2007/08 Annual Review
Welcome Tim Lynch, Chief Executive There have been many successes this year for Great Western Ambulance Service (GWAS) as well as a number of challenges. At the same time as keeping up with national targets on delivery of patient care, we have been working to get structural systems into place following the merger of the three ambulance trusts in 2006. We have made big strides with new technology, joining up our three predecessor systems into an interim Computer Aided Dispatch (CAD) system, and installing new human resources software. Each year Ambulance Trusts are measured in a number of ways against various national government targets. Perhaps the most important of all is how quickly we reach our patients. Though we didn’t reach the national target across the whole year, the introduction of better systems, coupled with the dedication of our staff has helped us to become quicker and more accurate in our responses. Next year we will have to cut a further 90 seconds from our response time to meet the latest “Call Connect” targets, a particular challenge with our large rural areas. We have met 37 of 39 Standards for Better Health targets this year. Though we did not meet our statutory training or appraisal targets for staff, our new HR system will help us track these better next year. We trained and licensed more Paramedics to give thrombolysis and expect to hit our joint thrombolysis target by the autumn of 2008. We’ve also trained eight new critical care practitioners in anticipation of the arrival later in 2008 of our new air ambulance. Emergency Care Practitioners (ECP) are helping us expand our urgent care services offering more choice, treatment at home and support for referral.
Our ECPs, together with our fledgling clinical desks, access to care and out of hours services, are already successfully providing more choice and more appropriate routes to care than admission to hospital. We’ve started a programme of review and updating of our ambulance stations, improved the quality and amount of equipment available to our Paramedic teams and in 2008 will be introducing a new service wide standard uniform, designed to resist infection. New “Make Ready” teams are regularly deep cleaning our vehicles and we have a contract with Royal United Hospital Bath to provide infection control advice and support. As well as making progress in our services and operations, our financial position has been managed prudently. We have ended the year with a surplus of £1.45m which has enabled us to pay off the debt of our predecessor organisations. The number of Primary Care Trusts in the GWAS area has made commissioning of our services complex, and this year we welcome a new lead commissioner for our services, Gloucester PCT. With the national dissolution of Patient and Public Involvement Forums, and the diversity of our large geographical area, we are still working with partner organisations on how enhance and improve public involvement. We don’t want to lose the value and experience of the existing Forum members while the new Local Involvement Networks set up, so we will be inviting them to work with us next year on various projects. We’ve still much to do to meet our three year plan, but much progress has been made.
Welcome Tony FitzSimons, Chairman It is our aim at Great Western Ambulance Service that our patients receive the right care at the right time and in the right place. This no longer just means rapid responses to 999 calls or transporting patients to hospital, it is challenging us to develop into the mobile, urgent healthcare service of the NHS. Entrance to care has often meant entering the doors of an accident and emergency unit - whether or not it was appropriate. Our emerging urgent care services provide joined up partnership-working to assess, treat and arrange alternative care options. Even where admission to hospital is the right solution, we aim to arrange it directly with the appropriate ward. We are investing in and developing the skills of our staff to respond to this changing agenda. We are currently training 53 Paramedics as Emergency Care Practitioners and will train a further 20 next year. We are giving another 80 Ambulance Practitioners the opportunity to qualify as Paramedics. We are also recruiting more Emergency Care Assistants.
are already starting to base our clinical services in GP and Minor Injury Units. We need to examine whether we can sustain and improve our response times if we base emergency ambulances alongside such clinical care, rather than from existing ambulance stations. Change is inevitable as we respond to the urgent healthcare service relevant to today’s patient. This means a challenging working environment for our staff, but their commitment to their patients is clear. This year they have saved more lives, transported more people more quickly, and developed our urgent care services. It is therefore right that this year’s annual report is led by our staff, taking you on a journey through the services we offer explaining what they do.
Next year will bring further challenges about which we will be consulting with our staff and the public. We need to work efficiently and cost effectively and are proposing to centralise our patient transport call centres into a single hub. We
Please tell us what you think of our annual report. To give us feedback please e-mail to pals@gwas.nhs.uk , phone our PALS co-ordinator on 01249 858500 or write to us at GWAS, Jenner House, Langley Park Estate, Chippenham, Wiltshire SN15 1GG.
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999 or mobile healt
Always there, how
How we did Category A Calls • We arrived at 72.2% of immediately life threatening incidents within 8 minutes. The national target is 75%. By the end of March we were responding to 78.7%. • A transport vehicle arrived at 93.1% of immediately life threatening incidents within 19 minutes. The national target is 95%.
The ambulance service is evolving into the mobile healthcare arm of the NHS. As we work more and more closely with hospitals, social and community health services, we are no longer just a 999 service. Our Paramedics can treat you in your own home when the right response isn’t a trip to hospital. Assessing the type of response you might need is the role of our Emergency Medical Dispatch Service.
Category B Calls • We arrived at 85.8% of urgent but non-life threatening incidents within 19 minutes. The national target is 95%.
Category C Calls • We arrived at 82.6% of non-urgent, non life threatening incidents within 60 minutes. Our local target is 95%.
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Melanie’s story: inside the call centre When you ring 999 and get put through to the ambulance service you could find yourself talking to Melanie Battin, one of our Call Handlers. “The call comes straight through to your headset. The 999 operator passes on the telephone number and you start to type in a description. We take the patient through a series of questions which establishes the priority, either Category A, the highest, Category B, serious but not life threatening or Category C, not
life threatening but in-need of transport or other urgent care support. The information I put in the system is picked up by a Medical Dispatcher who organises the type of response. If necessary we stay on the phone to give first aid advice on how the patient can be helped.” “You feel you’ve done your bit to help. We offer first care, reassurance and support. It makes you feel really good, I love it.”
thcare
wever you need us Pauline’s story: medical dispatch
Key facts
Our Medical Dispatchers have at their fingertips a wide range of responses. Rapid response cars, ambulances, helicopters and Emergency Care Practitioners who can assess the care you require or provide on-the-spot treatment.
• Our team: 66 call handlers
Pauline Hartwell is a Medical Dispatcher in Gloucestershire. She dispatched the call the night of a major road traffic collision in Moreton-in-Marsh which hit the national news. “Normally I would have sent out a rapid response vehicle, but it would have had to come from Cheltenham
or Tewkesbury and there was an ambulance available in Moreton-in-Marsh that night so I dispatched it immediately and it arrived at the scene in less than four minutes. In a case like this the crew of the first vehicle assesses the situation and calls us back if they need more help or assistance. You could tell by their voices when they rang back that there had tragically been a fatality. Sometimes our job is very challenging, but I enjoy working for the NHS, you feel it is really worthwhile and that you are helping people.”
and 30 dispatchers
• 216,810 – the number of 999 calls we responded to:
o 73,668 – Category A o 91,055 – Category B o 52,087 – Category C • 52 – the number of times we used Language Line.
This year • We standardised Computer Aided Dispatch systems across GWAS and introduced new mobile data technology in Gloucester.
Next year • From 1 April 2008 the national response time targets start from the moment the call hits the call centre. We call this “Call Connect”. Previously timing started once the Call Handler had the address, telephone number and chief complaint. Our challenge is to arrive with our patients 90 seconds earlier.
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Your emergency te
Always there, how
Key facts • We employ o 324 Paramedics
(including Critical Care Practitioners)
o 330 Ambulance Practitioners
o 103 Emergency Care Assistants
o 59 Clinical Team Leaders o 9 Service Delivery Managers
• Our emergency teams use: o 104 Ambulances o 74 Rapid Response Cars • In Gloucestershire we second staff to the County Air Ambulance Service based in the West Midlands at Strensham Motorway Services
• In Wiltshire we share a joint helicopter with the police – it has three crew: a pilot, a police observer and a Paramedic.
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Paramedics lead the teams responding to a 999 emergency call. They assess the patient’s condition and give essential treatment.
Rhonda’s story: critical care Critical Care Paramedics have advanced training in life-saving procedures, including delivery of drugs and anaesthetics. They arrive at the scene in a fast response car or helicopter. They often work with a doctor accredited by the ambulance service. Rhonda Collins, a Critical Care Paramedic explains their role: “We deal with the most serious critically ill patients, often those involved in road traffic collisions or with gunshot wounds, who have been stabbed or who are already unconscious. Time is critical and we save lives by bringing the hospital to the patient. Patients are often in severe pain, we can deliver advanced pain relief or even a general anaesthetic. This allows us to breathe for them while we deal with their injuries. We open airways when patients can’t breathe and perform surgical procedures usually associated with hospital. When they are as stable as we can make them,
we transport patients to the most appropriate (not the nearest) hospital to deal with their injuries. We are getting an air ambulance in summer 2008, so my team has completed Helicopter Emergency Medical Service Air Crew training. This means we can act as navigators in aircraft as well as caring for critically ill patients in flight.”
eam
wever you need us Thrombolysis • Saves lives and drastically improves the quality of life by preventing heart muscle from dying
• The sooner it is given, the greater the benefit to the patient
• GWAS, the Acute
Gail’s story: paramedic care Gail Snook is a Paramedic gave him some pain killing working on a two-person drugs. There were no obvious ambulance. She’s one of the changes at first, but 11 minutes increasing number of our later the ECG machine sensors Paramedics giving triggered. The patient thrombolysis, a vital started to have crushing life-saving drug chest pain, his colour It is nice to treatment which changed and he looked think that breaks up the blood very poorly. He gave us you can do clot that causes permission to give the something a heart attack. clot busting drug. It was that makes a difference in Convinced of its amazing. The change a real way. importance, Gail was dramatic. recalls the first time she gave drug: Within minutes, the obvious changes to his ECG had “We got a call out to a man settled down and by the time who was experiencing chest we got him to the Accident and pain. He had previously had Emergency Department he was two heart attacks. When already looking much better. we got there he looked It is nice to think that you can reasonably well, but we took do something that makes a an electrocardiogram (ECG) difference in a real way. to check his condition and
“
Trusts and Primary Care Trusts in Avon, Gloucestershire and Wiltshire have a joint target to thrombolyse 68% of patients within one hour of calling for help. (Current results 56% - full year results due June 2008).
“
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Skilled and experie
Always there, how
Simon’s story: emergency care assistants Simon Barnfather is an Emergency Care Assistant. He works with a Paramedic in a two person ambulance, assists with giving care and has advanced driver training. It’s his job to reach patients rapidly and ensure they get to hospital quickly and safely. “One late evening we were called out on 999 to a man whose chest pain had lasted for several hours. We often struggle to find addresses when house numbers or names are poorly displayed and this can significantly delay our arrival. Fortunately the patient had switched on all the lights and had opened the
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curtains so the house was easy to find. He looked ill when we arrived, he was pale and clammy. I helped my Paramedic crewmate, reassuring the patient and taking basic observations. Once we had stabilised him, it was my job to get us swiftly to the hospital. Fortunately, we don’t often have to use blue lights and sirens to take patients to hospital but sometimes the outcome for the patient depends on it. We were delighted to find later that the man had made a full recovery.”
This year • 49 Ambulance Practitioners qualified as Paramedics • We developed the new role of the Emergency Care Assistant • We trained 41 new Emergency Care Assistants in clinical support and advanced driving • Paramedics can now thrombolyse a wider range of patients. Those who have been suffering chest pains for up to twelve hours may now be treated in the ambulance.
Neville’s story:
clinical team leader
Paramedics know our service and are involved in leading it. This year we have introduced a new development role, Clinical Team Leader. Neville Levy explains: “Clinical Team Leaders are Paramedics who manage a team of ten and are responsible for ensuring services are available around the clock. The role offers an opportunity for promotion and management while still working as a Paramedic in
enced
wever you need us Maggie’s story: ambulance practitioner Over the next few years all our Ambulance Practitioners are being offered the opportunity to become Paramedics. Maggie Plank has just finished her Paramedic course. “Working with colleague Paramedics for six years, I was becoming frustrated when jobs needed Paramedic intervention. This was the final push I needed to apply for a course to become a Paramedic myself. The course was great. I very
Next year • A new air ambulance will be delivered to our team of Critical Care Paramedics much enjoyed the theory which was broken into manageable modules. The second part of the course was based in hospital and included placements in operating theatres, intensive care and casualty. I am really looking forward to putting my new practical skills into use on the road. The course has re-kindled my enthusiasm and determination to continue to improve my skills.”
• We will be taking part in an international trial comparing thrombolysis in an ambulance to rapid access to a cardiac catheter laboratory • We are on target to thrombolyse 68% of patients by Autumn 2008 through an action plan to train and qualify more Paramedics to deliver the drug
148 Staff were promoted during the year. your team. It’s your job to support the welfare and clinical development of your staff. Staff really like the change to a fixed team leader rather than reporting to whoever happened to be on call.
I’ve now had the opportunity to develop from Clinical Team Leader into a Service Delivery Manager. I am responsible for a group of Clinical Team Leaders and their staff. I’m also responsible for investigating complaints and work directly with our partners, such as the local Emergency Department. The job gives me the opportunity to improve the service, and working conditions and quality of life for my staff.”
• We will be training a further 80 Ambulance Practitioners as Paramedics • We will be replacing a third of our ambulances.
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Community First Re
Always there, how A tragedy averted... Phil Hardborn is a Community First Responder (CFR) living in Gloucestershire. Last year he got a call about a patient needing assistance on Rodway Hills golf course close by. Phil was at his patient’s side within minutes. Phil Hardborn (L), Thomas Finnigan (R), Sean Finnigan (in cart)
Thomas’s story: “Sean, my son, and I were out for our regular round of golf at the Rodway Hills Golf Course. We played the first three holes and then I tee’d off on the fourth and woke up in Intensive Care in Gloucestershire Royal Hospital. I’ve had a series of problems with my heart for twenty years and have had a triple bypass operation. It could have happened to me at any time, but an irregular heartbeat meant my heart just stopped beating. Phil Hardborn quickly arrived on the scene. He used his hands-on-experience and mobile defibrillator unit to stabilise me until the ambulance arrived. Apparently it was a close run thing, but the cardiac unit also managed to keep me alive. Two months later I was fitted with an internal defibrillator in my chest. I’m now back at work and able to do pretty much everything, but the wonders of modern technology would have been of no use to me if it were not for the existence of the Community First Responders who give their 10
time unstintingly to help people they have never known or met but are willing to respond when they get the call. On the first anniversary of my ‘incident’ I returned to play golf with Sean and meet the members of the St John’s Ambulance Group. It gave me the opportunity to thank them for saving my life and to personally thank Phil and Kevin, the Community First Response Manager.”
Community First Responders Our Community First Responders are a vital part of our emergency care services. They are volunteers who respond from their home addresses or work places to patients with life threatening medical emergencies. They either keep or have rapid access to a defibrillator and their speed of attendance can mean life or death whilst an ambulance is on the way. If you live in the Great Western Ambulance Service area and would like to know more about becoming a Community First Responder at work or from home, contact us on: 0117 928 0485.
esponders
wever you need us
Phil Harden and members of the Gloucestershire Community First Responders
Phil’s story: “The reunion on the golf course was quite an emotional event. Realising that the guy I was talking to wouldn’t have been here without the immediate assistance I was able to give as a first responder was a really good feeling. Everything fell into place exactly right for Thomas, he
was with other people when he collapsed, another golfer started CPR straight away and when I got the call I was only a mile away. This was only the third call out for my team and it has given us and the rest of the responders a great boost knowing that we really can make a difference. The training we receive through St John Ambulance in the use of defibriliiators and oxygen prepares you to deal with incidents like this confidently and effectively. It was good to meet up with Thomas and his son and see them enjoying another round of golf at Rodway Hills.”
Key Facts • There are around 300 Community First Responders across GWAS • Around 300 life threatening incidents are attended each week across GWAS by Community First Responders, people using defibrillation equipment placed in public sites or by co-responders such as fire fighters or police • CFRs operate within a 3 mile radius of their home or place of work • The average time it takes for a CFR to arrive on scene is 2.5 minutes • 92% of CFRs across GWAS provide life saving emergency care within 6 minutes of them calling for help • GWAS also works with other organisations including the Fire and Rescue Services.
This year • We placed around 120 defibrillators in the community • We have recruited around 70 new community first responders.
Next year • We are planning 24 new Community First Responder teams across the Trust. 11
Treatment at home or help on the phon Emergency Care Practitioners Not everyone needs or wants transport to hospital. Our Emergency Care Practitioners (ECP) are increasingly based in minor injury units or primary care centres across the region. ECPs are Paramedics or Nurses with advanced clinical assessment and treatment skills. They are able to provide face to face assessment and on-the-spot treatment. They’ve access to a wider range of drugs and medications and diagnostic tests than a Paramedic and can make referrals or transport patients to GP surgeries or minor injury units.
Mark’s story: ECP Mark Maisey says ECPs represent a new era in prehospital care and an exciting addition to the many core skills already gained from Paramedic experience. “A great advance is our ability to give antibiotics. I attended a man who was having rigors
side-swiped by a car and had
(uncontrollable shakes due to
an injured knee. I did a joint
high temperature) and gave a
assessment to check his knee
course of antibiotics. He could
wasn’t broken and was able
stay at home and I advised his
to prescribe painkillers for him
GP of my treatment. I was able
so he could go home and rest
to give intravenous antibiotics
rather than go to hospital.”
to a different patient who had sepsis (blood poisoning) and
Among our skills we are
arrange his direct admission to
trained to deal with closing
a hospital ward avoiding the
wounds with steri-strips, staples
Emergency Department.
or stitches when previously an Emergency Department
On the roadside I was able to
admission would have been
come to the aid of a young
unavoidable.”
motorcyclist who had been
ne
Always there, however you need us
Key facts We employ: • 9 ECP Clinical Team Leaders • 28 ECPs • 12 urgent care doctors • 58 call takers, clinicians and support staff We took:
Urgent care
• 108,547 calls at
Our urgent care and out of hours services work closely with social services and GPs to find the right solutions for patients. Our clinical desks are staffed 24 hours a day by Nurses, staff from NHS Direct and Emergency Care Practitioners. They take some Category C 999 calls to assess their urgency and support practitioners in the field.
Gloucestershire Hub for Health • around 1500 calls a month in Wiltshire Access to Care Services • 165 calls in March at Avon Clinical Desk 110 were referrals from ambulance crews
Brian’s story: clinical desks
This year • 53 Emergency Care
Clinical desks don’t just assess patients with physical problems. They also arrange care for patients with mental health problems. Brian Jarvis explains: “Sometimes a caller with a mental health issue will ring the urgent care
us, them and the patient. The
desk. Once we have ruled out
person may require immediate
any life threatening illness or
admission or an appointment
injury, we consider how best
to be seen the next day. We
we can help address their
alert the patient’s GP via
underlying mental health.
some special software, so
We contact the mental health
they are aware of how often
crisis team, or duty care team
the patient has called, the
and may arrange a three way
nature of their distress and any
telephone conference between
arrangements made for them.”
Practitioners started training • Over 25% of ECP call-outs avoided admission to hospital • Wiltshire Access to Care Services started in July 2007 • Avon and Gloucestershire Clinical Desks started in December 2007.
Next year • We will train 20 more ECPs • Following its successful pilot the Gloucestershire Hub for Health and Social Care will be fully implemented in April 2008. 13
Help on the phone Always there, however you need us
Gloucestershire Hub for Health Gloucestershire is leading the way on urgent care with its “Hub for Health and Social Care”. Gloucestershire’s out of hours service is run in partnership between Gloucestershire PCT and GWAS. Anita Harris, a Paramedic explains: “We are there to help both patients phoning in directly and also to support other healthcare professionals. We work very closely with social services care co-ordinators, GPs and District Nurses. We have access to local services and resources at our finger tips. Call Handlers pass us calls to assess and we look for the best solution.
A lady who was the sole carer for her disabled husband needed to go into hospital urgently, but she was reluctant to leave him. The Paramedic rang us to see if we could help. We arranged with the Social Care Co-ordinator for a respite bed for her husband and transport to get him there and the lady was then happy to go into hospital.” Dr Jasmine Goraya is one of three doctors on call each night who with their driver can travel anywhere across Gloucestershire on home visits. “We get calls from the centre and information comes to the computer in our car about patients who have been referred for a home visit. We have access to a much wider range of equipment and drugs than a GP visiting a patient,
who would often have to refer the patient to hospital. I recently saw a gentleman in his 50s who had terminal cancer. He didn’t want to go back to hospital again, but was in great pain and dehydrated due to vomiting. I was able to set up an intravenous drip and provide him with morphine and drugs to stop his vomiting. Via the hub I spoke to the District Nurse on-call who came in to set up a continuous pain killing infusion with the medication I was able to leave. My treatment is relayed by the car’s computer back to the hub and automatically faxed through to GP surgeries.”
Wiltshire’s Access to Care Services
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In Wiltshire we provide a 24 hour single point of contact for all health and social care practitioners. It is designed
to refer patients to the right solution whether that is overnight assistance, mental health care, or home support.
Supporting the team Always there, whenever you need us Ambulance crews are responsible for cleaning their vehicles day to day, but preventing cross-infection is vital when you have patient after patient in the back of your ambulance. This year we started to employ new GWAS Make Ready Teams to ‘deep clean’ our vehicles.
Key facts • 62 staff and managers support our operations, including 12 mechanics and 5 make ready personnel.
This year • We deep cleaned 723 ambulances • Over 200 staff registered for the
Mickey’s story: make ready team Mickey Mack is a one of the new team, deep cleaning vehicles. “As a retired Paramedic, I know just how vital infection control is both for our patients and for us as staff. GWAS started a programme of deep cleaning ambulances in April 2007 and it’s my job as part of the Make Ready Team, to ensure all vehicles are deep cleaned every four to five weeks or whenever there has been any contamination by bodily fluids.
We’ve had a great response from the ambulance and vehicle crews who have commented on the pleasure of going on duty in such a nice clean vehicle.”
NHS core learning infection control package • We agreed a contract with Royal United Hospital NHS Trust for infection control advice, audit, and training • Since its implementation in November 2007 infection control advice has been available around the clock • We have included infection control in our specification for new ambulances across the Trust.
Next year • New uniform trousers will provide greater infection control as they are treated with Permaguard a special layer that reduces the risk of infection being carried on the garment • New short-sleeved shirts and fob watches will help ambulance staff remain bare below the elbow to improve hand hygiene • We will be producing a patient information leaflet • GWAS is taking part in the ‘Clean Your Hands’ campaign which will be 15 launched on 30th June.
Transporting Patien
Always there, how
Key facts • 192 - the number of people we employ in our patient transport services
• 180 - the average number of volunteer drivers
• 88 – the number of patient transport ambulances
• 15 - the number of vehicles with stretchers
• 315,399 – the number of patient journeys.
Isabel’s story: ambulance care Ambulance Care Assistants deliver our Patient Transport Services. They look after patients on the journey to and from hospital for routine admissions or outpatient appointments. Many of the passengers are in poor health so all our Ambulance Care Assistants have first aid skills in case of a medical emergency. Isabel Rodriguez explains her role:
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“Being an Ambulance Care Assistant is about solving problems. Every job is a rolling risk assessment! Getting patients in and out of their homes either walking, in a wheelchair or on a
stretcher means thinking out of the box. You are constantly having to solve problems like how to get a wheelchair up steps on an angle, or get a stretcher past a corner in a house with a narrow passage way. I love the patient care, you meet so many different people every day and you are, you hope, part of their improving health. It’s really rewarding. Patients are very grateful especially those who are housebound as even a visit to hospital can be a trip out for them, making their days nicer and more interesting. It also gets you out and about.”
nts
wever you need us Caroline’s story: patient transport Caroline Plant works for GWAS Patient Transport Services as a dispatcher. She arranges for patients to be transported to outpatients, or for admission to or discharge from, hospital. It’s her job to work out the best use of drivers and vehicles. “Quite a lot of our work is pre-booked, but we also have to work out the best way to fit in last minute jobs such as arranging transport for people being discharged from hospital. We negotiate with the wards and liaise with the ambulance
crews, fitting in additional pick-ups around scheduled work. This often means re-arranging the priority of calls. We recently got a phone call asking for help after a ward in a local hospital had flooded. All the mobile patients had been moved, but one lady was too ill to be left unattended. She needed a stretcher and transport to another hospital so she could receive the care she needed. A crew had just arrived at the hospital to pick up another patient, so I reprioritised their work so they could take this lady first.”
Audrey’s story: volunteer driver GWAS also has a small army of volunteer drivers who take mobile patients to hospital in their own cars. Audrey Pring is a long serving volunteer driver: “I started work with the Ambulance Service as a volunteer driver in 1985. I take patients who need treatment
back and forward to hospital. Patients might be having regular treatment for cancer or have kidney dialysis, so you build up a rapport with them over a period. You also have a good camaraderie with the other drivers. To do the job you have to be caring and patient as there is a lot of waiting around. Fortunately we have a very supportive set of journey planners who work around our individual requirements. There are ups and downs like any job, but would I do it all again? Yes I would.”
This year • We installed new control room computer systems in Gloucester and Devizes.
Next year • We will install a new control room computer system in Bristol
• We will consult with staff about central coordination of the service
• We will be replacing 30 PTS vehicles, over a third of the fleet.
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Partnerships Always there, whenever they need us Key facts
Richard’s story: civil contingency
• GWAS covers three Local
Last year’s flooding in
were experiencing very real
Gloucestershire highlighted the
difficulties in reaching patients
vital need for services to work
and were receiving a significant
closely together on emergency
rise in calls for assistance.
Resilience Forums • We have seven dedicated Major Incident Support Units across the Trust area • We have 140 Special Operations Response Team personnel trained to deal with chemical decontamination.
This year • We replaced our mobile personnel decontamination units • We trained our Clinical Team Leaders how to respond in emergencies • We planned for Pandemic Flu including vaccine preparation, infection control and contingency planning for up to a third of emergency staff off sick. • We opened a new central incident command suite.
Next year • We will be holding a live major incident exercise in Wiltshire. 18
planning. The head of our Civil Contingencies team, Richard
The following two weeks
McKeand explains:
presented a real challenge. Many staff were victims
“For emergency planning
themselves, some being
we work with partners in
seriously flooded and without
the Local Resilience Forums.
running water, many couldn’t
Partners include local hospitals
get home. Despite these
and Primary Care Trusts, the
difficulties GWAS staff were still
police and fire services, local
out and about helping others.
authorities and the Health
Staff on duty in Moreton-in-
Protection Agency. We plan
Marsh worked for over 24 hours
for emergencies such as train
without a break. Emergency
or plane crashes, public health
staff waded chest deep in
issues such as pandemic flu or
flood waters to reach seriously
severe weather.
ill patients. Our volunteer car drivers worked throughout the
GWAS was the first to declare
night to transport renal dialysis
a Major Incident during
patients for treatment to
the flooding in 2007. We
hospitals in Birmingham.”
Our staff There for you, however you need them
You’ve met some of our staff already. The service wouldn’t run without them. This year and next we are doing more to formally recognise their achievements.
Key Facts
This year
• We employed 1478 staff
• Chief Executive Commendations were introduced. The
at the end of March 2008 - of those:
o 266 were new starters o 236 declared an ethnic origin other than White British*
o 2 declared a disability* o 148 staff received promotion
o 80 emergency and
non-emergency staff with 20 and 30 years service were honoured in the first Great Western Ambulance Service Awards Ceremony.
*Declaration is voluntary and not all staff disclose this information
first was awarded to Michaela Myers, a Paramedic, for services above and beyond the call of duty. Michaela was out shopping in a supermarket with her children when she came to the aid of a customer
• We introduced a new payroll system this year and updated information about the composition of our staff.
Next year • In 2008 we will be celebrating the 60th Anniversary of the NHS
• A new ‘Pride of GWAS’ ceremony will host many new awards including Student, Community Responder, Accident & Emergency, Patient Transport and Support Service Person of the Year. There will also be awards for Innovation, Lifetime Achievement and best Chief Executive’s Commendation.
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Patient and Public Involvement
Involving you in what we do
Key facts
As customers of our services, the public have an important role
• 10 - the number of
ways of becoming involved was through the Patient and Public
people on GWAS PPI
to play in how we deliver our services. During 2007-08 one of the Involvement Forum (PPIF).
Forum
• 320 - the number of PALS enquires in 2007-8
• 330 - the number of complaints in 2007-8
• 311 - the number of letters of thanks received in the six months to March 2007.
Albert’s story: PPIF member We interviewed Albert Weager, a PPIF member: How did you become involved with PPIF? I had a heart attack. Did you know that 6am on a bank holiday is a very good time to get an ambulance? I woke up with intense chest pain, and was quickly whipped off to hospital. I actually knew one of the ambulance Paramedics socially, and the whole experience gave me a warm feeling towards the ambulance service. I was involved with a hospital group in Gloucester and when I had recovered they said, why don’t you get on the PPIF? I had a thirty minute telephone interview and got invited to join the Gloucestershire Ambulance PPIF just as it was merging to become GWAS.
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What are the benefits of the public being involved? We represent outside interests; we sit on the other side of the fence and can put forward views representing patients and the
public. We can see things from a wider perspective not just an organisational or corporate interest. I think being involved is very important. What sort of things do you actually do? We can liaise with the public about changes to proposed services. If you sit on a committee you can make comments or suggest different ways of doing something. Last year we did a survey with the PPIF for the Gloucestershire Primary Care Trust (PCT), which commissions GWAS services. It was about different ways patients get to hospital, how long it takes and accessibility issues such as parking. We also looked at patient transport services. We concluded that there were a number of actions from a previous report that still needed implementation. PPIFs were disbanded on 1st April 2008, how will you continue to be involved? GWAS is setting up a series of committees to look at different aspects of the service. We are all being invited to join the committees to continue our role.
Patient Advice and Liaison
Listening to you, whenever you need us Patient Advice and Liaison Service (PALS) is an accessible and confidential service for patients, relatives, and carers. It is there when you don’t know where to turn, when you need information or advice, or have concerns about the Ambulance Service.
This year • We went out to public consultation on our equality and diversity strategy.
Next year • GWAS will be working towards a joint health overview scrutiny committee with all seven authorities in the GWAS area and developing the GWAS Local Involvement Networks.
Kim’s story: PALS and Complaints co-ordinator Kim Birch is the GWAS PALS co-ordinator. She actively listens to patients’ concerns suggestions or queries and sorts out problems quickly on their behalf. She also arranges for complaints to be investigated.
advice on how to become a Paramedic.
It must be quite difficult to deal with complaints? No actually, it is a really important part of our service. We need to know if things are going wrong so that we can put them right in the future.
What type of complaints to you get? Sometimes it’s about the length of time it has taken to respond to a 999 call. For non life-threatening conditions such as a broken ankle, the call priority is Category C or non-life threatening. The target for arrival is an hour and that will seem a very long time to someone in pain. In a few cases, the complaint can be something quite serious which needs a detailed and thorough investigation.
What sort of queries to you get? It might be that they want to get hold of a policy document or leaflet about the service, to say thanks to a local ambulance crew or even ask
What attracted you to the job? I enjoy helping people to resolve their concerns and its satisfying to help people understand how the ambulance service works. 21
Our Board of Directors Executive Directors Tim Lynch
Ossie Rawstorne
Chief Executive
Clinical Director
Karl Henderson
Judy Saunders
Director of Finance
Director of HR & Organisational Development
Steve West Director of Operations
Rachel Pearce Director of Corporate Development
Non Executive Directors Tony FitzSimons Chairman, Non Executive Director
Liz McLoughlin Non Executive Director 22
Leo Doyle Non Executive Director
Christopher Davidson Non Executive Director
John Higginson Non Executive Director
John Newman Non Executive Director (appointed 1st November 2007)
How much does it cost? 10%
4%
49%
In 2007/8 we spent £67.54m Distribution 7%
1%1% Call Centres who take the initial call and respond the request sending a message to a waiting vehicle.
10% 10% £4.72m
1%
Fleet
£6.70m
18% Maintenance and service of all the Trust’s vehicles. 18%
Logistics
10% 10%
18%
18%
1%1%
Management of the supplies held in the Trust vehicles.
Urgent Care
1%
1%
£0.49m
10% 10%
10%
Providing primary care services outside core working hours.
1%
1%
4%4%
10%
4%
£2.79m
10%
18%
4%
Production
49%
Emergency Response including ambulance staff and emergency care practitioners. 49% 49%
Patient Transport Service
1%
£33.36m 7%
10%
Transporting patients for non-emergency treatment.
1%
£6.55m
49%
4%
10%
Central Overheads Cost of IT, Finance, Human Resources, Executive7%7% Management, Board, Training, Governance.
Financing Costs
18%
£12.42m
7%
Trust debt remuneration minus interest from investments.
1%
49%
1%
£0.51m
10%
10%
We received £68.99m Accident and Emergency Urgent Care Patient Transport Service Other
18%
£56.09m
£3.17m
£7.66m
£2.07m
4%
Our overall financial 7% performance for the year was a surplus of £1.45m. We used this money to pay back the 1% debts of our three predecessor Trusts. 49%
10%
You can write us at:
You can telephone or fax us on:
Great Western Ambulance Service Jenner House, Langley Park Estate Chippenham, Wiltshire SN15 1GG
Tel: 01249 858 000 Fax: 01249 850 091 You can email us at pals@gwas.nhs.uk www.gwas.nhs.uk
We can supply larger print copies of this leaflet and we can put it on tape. Please ask if you would like this publication in another language.
©2008 Great Western Ambulance Service NHS Trust
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