised to undertake clinical interventions within their authorised Ambulance scope of practice

— Where NSW Ambulance has the capacity to respond it will be to the level of basic life support


Emergency management services and multi-agency operations

— Hallmark, special and sporting events — SOT, Rescue, Logistics, Planning & Operations — Emergency Management services and liaison with

agencies on behalf of health — Emergency coordination services for multi-agency

operations — Provision of ambulance services for multi-agency

operations


Health Emergency Management Unit

— Health Emergency Management coordination, training, policy, administration and leadership


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SCHEDULE E: Performance Measures

KPIs The performance of NSW Ambulance will be assessed in terms of whether it is meeting the performance targets for individual KPIs. • Performing - Performance at, or better than, target • Underperforming - Performance within a tolerance range X Not performing - Performance outside the tolerance threshold

KPIs have been designated into two categories: • Tier 1 - Will generate a performance concern when the Health Service performance is

outside the tolerance threshold for the applicable reporting period. • Tier 2 - Will generate a performance concern when the Health Service performance is

outside the tolerance threshold for more than one reporting period.

Service Measures A range of Service Measures are identified to assist NSW Ambulance to improve provision of safe and efficient patient care and to provide the contextual information against which to assess performance.

Other Measures Note that the KPIs and Service Measures listed are not the only measures collected and monitored by the NSW Health System. A range of other measures are used for a variety of reasons, including monitoring the implementation of new service models, reporting requirements to NSW Government central agencies and the Commonwealth, and participation in nationally agreed data collections. Relevant measures specified in NSW 2021: A Plan to Make NSW Number One, have been assigned as NSW Health KPls, Service Measures or Monitoring Measures, as appropriate.

Safet and Qualit

Cardiac Care: Out of hospital patients with suspected myocardial ischemia who are reported as having received the prescribed cardiac care (%)

Tier 2 Trauma: % of major trauma patients managed as per Protocol Ti by direct transport to a Trauma Service OR transported to a local hospital or Ti Preferred Destination with AMRS notification

Tier 2 Mental Health: Assessment (Scene/Final): % of mental health patients who have had a mental health assessment on scene

Tier 2 Death Review: of medical records for witnessed deaths where care was compliant with Ambulance procedures (review to occur within 45 days) (%)

Tier 2 Complaints Management: resolved within 35 days (%)

Tier 2 Root cause analysis: Ambulance Internal RCAs completed in 70 days

Tier 2 Traumatic Pain Management: percentage of medical records for adults experiencing pain who had a mean reduction in their pain score

Medication Safety: T.A.B.L.E.T.S.: patients who are on medication arriving at hospital with their medications or a record of their medication (%) Between the Flags: Percentage of adult patients transported to hospital where the final respiratory rate is in the Red Zone (<5 or >30/min) and a pre-notification was provided

Service Measure Hypoglycaemia: Percentage of hypoglycaemic patients who had an initial BSL (Blood Sugar Level) of _.c4 who was administered Glucose or Glucagon and had a final GCS (Glasgow Coma Scale)> their initial GCS.

Suspected Narcotic Overdose: Percentage of suspected narcotic overdose patients who were administered Naloxone and had a final GCS>their initial GCS.

Tier 2

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Patient Flow Tier 2

Tier 2

Service Measure

50th percentile 1A Response Times — NSW

Triple Zero time to answer — 90% in 10 seconds


50th percentile Response Times — Metropolitan Region

50th percentile Response Times — NSW (excluding Metropolitan Region)

Supported non-transport: P5, P7 and ECP non-transport cases reviewed for compliance with BTF criteria

Quality of triple zero call taking — NSW

% of appropriate Triple Zero calls referred to healthdirect for secondary triage

Avoided ED admissions from ECP interventions

Peo•le and Culture Workplace injuries. A 5% reduction on the latest 3 year (average) baseline of 11.8 (%)

Recruitment: improvement on baseline average time taken from request to recruit to decision to approve/decline recruitment (days)

Service Measure

Aboriginal Workforce as a proportion of total workforce

Reduction in actual workers compensation payments for s36, s37 and s40 across Operations to overall reduce the workers compensation premium.

Reduction in actual workers compensation payments for s38 across Operations to overall reduce the workers compensation premium.

Finance and Manasernent Expenditure matched to budget (General Fund): Year to Date; June projection

Revenue matched to budget (General Fund): Year to Date; June projection

Tier 1 Recurrent Trade Creditors > 45 days as a percentage of rolling prior 12 months G&S Expenditure (excluding VM0s) (%)

Small Business Creditors < 30 days from receipt of a correctly rendered invoice (%)

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Performing

<90% > 90% and <

100% Target met

<75%

<80%

> 75% and < Target met 80% or bettered

> 80% and < Target met 90% or bettered

<40% >40% and Target met

<50% or bettered

<80% > 80% and < Target met

90% or bettered

Detail — targets and performance thresholds

Cardiac Care: Out of hospital patients with suspected myocardial ischaemia who are

90

reported as having received the prescribed cardiac care (%)

Trauma: % of major trauma patients managed as per Protocol Ti by direct transport to a Trauma Service OR transported to a local

95

hospital or Ti Preferred Destination with AMRS notification

Mental Health — Assessment Tier 2 (Scene/Final): % of mental health

patients who have had a mental health assessment on scene

Death Review: of medical records for witnessed deaths where care was compliant with Ambulance 100 procedures (review to occur within 45 days) (%)

Complaints Management: % complaints acknowledged and 80 resolved within 35 days (%)

Root cause analysis: Ambulance Internal RCAs completed in 70 90 days

Traumatic Pain Management: percentage of medical records for adults experiencing pain who had 50% a mean reduction in their pain score

Tier 2

Tier 2

80

Tier 2

Tier 2

Tier 2

Tier 2

<80% > 80% and <

90% Target met or bettered

<85% > 85% and <

95% Target met or bettered

<70% > 70% and < Target met

80% or bettered

Service Measure

Medication Safety — T.A.B.L.E.T.S.: patients who are on medication arriving at hospital with their medications or a record of their medication(%)

Between the Flags: Percentage of adult patients transported to hospital where the final respiratory rate is in the Red Zone (<5 or >30/min) and a pre-notification was provided

Hypoglycaemia: Percentage of hypoglycaemic patients who had an initial BSL (Blood Sugar Level) of 54 who was administered Glucose or Glucagon and had a final GCS (Glasgow Coma Scale)> their initial GCS.

90

20.3 <10.3 >10.3 and 20.3 Target met

or bettered

Base line to be established and reviewed at first quarterly

performance meeting. Target to be improvement from the

established baseline

18

Tier 2

50th percentile 1A Response Times - NSW

Tier 2 Triple Zero time to answer — 90% in 10 seconds


50th percentile Response Times — Metropolitan Division

50th percentile Response Times — Regional Division

Service Measure

Supported non-transport: P5, P7 and ECP non-transport cases reviewed for compliance with BTF criteria

Quality of triple zero call taking — NSW

10

90%

15

12.9

12.2

KPIs Target Not Performing

X

Underperforming Performing

Suspected Narcotic Overdose

Percentage of suspected narcotic overdose patients who were administered Naloxone and had a final GCS>their initial GCS.




Patient Flow >10 and <11

minutes

>85% and < 90%

>16.5 >15 and <16.5 minutes minutes

>11.84 and <12.87 minutes

>11.30 and <12.23 minutes






established baseline Base line to be established and

reviewed at first quarterly performance meeting. Target to

be improvement from the established baseline




> 11.0 minutes

<85%

% of appropriate Triple Zero calls referred to healthdirect for secondary triage

Avoided ED admissions from ECP interventions

> 12.87 minutes

> 12.23 minutes

Target met or bettered





People and Culture

11.9%

2.6%

52.2

13.09%

<2.34

>57.4

Workplace injuries. A 5% reduction on the latest 3 year (average) baseline of 11.8 (%)

Recruitment: improvement on baseline average time taken from request to recruit to decision to approve/decline recruitment (days)

Aboriginal Workforce as a proportion of total workforce

>11.9 and <13.09

>52.2 and <57.4

>2.34 and

<2.60




Service Measure

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KPIs

Reduction in actual workers compensation payments for s36, s37 and s40 across Operations to overall reduce the workers compensation premium.

Target

5%

Not Performing Underperforming Performing

5.5 >5 and

<5.5


Reduction in actual workers compensation payments for s38 across Operations to overall reduce the workers compensation premium.

10% 11 >10 and

<11


Finance and Management

Tier 1

Expenditure matched to budget (General Fund): Year to Date; June projection

a) Year to date - General Fund (%)

On budget or

Favourable

> 0.5% Unfavourable

>0% but

<0.5% Unfavourable

On budget or

Favourable

b) June projection - General Fund

(%)

On budget or

Favourable

> 0.5% Unfavourable

>0% but

<0.5%

Unfavourable

On budget or

Favourable

Tier 1

Own Source Revenue Matched to budget (General

Fund):

a) Year to date - General Fund

(%)

On budget Or

Favourable

> 0.5% Unfavourable

> 0.5% Unfavourable

>0% but

<0.5% Unfavourable

On budget Or

Favourable

b) June projection - General

Fund (%)

On budget or

Favourable

>0% but

<0.5% Unfavourable

On budget or

Favourable

Recurrent Trade Creditors > 45 days correct and ready for payment (Number)

0 > n.a.

Small Business Creditors > 30 days from receipt of a correctly rendered invoice

> 0 n.a. 0

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SCHEDULE F: Governance Requirements

The Chief Executive is responsible for having governance structures and processes in place to fulfil statutory obligations and to ensure good corporate and clinical governance, as outlined in relevant legislation, NSW Health policy directives and policy and procedure manuals.

In regard to Clinical Governance, the Patient Safety and Clinical Quality Program provide an important framework for improvements to clinical quality.

NSW Ambulance is also part of the NSW Public Sector and its governance and accountability framework. NSW Ambulance must have effective governance and risk management processes in place to ensure compliance with this wider public sector framework.

Compliance of the NSW Health Corporate Governance and Accountability Compendium is to be reported quarterly by exception. NSW Ambulance must submit an annual: > Corporate Governance Statement for the financial year by 31 August each year (refer to the

NSW Health Corporate Governance and Accountability Compendium) > Internal Audit and Risk Management Attestation Statement for the financial year by 31 July

each year (refer Internal Audit Policy Directive PD2010_039).

Clinical Governance

The NSW Patient Safety and Clinical Quality Program requires NSW Ambulance to meet the following standards:

• Standard 1: Systems in place to monitor and review patient safety. • Standard 2: Developed and implemented policies and procedures to ensure patient safety

and effective clinical governance. • Standard 3: An incident management system is in place to effectively manage incidents

that occur and risk mitigation strategies are implemented to prevent their reoccurrence. • Standard 4: Complaints management systems are in place and complaint information is

used to improve patient care. • Standard 5: Systems are in place to periodically audit a quantum of medical records to

assess core adverse events rates. • Standard 6: Performance review processes have been established to assist clinicians

maintain best practice and improve patient care. > Standard 7: Audits of clinical practice are carried out and, where necessary, strategies for

improving practice are implemented.

The following guiding principles, based on the National Safety and Quality Framework, will be demonstrated in meeting clinical governance obligations: • Consumer centered — which means:

- providing care that is easy for the patient to get when they need it - making sure that healthcare staff respect and respond to patient choices, needs and

values - forming partnerships between patients, their family, carers and healthcare providers

• Driven by information — which means: — using up to date knowledge and evidence to guide decisions — safety and quality data are collected, analysed and fed back for improvement — taking action to improve patients' experiences

• Organised for safety — which means: — making safety a central feature of how healthcare facilities are run, how staff work and

how funding is organised.

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