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    27th May 2015

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    The Welsh Ambulance Services NHS Trust (WAST) provides ambulance services

    for the people of Wales which delivers high quality and patient led clinical care

    emergency, urgent, scheduled wherever and whenever needed.

    The Trust is changing the focus of its service to establish it as a quality focussed,

    clinically led, clinically driven emergency medical service, non-urgent patient care

    service and a 24 hour health care and advice service that focuses on delivering the

    best clinical outcomes for patients. The Trust should be seen as an integral part of

    the front line of the seven healthcare systems in Wales, with emergency and urgent

    care services a fundamental part of the national unscheduled care system. The

    Trust also works closely with Public Health Wales in our public health messaging

    and understanding the changing health demographics that impact on the

    unscheduled care system.


    WASTs three primary service lines are:

    Emergency Medical Services (EMS) and Urgent Care Services (UCS)

    Patient Care Services (PCS) non emergency/ elective patient transport

    NHS Direct Wales services.

    The Trust also provides and supports a range of specialist services including:

    HART (Hazardous Area Response Team)

    SORT (Special Operations Response Team)

    Supporting the Emergency Medical Retrieval and Transfer Service (EMRTS)

    CHANT (Cymru inter Hospital Acute Neo-natal Transfer service)

    Volunteer Car Service

    Community First Responders

    Cycle Responder Unit

    Co-responder service (use of fire and police services staff)

    Training in first aid.

    The Integrated Medium Term Plan (IMTP) covers the three year period from 2015/16

    to 2017/18 and builds on, and replaces, Working Together for Success 2011-16, the

    Integrated Business Plan 2014/15-2016/17 and the Annual Delivery Plan 2014/15.

    The IMTP provides the framework for the Welsh Ambulance Services NHS Trust

    (WAST) to:

    provide a clear statement of ambition for the benefit of patients, the public of

    Wales, Trust staff and NHS partners (together with other external


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    set out how it will deliver the Commissioning & Quality Delivery Framework

    (CQDF) agreed with the Emergency Ambulance Services Committee (EASC)

    describe the modernisation of non-emergency transport services

    support the transition of NHS Direct Wales to the planned 111 service

    Formal feedback regarding the original IMTP was received from Welsh Government on April 22, 2015. The feedback highlighted the following: Welcome progression in areas of the plan from earlier draft versions shared.

    Recognition that this year is a pivotal year in the transformation of WAST as

    the new arrangements bed down and the new commissioning framework is implemented.

    The subsequent recognition that, in light of the point above, an approvable IMTP is unrealistic at this point.

    The realisation that Welsh Government needs to work alongside WAST, the Chief Ambulance Commissioner, the Emergency Ambulance Services Committee and LHBs to ensure that the new arrangements translate to a more stable service model, improved performance and result in tangible benefits for patients, staff and the wider system.

    The need for further discussions on WASTs approaches to strengthening and embedding planning across WAST and how the organisations plans will be developed with LHBs so that plans are aligned.

    The need to understand the key milestones for the development of the organisations 2016/17 IMTP.

    Advise that, until such time as the Trust Board and Welsh Government have approved an IMTP, the organisation will continue to be held account against the NHS Quality Outcomes Framework through bi-lateral discussions with the Director General/NHS Wales Chief Executive, the Quality & Delivery Meetings and supporting performance management structures as well as by commissioners.

    This refreshed IMTP takes into account feedback from Welsh Government and specifically highlights the priorities and actions required in the coming year 2015/16 which will form a robust platform on which to build the Trusts three year strategy and secure approval of a three year IMTP from 2016/17. The IMTP refresh therefore:

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    Places a greater emphasis on the priorities for Y1 to ensure there is a robust

    platform and a plan for moving into Y2 & 3.

    Describes robust plans for actual delivery of the priorities that demonstrate

    achievement in this year and instil confidence in delivering in future years.

    Demonstrates that the critical areas of the original Strategic Transformation

    Programme are incorporated into the IMTP, mapped to the organisations

    priorities for 2015/16 and beyond and are managed effectively.

    Demonstrates a golden thread running through the IMTP, the Quality

    Delivery Commissioning Framework, financial plans and workforce plans so

    that plans are integrated with key dependencies identified and managed to

    deliver the overall vision and strategy of the Trust.

    PRIORITIES FOR 2015/16

    1. Developing a community engagement strategy and implementation plan to enable us to interact with all relevant stakeholders and promote community ownership of the service.

    2. Agreeing, embedding and sustaining new clinical models in EMS, NEPTS and the transition from NHSDW, establishing the role of the Trust as a healthcare provider and clinical service rather than simply a transport service

    3. Developing plans that localise the delivery of the IMTP (LDPs) minimising demand on the Ambulance Service, promoting choice for patients and improving the quality of patient outcome

    4. Developing and implementing a Quality Improvement Plan that promotes better service user/patient experience and outcomes and forms the backbone of the transformation agenda.

    5. Developing an integrated service, workforce and financial planning framework, delivering a balanced financial and workforce plan for 2015/16 that ensures safe and affordable establishments and demonstrates value for money and secures ongoing financial stability.

    6. Developing a robust performance management framework that demonstrates accountability and transparency, meets the needs of the Trust and Commissioners and is timely and sufficiently detailed for a range of stakeholders within and outside the Trust.

    7. Developing a workforce, OD and improvement transformation programme that is aligned to delivering the IMTP, and enables the Trust to achieve its aspiration to become a high performing organisation.

    8. Strengthening the infrastructure required to support delivery e.g. governance framework, estates strategy, health informatics

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    The key priorities identified for the coming year are supported by clear plans

    on a page, have defined executive sponsorship and a robust performance

    management framework for delivery.


    WASTs strategy for the period to 2017/18 needs to be seen within the following


    An increasingly elderly population and the growing incidence and prevalence

    of chronic disease will drive changes in demand for emergency care.

    WAST must redesign at pace its current clinical/ service model for emergency

    care, patient care services and its workforce , as well as preparing for the

    transition to 111.

    There is an opportunity for WAST to extend its role to include better

    supporting primary care and other forms of OOH/ unscheduled care to

    improve integrated working.

    There is an imperative to provide high quality care and deliver improved

    efficiency/ productivity.

    Commissioner requirements of WAST are evolving and commissioning

    arrangements will mature over time. WAST will work collaboratively with its

    commissioners and partner Health Boards to collectively improve the delivery

    of unscheduled and planned care across the health system in Wales and

    improve the experience and outcomes for patients.

    WASTs strategy for the next three years is to:

    Move from an emergency transport service to a clinically led, clinically driven

    healthcare provider of emergency medical services and urgent care services

    that focuses on optimum clinical outcomes for patients

    Establish a reputation as a credible organisation which is an integral and

    respected part of the Unscheduled Care system.

    Be seen as a key partner in the delivery of a responsive, efficient, effective

    and fully integrated transport and clinical care service that delivers dependent

    users to care

    The Trust will achieve this through:

    Stabilising operational and financial performance(S)

    Improving quality and safety (I)

    Re-orientating the organisation in line with its mission to provide high quality

    and patient led clinical care emergency, urgent, scheduled wherever and

    whenever they are needed (R)

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    Transforming the effectiveness and efficiency of the organisation through a

    process of organisational development, efficiency improvement, technological

    innovation and engagement with both other emergency services and local

    communities (T)

    Organisational Design and Development Strategy

    The Trust has set itself the ambitious target of becoming a High Performing

    Organisation. This sets the scene for the organisations OD challenge. In 2014/15

    the OD Plan Being our Best focussed on mind-set and bringing about behavioural

    change across the Trust, starting with a refresh of our organisational values and

    expected behaviours. This strategy is beginning to gain momentum with evidence of

    staff taking on board the simple messaging linked to the idea of ask, dont tell.

    Values will be refreshed and agreed with the engagement of staff and their

    representatives in 2015/6.

    In 2015/16, we will refresh and expand our OD Strategy to build upon the work that

    has gone before, and align strategy, priorities and plans towards delivering the

    aspiration to become a High Performing Organisation. To do this, we need to ask

    whether our strategy, plans and activities help us to do one or more of the following:

    Drive Operational Excellence

    Balancing planning for the future with delivering short term priorities, providing a

    focus on delivering excellence using service improvement methodology to challenge

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    systems, processes and ways of working. Identifying opportunities to transform

    business as usual processes.

    Develop Authentic, Empowering Leaders

    Identifying and developing Leaders and true leadership behaviours; identifying

    leaders capable of collaboratively involving others to develop a shared vision,

    aligning strategy and operational delivery, listening and building trusting

    relationships, and empowering people to do their jobs and operate at the top of their

    scope of practice and competence. Developing clinical leaders who will provide

    encouragement for innovation and support for considered risk taking; challenging

    norms, developing talent, and importantly, leaders who can lead through uncertainty.

    Create Co- Productive Partnerships

    Involving, actively listening and responding to our patients, partners, staff, trade

    unions and public expectations. Ensuring staff have the skills to understand and

    value the contribution that engagement makes. Building a co productive

    partnerships, to improve, develop and deliver services, ensuring real opportunities

    for effective feedback, communication, engagement and listening.

    Invest in People and Performance

    Investing in our people to build capacity and capability, focussing on developing high

    performing individuals and teams. Delivering improvement through performance

    management processes, KPIs and ensuring clear accountabilities. Creating a

    flexible, sustainable future workforce, resilient and ready for change.

    The Trusts IMTP identifies 8 key enabling strategies and/or underpinning

    programmes of work (including a need to ensure the infrastructure for delivery) as its

    2015/16 priorities. The Workforce, OD & Improvement Programme is one of these

    enabling programmes of work and will underpin and support the Trust to deliver

    against all these ambitious OD aims and against IMTP priorities.



    Prior to the formation of EASC, there were inadequate arrangements and

    documentation in place covering the commissioning of emergency ambulance

    services between Health Boards and the Welsh Ambulance Services NHS Trust


    The Emergency Ambulance Services Committee (EASC), at its inaugural meeting in

    April 2014, sponsored the use of CAREMORE for the creation of a Commissioning,

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    Quality & Delivery Framework Agreement (Framework Agreement) for Emergency

    Ambulance Services.

    A Collaborative Commissioning Project Group was established to lead the

    production of the Framework Agreement, which consisted of representation, at

    executive director level, from all Health Boards and WAST, together with Welsh

    Government and Public Health Wales. Collaborative Commissioning was the

    favoured methodology as it endorses the national once for Wales approach to

    share and develop ideas in a non-competitive environment. This is the situation in

    which CAREMORE has been successfully applied to develop the Framework


    An Interim Collaborative Commissioning Agreement (ICCA) for 2014/15 was

    developed by the Collaborative Commissioning Group and then agreed for 2014/15

    between EASC and WAST. This agreement set out the original intentions for each

    Section of the Framework Agreement, together with the interim arrangements for

    2014/15 as a transitional year

    The National Collaborative Commissioning Quality and Delivery Framework is an

    agreement on key areas of service between NHS Wales Health Boards and WAST

    through a new National Collaborative Commissioning: Quality & Delivery Framework

    Agreement, which details:

    what is required (commissioning);

    how assurance is given for what is required (quality); and

    how the what is required will be achieved (delivery).

    The Quality and Delivery Framework, and the development of the new clinical

    model, has a significant influence on the development of the revised Planning and

    Performance Framework, the design and delivery of the workforce, organisational

    development and improvement transformation programme and the finance and

    resources plan that are detailed later.

    EASC and WAST have sanctioned the Framework Agreement to become

    operational from 1st April 2015 for a minimum of a three (3) year period that is

    2015/16 to 2017/18.

    It is recognised that the Framework Agreement will need to be a live document to

    enable updating to take place as collaborative relationships/understandings of

    service provision and required improvements between stakeholders develop.

    Updating will also take place as and when policy changes are agreed and

    implemented. Ther...


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