Strategic Winter Framework Local Integrated Winter Plans ......Strategic Winter Framework 2015/16 Version Status Date Notes V1.1 Draft (Initial review) Sept 2015 - 2014/15 Strategic

1

Welsh Ambulance Services NHS Trust Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru

Strategic Winter Framework &

Local Integrated Winter Plans 2015 / 16

Owner: Director of Operations Date: September 2015 Version: 1.3

Status: Approved

2

Document Control Strategic Winter Framework 2014/15 Version Status Date Notes

V1.8 Final Version

Oct 2014 Approved by Quality Delivery Committee

Strategic Winter Framework 2015/16 Version Status Date Notes

V1.1 Draft (Initial review)

Sept 2015 - 2014/15 Strategic Winter Framework reviewed and updated by James Houston / Keith Williams.

- Shared with Operations Directorate

to review and feedback; - Submitted to Executive Management

team for comment on 16th Sept.

V1.2 Draft Sept 2015 - Updated version incorporating changes from the Operations Directorate;

- Updated version re-sent to Executive

Management Team;

V1.3 Approved Sept 2015 - Trust Board

3

Introduction The historical demands brought about during the winter period are well known and require health and social care providers to put into place joined up arrangements to maintain effective health care provision across Wales. The Welsh Ambulance Service NHS Trust (WAST) is a key partner in this, requiring plans that underpin the provision of Emergency Medical Services, Planned Patient Care Services and NHS-Direct Wales. Purpose This framework sets out a series of 16 overarching principles to guide and support the Trust during the 2015/16 winter period to maintain the delivery of a safe and high quality service. The aim of the Strategic Framework is to: “Ensure that the WAST is well placed to maintain safe and robust patient services throughout the 2015/16 winter period.” Objectives In order to achieve the aim the Trust has identified the following key objectives:

1. To provide a clinically safe and effective service that meets the clinical need of the patient;

4. To work with health and social care partners in the development and execution of our plans;

3. To ensure that our plans are well communicated throughout the organisation, responsive in their delivery and based on sound principles that have been tested against the core beliefs of the Trust;

2. That our plans are proportionate in their expectations and maximise on both the financial and physical resources available to the Trust;

4

Scope, Accountability and Governance The Director of Operations is responsible for the delivery and implementation of this „strategic framework‟ is the Director of Operations. This “Strategic Winter Framework” has been developed to demonstrate the actions the Trust will implement in order to provide robust winter resilience. Therefore, it assumes that arrangements relating to major incidents, detailed escalation plans and business continuity arrangements are in place. Therefore, this framework should be read in conjunction with the following:

WAST Major Incident Plan;

WAST Business Continuity Policy and Supporting Arrangements;

National Emergency Pressures Escalation and De-escalation Plan;

NHS Wales Hospital Handover Guidance;

Integrated Winter Plans (WAST / Health Boards / Local Authority plans)

WAST Local Winter Plans; This framework has been developed in conjunction in accordance with a wider range of internal and external winter planning arrangements as required by Welsh Government, local Health Boards and WAST. This includes:

(i) Integrated Winter Plans – these plans have been developed in partnership with each local health board and local authority and forms part of the winter planning arrangements facilitated by Welsh Government. These individualised plans ensure that there is a multi-agency integrated approach to winter planning that spans health and social care, providing joined up solutions to manage winter pressures. (These plans have been embedded into the appendix of this framework).

(ii) WAST Local Winter Plans – in addition to the above integrated winter plans, every Head of Operations has been tasked with developing and implementing robust winter plans outlining the key internal actions to be undertaken across their respective health board area to maintain the delivery of frontline services during the winter period.

Planning Assumptions This framework and underpinning plans have been developed based on the following planning assumptions:

That escalation into the winter period will commence on the 1st October 2015 to 31st March 2016.

That the delivery of the strategic framework and underpinning plans will occur within existing financial and physical resources.

That each health board and local authority will work with the Trust in achieving our stated aim by providing equally sound planning, strategic

5

leadership and arrangements which take account of the impacts their actions may have on the pressures experienced by WAST.

That the influence of an Influenza Pandemic or other similar disease pathogens is not realised, though the Trust will continue to develop arrangements to meet such a challenge using existing planning arrangements.

The Trust will adhere to the national plans / guidance regarding Viral Haemorrhagic Fever (Ebola).

6

Key Strategic Principles The table below outlines the 16 key strategic principles that the Trust will adhere to during periods of winter related pressures;

1 Escalation / De-escalation To manage resource pressures through effective application of the National Emergency Pressures Escalation and De-escalation Plan

2 Clinical Model To utilise and review the application of the new „Clinical Model‟.

3 Paramedic pathfinder & Alternative Pathways of Care To adhere to the principles of Paramedic Pathfinder. Maximising the use of, where clinically appropriate, Alternative Care Pathways / Minor Injury Units / GP referrals and Direct Admission protocols.

4 Staffing and demand management To ensure robust staffing levels are in place throughout the winter period with explicit attention placed upon the staffing of key events / dates (e.g. „bleak‟ Friday / New Years Eve). To engage with key partners to support services during periods of „peak‟ demand.

5 Effective Deployment Plans Seek to achieve or exceed compliance with Status Plan Management and Status Deployment Planning

6 Collaborative operational management To provide collaborative frontline operational management of services across the Unscheduled Care system and wider NHS.

7 Job cycle efficiencies To minimise „lost hours‟ during operational delivery (job cycle).

8 Abstractions, sickness management & Vaccinations To be proactive in sickness absence, workforce abstractions management and supporting the health and well being of our staff through internal vaccination programme

9 Operational leadership To provide robust strategic, tactical and operational leadership

10 Management of external influences To anticipate and react to external influences or events which may have an impact on organisational service delivery

11 Community First Responders / co-responder schemes To maximise the utilisation of Community First Responders (CFRs) & co-responder schemes.

12 Specialist response assets To ensure access to specialist response assets.

13 Business disruption and preparedness To have business disruption and emergency preparedness arrangements in place

14 Supporting our staff To ensure staff are supported in performing their duties and the expectations of the Trust are clearly communicated

15 Suitable staff facilities To provide suitable facilities from which to deliver effective services that are capable of supporting staff needs.

16 Co-ordination of Clinical Telephone Assessment Processes To ensure appropriate utilisation of NHS Direct Wales and the Clinical Support Desk to maximise clinical telephone assessment to support efficient and effective patient care.

7

Strategic Framework

Principle 1 Escalation / De-escalation Objective: To manage resource pressures through effective

application of the National Emergency Pressures Escalation and De-escalation Plan

Description: WAST along with health board partners operate a shared

National Emergency Pressures Escalation and De-escalation plan which sets out the respective actions incumbent on the organisation dependent upon the demands being experienced across the health economy. Reaction to escalation triggers brings about shared actions between WAST and the health board which aim to prevent further escalation and mitigate the effects of the demand being experienced at that given time.

Benefit: A reactive response to escalation levels ensure that appropriate

measures are taken to reduce the demands on the organisation thus ensuring a safer clinical environment, improved patient experience and reduced staff fatigue.

We will achieve this by:

The Trust will adhere to the National Emergency Pressures De-escalation action plan.

The operational manager for each health board area will use WAST resource, demand and external influences along with hospital situation reports to inform the decision making process and escalate the need to move between levels, upwardly reporting to the Head of Operations (in hours) or on-call Gold (out of hours).

The Trust will continue ensure appropriate representation on daily (Bronze, Silver & Gold) conference calls. Ensuring that issues are escalated appropriately to the right level to ensure a pro-active timely response. Ad hoc teleconferences / meetings may be arranged at short notice to address any immediate concerns or issues for the Trust / wider health system.

Risk Assessment: Hazard Likelihood Impact Total Score Residual risk

score if objective is achieved

Failure to apply the National Emergency Pressures Escalation and De-escalation plan

2 4 8 5

8

Principle 2 Clinical Model Objective: To utilise and review the application of the new ‘Clinical

Model’. Description: WAST will be introducing a new „clinical model‟ on the 1st of

October that will change the way calls are categorised and response requirements. The changes have been founded on ensuring safe clinical practise and evidence based outcomes. Effective application of this model ensures that the most appropriate clinical response is provided to each presenting patient thus ensuring maximum utilisation of resources and adherence to performance standards.

Benefit: A proportionate response model ensures that each presenting

patient receives the most appropriate intervention for their respective condition in an appropriate timeframe thus allowing WAST to direct its frontline resources to those patients with the highest clinical need whilst maintaining a safe service to those with a lower clinical acuity.


Ensuring resource allocation adheres to the principles of the new clinical model and the most appropriate deployment of resources (Paramedic / Urgent Care Service / Patient Care Services / Clinical Desk / NHS Direct Wales) are utilised.

Maximise the utilisation of „hear and treat‟ assets ensuring the appropriate allocation of calls to the clinical desk for secondary triage, and appropriate referrals of Green calls (as per the new clinical model) are passed to NHS Direct Wales for nurse triage /advice.

Ensuring appropriate Green calls (as per the new clinical model) not passed to NHS-Direct Wales are responded to using non Emergency Ambulance resources where appropriate (e.g. Urgent Care Services).

Adherence to the principles of Paramedic Pathfinder to ensure all patients receives the most clinically appropriate pathway of care where available.



Failure to apply the Clinical Response Model

2 4 10 4

9

Principle 3 Paramedic Pathfinder & Alternative Pathways of Care Objective: To adhere to the principles of Paramedic Pathfinder.

Maximising the use of, where clinically appropriate, Alternative Care Pathways / Minor Injury Units / GP referrals and Direct Admission protocols.

Description: WAST has implemented „Paramedic Pathfinder‟ an on-scene

clinical decision making support tool to identify the most

appropriate care based upon the patient‟s medical needs.

Benefit: Potential to reduce avoidable conveyances to the Emergency Department (ED) through utilising alternative provisions of care.


Clinical Team Leaders to monitor the utilisation of their teams using Paramedic Pathfinder (Paramedics only).

Monitoring and promoting the utilisation of available Alternative Care Pathways (national & local) / MIUs and other provisions of care across all Health Board areas.

Ensuring that existing multi agency partnerships such as the “Alcohol Treatment Centre‟ in Cardiff” and “Help Point Plus” scheme in Swansea and other schemes across all Health Board areas are fully utilised.

Advanced Paramedic Practitioners will provide clinical leadership, mentorship and guidance to the core paramedic workforce to improve clinical decision making and confidence to utilise alternative care pathways / safely resolve more patients‟ on-scene.



Failure to provide alternative pathways

3 3 9 6

10

Principle 4 Staffing and demand management Objective: To ensure robust staffing levels are in place throughout the

winter period with explicit attention placed upon the staffing of key events / dates (e.g. ‘bleak’ Friday / New Years Eve). To engage with key partners to support services during periods of ‘peak’ demand.

Description: There are a range of options to support the Trust to support

staffing levels through ensuring (i) effective management of planned resources, and (ii) utilising a range of measures (as listed below) to bolster / increase staffing levels for key dates and events.

Benefit: Ensuring staffing levels are aligned to predicted demand to

ensure optimum resource coverage. We will achieve this by:

Review staffing levels (UHP) daily and bolster resourcing by (i) matching up „singles‟ prior to shift commencement, and (ii) prioritising vacant shifts for overtime allocation.

Continue to implement demand led frontline rosters (EMS).

Ensure effective management of operational „meal breaks‟ in line with policy.

Operational teams to develop local winter plans with a clear focus upon actions to bolster staffing levels across the winter period and with a close focus upon key events / dates (bleak Friday / New Years Eve.

Utilise St Johns Ambulance and other Private providers to bolster frontline resource levels when below optimum levels.

In periods of operational pressure / escalation Response Capable Managers (staff that are clinically trained and competent to respond to 999 calls) will be requested to undertake frontline operational support.

Suitable managers will also be expected to support operations through undertaking roles such as HALO‟s (Hospital Ambulance Liaison Officers) to manage patient flow. Where feasible non-clinical managers should be utilised to undertake this role to ensure clinical managers can support operations.

11

Other tactics will be used dynamically to increase resourcing levels, which includes the temporary „postponement‟ of training and Continual Professional Development (CPD) and the cancelation / restriction of staff / trade union abstractions.

In addition to the development of local winter plans and the actions outlined above, the Operations and Resource department to explore additional options to bolster resourcing over the Christmas period and key events dates / events (e.g. bleak Friday / New Years Eve) with proposals submitted to the Executive Management Team (EMT) for approval.

Operational managers to minimise abstraction levels through the close management of sickness absence and monitoring of annual leave allocation.

Continue working in close partnership with the Police, Fire & rescue service and other providers to manage demand appropriately.

All health boards to continue demand management activites with the local health boards, including multi-agency activity to manage frequent fliers.



To provide insufficient resource output to met anticipated demand

4 4 16 8

12

Principle 5 Effective Deployment Plans Objective: Seek to achieve or exceed compliance with Status Plan

Management and Status Deployment Planning Description: Deployment of operational assets to known areas of high

demand at peak periods provides a more dynamic and flexible resource profile. The Trust utilises Status Plan Management (SPM) and Status Deployment Planning (SDP) to predict, pre-identify, locate and performance manage its resources in this way, adherence to these principles bring about better utilisation of response assets.

Benefit: SPM and SDP provides for the most efficient methodology in

utilisation of deployable assets and provides a consistent planned approach that removes individual preconception towards the volume of demand and most productive location to achieve the best efficient timely response resulting in better patient experience and enhanced performance.

We have achieved this by:

Ensuring Clinical team Leaders and Duty Centre Managers review missed red activity, dynamically challenging allocation or deployment and where necessary escalating and managing poor performance.

Reviewing social deployment locations in order to ensure their location matches the latest demand analysis and provides a suitable deployment location to achieve the greatest performance.

Ensuring coverage at Priority 1 postings moving resources, when available between plans.



Failure to apply Status Plan Management and Deployment

2 3 6 4

13

Principle 6 Collaborative operational management Objective: To provide collaborative frontline operational management of services across the Unscheduled Care system and wider NHS Description: Critical to providing an effective patient focused response is

dependent on the whole of the health economy working in a co-ordinated and collaborative way. The Trust should utilise its first line management assets to support a physical or virtual presence at any planned or dynamic coordination arrangements established by acute hospital sites thus ensuring a shared situational awareness and ownership of systemic pressures.

Benefit: The ability of the Trust to dynamically react to system wide

pressures with early deployment and management of resources, escalating early to mitigate risk, working in collaboration across the unscheduled care system / wider NHS.


Jointly working with health boards and local authority to develop local integrated winter plans.

Ensuring that our Operational Managers are linked to the hospital bed management teams / emergency department meetings to jointly manage operational pressures.

Escalating concerns early to ensure a plan can be developed and delivered before issues / concerns cause significant upon service delivery.

Ensure robust on-call management arrangements are in place and rosters are fully staffed to provide maximum coverage where required.

Utilise Hospital Ambulance Liaison Officers (HALO‟s) to work with hospital staff to manage patient / ambulance flow.



Failure of the health economy to work together in a collaborative way

3 5 15 8

14

Principle 7 Job cycle efficiencies Objective: To minimise ‘lost hours’ during operational delivery (job

cycle). Description: Ensure frontline resources are effectively utilised through

minimising „lost hours‟ throughout the job cycle. Benefit: Through reducing „lost hours‟ frontline resources are more

readily available to respond to incoming 999 calls. We will achieve this by:

Ensuring that daily (7 days per week) Bronze conference calls are held which review the available resources, implement measures necessary to mitigate shortfalls in performance.

Ensuring the regular Co-Op meetings take place with Control & Operations to monitor and manage post production „lost hours‟.

Duty Centre Managers and Clinical Team Leaders to dynamically manage the job cycle and intervene where protracted delays occur during the job cycle (booking on, mobilisation / hospital handover / calling clear at hospital, meal break management and shift over runs).

Monthly performance management meetings with the Director of Operations and Head of Operations to manage job cycle efficiencies.



Failure in providing a co-ordinated resource utilisation plan

2 4 8 6

15

Principle 8 Abstractions, sickness management & Vaccinations Objective: To be proactive in sickness absence, workforce

abstractions management and supporting the health and well being of our staff through internal vaccination programme

Description: Robust management of short-term sickness and the dynamic

management of abstractions improve the ability of the Trust to utilise its work force in the most effective way.

The Trust will be alert to emerging infectious disease pathogens,

ensuring that opportunities to promote and take-up vaccination programmes are provided to the workforce.

Benefit: Robust staff sickness management, control of abstractions and

uptake of vaccinations promotes a healthy workforce and reduces fatigue.


Ensuring all short term staff sickness receive contact from their line manager on the first day of sickness wherever possible, with follow up contacts in line with Trust Policy.

Ensuring all short term staff sickness is referred to the Occupational Health & Wellbeing Team.

Ensuring that all Management Teams review on a weekly basis the levels of sickness, and Where practically possible, ensure return to work interviews take place within 48 hours of staff returning to work

Engage and promote staff up-take of the Flu vaccination programme through providing regular and accessible clinics for staff to attend.

Working with Public Health Wales in order to identify trends in infectious diseases and take steps to implement measures to protect our workforce by promoting access to vaccination clinics or other similar strategies.

Ensuring abstractions from core operations are reviewed by the Health Board area Management Teams and actions taken in line with the respective escalation level or shortfalls.



Failure to provide robust sickness management

1 4 4 2

16

Principle 9 Operational leadership Objective: To provide robust strategic, tactical and operational

leadership Description: It is critical that operational and tactical planning and response is

based on sound strategic direction. The Trust therefore provides 24/7 strategic leadership which is accessible within the organisation and to our external partners thus allowing an ability to escalate concerns / pressures or bring about a co-ordinated top-down approach to emerging challenges.

Furthermore, the Trust will provide robust 24/7 Tactical and Operational leadership with appropriate managers trained to fulfil these roles.

Benefit: Clear communicated strategic direction provides un-ambiguous

tactical parameters within which the Trust can operate, as well as providing our health and social care partners clear direction in terms of what support can be provided or would be required by the Trust in meeting the presenting demands, which leads to providing more effective services across the whole of the health economy.


Ensuring 24/7 continuity in on call management at Gold, Silver and Bronze levels with relevant communications pathways shared with key partners including health boards.

Anticipating the impact of external events such as severe weather and taking action to enhance our on-call arrangements through activating Gold, Silver or Business Continuity.

Continuing to access or deliver Gold, Silver and Bronze commander training.

If the Trust enters escalation Level 4 or 5 (Business Continuity), the Trust will consider initiating the Regional Performance Co-ordination Cell (RPCC). The function of the RPCC is to deliver robust performance management to ensure the effective and efficient delivery of frontline services. In collaboration with ops managers, CCC and frontline staff to deliver improved job cycle efficiencies and improved „real time‟ communication.



Failure to provide robust leadership

2 4 8 3

17

Principle 10 Management of external influences Objective: To anticipate and react to external influences or events

which may have an impact on organisational service delivery

Description: Anticipating where external influences may bring about service

delivery pressure allows for proactive and pre-emptive preparation.

Benefit: Pre-emptive preparation allows the Trust to anticipate

challenges which may affect the normal service delivery model and therefore create specific arrangements which maintain patient safety and effectiveness of our response ensure our staff safety and utilisation of specialist deployable assets.


Working with partner agencies to identify or source information which could cause undue pressure on WAST resources or require a response greater than that available through normal core rostering.

Developing specific operational or tactical plans to communicate our intentions and provide a basis on which to manage the response, which in themselves will be developed in partnership with other responders such as the police, fire service, health boards, local authorities or voluntary agencies.

Ensure that core staffing is increased to attempt to match anticipated demand.



Failure to anticipate external events which may have an impact on service delivery

3 4 12 6

18

Principle 11 Community First Responders / co-responder schemes Objective: To maximise the utilisation of Community First Responders

(CFRs) & co-responder schemes. Description: Community First Responders / co-responders provide a valued

and important role supporting frontline services to respond to incoming 999 calls in the community. .

Benefit: Early intervention from trained and equipped responders brings

a much enhanced patient outcome with reduced morbidity and mortality, better long term prognosis and ultimately reduced burden on the financial resources of the wider NHS.


Actively contacting first responder / co-responder schemes on a daily basis in order to achieve greatest availability.

Continue to recruit and establish additional CFR schemes.

Where feasible the CCC to staff a dedicated CFR desk to manage and co-ordinate CFR activity.

Continue to roll out and utilise Public Access De-fib Sites (PADS)



Failure to achieve stretcher performance targets for Community First Responders

4 3 12 9

19

Principle 12 Specialist response assets Objective: To ensure access to specialist response assets. Description: The winter period bring about challenging environmental

conditions which can and often exceed the capabilities of normal road based ambulance vehicles.

Benefit: As a peripatetic clinical organisation the Trust is highly

dependent on its ability to get a response to a patient‟s side, therefore these assets bring about direct patient benefit, staff safety through the provision of vehicles capable of travelling in snow or flood as well as organisational resilience in regards to being able to provide critical workforce transport to and from their place of work.


Utilising the Trusts appropriate winter specialist 4x4 vehicles (Land Rover Discovery / Honda CRVs).

Fitting our frontline fleet (Emergency Ambulance‟s, Rapid Response Vehicle‟s & Patient Care Services vehicles) with specialist “Cold Weather” tyres designed to ensure maximum traction in snow or icy conditions.

During periods of prolonged severe weather (i.e. snow) the Trust will consider the utilisation of regional „silver cells‟ to support the robust and safe management / co-ordination of frontline staff and resources.

Where required, the Trust will seek to hire additional specialist assets (4x4 vehicles) to bolster the fleet capabilities of driving in extreme weather conditions (heavy snowfall / ice).

To maximise, where available third sector providers (voluntary, private and other organisations) to support the Trust with specialist assets (e.g. 4*4 support to transport staff into work / home).



Failure to identify specialist response assets

2 4 8 6

20

Principle 13 Business disruption and preparedness Objective: To have business disruption and emergency preparedness

arrangements in place Description: The Trust will ensure severe weather plans and other

emergency preparedness arrangements are in place and up to date (e.g. fuel disruption / Pandemic flu).

Benefit: Recent winter periods have seen significant challenges brought

about through severe weather events, such as the snow in 2012/13. Underpinning the Trusts ability to maintain our external response capacity through effective business continuity planning is critical to ensuring that we are able to maintain an effective patient response capacity and staff are safe in performing the duties we ask of them.

Minimising episodes where operational hours are lost due to

vehicle down time ensures that operational staff availability is being used to the best of their potential thus enhancing our ability to react to patient needs.

We have achieved this by:

Ensuring operational plans relating to severe weather events, flooding and fuel disruption have been reviewed and in place.

General plans relating to the wider Trust response to a major incident is under review in order that it can draw on mutual aid from across the UK ambulance services.

During periods of extreme weather / severe pressures on frontline services, the Trust will consider the temporary postponement / cancellation of routine PCS work (e.g. outpatient appointments) to prioritise high risk patients receiving dialysis / oncology treatment or other life maintaining treatments.



Failure to develop and or implement business disruption plans

2 4 8 4

21

Principle 14 Supporting our staff Objective: To ensure staff are supported in performing their duties and

the expectations of the Trust are clearly communicated. Description: Staff absenteeism during the winter period brings about

challenges in terms of our capacity to match resource availability with demand; therefore it is imperative that the Trust is clear in setting out its expectations in regards to attendance but equally critical in terms of supporting staff in their return to work. The Trust will therefore utilise its HR Business Partners in order to be timely, accurate and consistent in providing advice and guidance to staff during periods of absenteeism.

Benefit: Clearly communicated supportive guidance relating to staff

absenteeism ensures that confusion relating to attendance at work during periods of severe weather does not result in shortfalls in available resources thus enabling the Trust to meet the anticipated demands and a consistent approach is taken across the Trust.


Issuing direct communications to staff when anticipated events determine the need.

Continue to communicate regularly with our workforce to ensure they are fully aware of Trust issues, improvement initiatives and directives to deliver services efficiently and effectively.



Failure to provide clear communications to staff resulting in shortfalls in resources

2 4 8 3

22

Principle 15 Suitable staff facilities Objective: To provide suitable facilities from which to deliver effective

services that are capable of supporting staff needs. Description: The winter period brings many challenges to the operational

estate, where high winds, significant rain or snow and extreme temperatures may cause elements of the estate or utilities which underpin the estate to fail. It is therefore critical that the preparedness of our estate is checked and any remedial works undertaken in anticipation of failure which may result in the need to relocate our operational serves. Furthermore, preparation regarding continuity of access and egress from our estate is vital during periods of extreme weather therefore arrangements to maintain access / egress will be developed.

Benefit: The resilience of our estate aims to provide continuity in the way

in which we deliver operational services, takes account of the welfare needs of our staff as well as protecting our capital investment.


Continue to undertake reviews of our estate to identify and rectify any issues with local facilities ensuring they are conducive to a safe working environment.

Continue to review and develop safe and effective social deployment points.



Failure to maintain operational service delivery from our estate

3 3 9 6

23

Principle 16 Co-ordination of Clinical Telephone Assessment processes Objective: To ensure strategies within NHS Direct Wales and the

Clinical Support Desk are cognisant and co-ordinated with those of ambulance EMS operations.

Description: Support provided by NHS-DW and the clinical support desk in

regards to alternative dispositions and the management of lower acuity activity allows for better resource utilisation and the most appropriate patient response. Therefore, the Trust will ensure resilience in the way in which it delivers clinical telephone assessment services and where necessary escalate theses to match anticipated challenges with demand.

Benefit: Intervention by clinical telephone assessment clinical staff with

patients whose clinical presentation would not routinely warrant the response from an emergency ambulance or the attendance at an emergency department greatly reduces the demand on these services, thereby providing a better patient experience and a greater capacity to deliver services to those with higher clinical needs.


Ensuring clinical telephone assessment staff reflects anticipated demand allowing capacity to take appropriate calls as per the new clinical model.

Remote monitoring of the RI stack by clinical telephone assessment where the services are not co-located.

Hazard Likelihood Impact Total Score Residual risk


Failure to ensure coordination between EMS and NHSDW

3 4 12 6

24

Appendix Local Integrated Winter Plans The following joint plans have been developed in collaboration between the Welsh Ambulance Service NHS Trust, Health Boards & Local Authority. These plans are awaiting approval by the respective LHB Board. ** Once approved all Integrated Winter Plans will be embedded below for information. Abertawe Bro Morgannwg University Health Board Aneurin Bevan Health Board Betsi Cadwaladr Health Board Cardiff & Vale University Health Board Cwm Taf Health Board Hywel Dda Health Board Powys Teaching Health Board

Documents

Strategic Winter Framework Local Integrated Winter Plans ......Strategic Winter Framework 2015/16 Version Status Date Notes V1.1 Draft (Initial review) Sept 2015 - 2014/15 Strategic