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WELSH AMBULANCE SERVICES NHS TRUST

REFRESHED INTEGRATED MEDIUM TERM PLAN

A FOCUS ON DELIVERING 2015/16 PRIORITIES

Version 1.0

27th May 2015

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INTRODUCTION

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.

Services

WAST‟s 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

stakeholders)

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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 WAST‟s approaches to strengthening and embedding planning across WAST and how the organisation‟s plans will be developed with LHBs so that plans are aligned.

The need to understand the key milestones for the development of the organisation‟s 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 Trust‟s 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.

OUR STRATEGY

WAST‟s strategy for the period to 2017/18 needs to be seen within the following

context:

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.

WAST‟s 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 organisation‟s 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, don‟t 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 Trust‟s 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.

MEETING THE NATIONAL COLLABORATIVE COMMISSIONING: QUALITY &

DELIVERY FRAMEWORK AGREEMENT

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

(WAST).

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

Agreement‟.

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. Therefore, during 2015/16, there will be four refresh exercises

undertaken during quarterly intervals with updated elements of the Framework

Agreement issued at:

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1st July 2015;

1st October 2015;

1st January 2016;

1st April 2016.

The refresh exercises will enable any documentation identified for inclusion within

the Framework Agreement but not yet finalised to be incorporated. Such changes

and documentation will be specified within the Document Management Section. It is

anticipated that the Framework Agreement may then be refreshed at six monthly

intervals during 2016/17 and 2017/18, that is:

1st October 2016;

1st April 2017;

1st October 2017.

Collaborative Commissioning: Quality and Delivery Framework

Actions 2015/16 Timescale Interfaces

Confirmation of current „fit‟ between CQDF requirements and Welsh Ambulance Service NHS Trust baseline.

Joint work with Welsh Government and Local Health Board Directors of Planning on the National Planning Framework and implications for commissioning of Welsh Ambulance Service NHS Trust services.

Development of revised proposals for improved joint working for discussion with EASC/CASC.

Qtr 1 Qtr 2 Qtr 3:

Planning and Performance management framework

Clinical service

modernisation programme

Demand and

capacity review

Financial plan

Clinical modernisation programme

Clinical modernisation programme and Quality Improvement strategy

ENGAGING WITH PATIENTS/SERVICE USERS, PARTNERS AND THE

COMMUNITY

The Trust‟s ambition is to gain the trust and confidence of patients, the public and

key stakeholders within Wales, promote community ownership of the organisation

and for the Trust to be seen as successful by UK and international peers.

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The Trust recognises that a lynchpin in the organisation‟s programme of operational

and cultural transformation, as well as its efforts to encourage responsible use of

999 and reduce demand, must be a coherent and comprehensive approach to

community engagement.

Such an approach must encompass patients/service users, stakeholders, partners

and the wider public, building shared understanding of the role and function of

WAST and developing community capacity and resilience through the development

of effective community partnerships. In addition, we must actively engage the public

in issues of service/model changes, both internal to WAST and across the wider

NHS Wales landscape and ensure that an effective programme of public education

and messaging supports appropriate use of 999 services.

In order to achieve this, the Trust recognises that its current engagement activities

need to be refreshed to ensure they are coherent and consistent with organisational

objectives, while acknowledging the good work already underway. The Trust has

committed to aligning its engagement activities through the development of a

discrete community engagement strategy, which will provide a clearly articulated

platform and delivery programme for this important aspect of our work.

The Partners in Healthcare Team lead service user engagement and have fully

implemented the National Service User Experience Framework. The Service User

Engagement Strategy 2014-2016 and implementation plan was approved by the

Quality Delivery Committee (QDC) in 2014 and patient experience feedback reports

are presented on a quarterly basis. Additionally patient stories are included on the

QUEST Committee and Trust Board agendas with updates on improvements made,

as a standing agenda item.

Community engagement is a key priority in year one of this IMTP and will underpin

the cultural move for the organisation and the public in respect of steps one and two

of the new clinical model and the establishment of the planned 111 service. The

Trust‟s community engagement model will require the support of Local Health

Boards and other local partners including the Third sector in providing the

opportunity for the Trust to contribute and participate in their community engagement

processes so that the work of the Trust is aligned with and integral to, the service

delivery of LHBs and the advisory role of other stakeholders.

Key priorities for 2015/16 include:

Measuring Patient Experience to inform us what it is like to be a user of Welsh

Ambulance Services

Real time capture of patient experiences

o reporting themes

o working with colleagues to identify and implement learning

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o identify services changes/benefits

Working with communities to raise awareness and educate on services such

as Community First Responders and Choose Well

Working with other emergency response organisations such as the fire service

and police force to consider how we better interface to streamline response

and meet community needs

Collaboration with NHS colleagues on shared capture of patient experience;

learning and actions to improve experiences of the NHS care/treatment

pathways

Integrated reporting of all methods of patient/service user feedback

Engaging with patients/service users, partners and the community

Actions 2015/16 Timescale Interfaces

Audit and review

existing pan organisational engagement activities to understand synergies and gaps

Map stakeholder interfaces

Interim plan to align

existing work with emerging strategy

Develop and agree generic community engagement strategy.

Execute appropriate

elements of the plan

30 June 2015 30 June 2015 31 August 2015 Draft 30 Sept 2015 Trust Board 30 November 2015 Ongoing Q3 & Q4

Improving the quality

and responsiveness of our services

Clinical modernisation programme

Quality Improvement strategy

Clinical model

modernisation programme

Planning and Performance Framework

Capacity & financial resource availability

Linked workstreams: NEPTS, Engagement with Emergency Services, Engagement in Local Health Board Change Programmes, Clinical Modernisation Programme (Step 1)

Planned refresh of Choose Well campaign by Welsh Government

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These activities represent a discrete Community engagement project which the

Trust has initiated. A plan on a page for this project is shown in annex 1.

DELIVERING FOR PATIENTS AND THE PUBLIC

The new clinical model for emergency medical services, non-emergency

patient transport and supporting the development of a 111 service

Emergency Medical Services

The current clinical/ service model focuses on time based response standards as a

means of recognising and meeting the needs of critically ill and injured patients.

Over time, however, increases in demand have forced changes in operational

practice, which, perversely, have resulted in inefficiencies and which have the

potential for unnecessarily high and unevenly distributed clinical risk. Recognised

examples cited in UK policy documents include:

Dispatching resources to a 999 call, on blue lights and sirens, before it has

been determined what the problem is, and whether an emergency ambulance

(EA) is actually required

Dispatching multiple ambulance vehicles to the same patient, on blue lights

and sirens, and then standing down the vehicles least likely to arrive first

Diverting ambulance vehicles from one call to another repeatedly, so that

ambulance clinicians do not focus on the care needs of the patient

Using a Rapid Response Vehicle (RRV) when this unit may provide little

clinical value to the patient (e.g. stroke victim), who then has to wait a long

time for a conveying ambulance to arrive

Very long waits for lower priority (“Green”) calls that nevertheless need

assessment and conveyance to hospital, and some of which have time

dependent conditions as determined by Health Care Professionals (HCP)

requesting patient transportation.

The new clinical model proposes a number of material changes to the current

model. The guiding principle underpinning the redesign process - improving patient

outcomes by offering the correct level of clinical intervention / care – is entirely

consistent with the Trust‟s commitment to prudent healthcare. The new model is

also entirely consistent with the requirement of commissioners to redesign EMS

along the five steps of the ambulance pathway.

Core elements

The core of the clinical model is the 5 step ambulance pathway agreed with

commissioners:

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STEP 1 („Help Me to Choose‟) – This step focuses on public education regarding

the services provided by WAST and how/when to access them appropriately. This

step will include the development of appropriate linkages between WAST and the

future 111 service, building on the success of NHSDW and its website.

STEP 2 („Answer my Call‟) – This step focuses on the response to 999 and Health

Care Professional (HCP) calls by WAST‟s Clinical Contact Centres (CCCs). This

step incorporates the provision of adequate time to assess a call and the use of the

Medical Priority Dispatch System (MPDS) to identify the priority of the call before

offering / sending the most appropriate response.

STEP 3 („Come to See Me‟) – This step focuses on how WAST makes decisions

about what resources to dispatch to assessed/prioritised calls. Broadly, three

response options will be available:

Emergency Ambulances (EAs) will be allocated to RED calls, and high acuity

GREEN calls („see & treat‟)

Clinical Telephone Assessment (CTA - „hear & treat‟) will be offered to all

other low acuity GREEN calls

A dedicated patient transport service will be created for low acuity GREEN

patients who are assessed by HCPs as requiring admission to hospital.

STEP 4 („Give Me Treatment‟) – This step focuses on the development and

delivery of a range of clinical care services able to offer a variety of treatment

options. The selection of the most appropriate treatment will be supported by

decision support tools eg Paramedic Pathfinder for „see & treat‟; the Manchester

Triage System and the Clinical Assessment System for „hear & treat‟). Treatment

options will include the use of Alternative Care Pathways or ACPs (set out in a

Directory of Services) allowing patients to be referred to primary and community

care. WAST will develop a Clinical Hub to coordinate the delivery of care to patients

(„sign – posting‟ for clinical advice, managing referrals to alternative care pathways,

and arranging non-emergency transportation i.e. managing any element of WAST‟s

services that is not time critical or an emergency transport to ED).

STEP 5 („Take Me To...‟) – Patients who require ongoing care and treatment will be

transported to hospital or to alternative care settings (e.g. Minor Injury Unit or a

primary/community care facility). The clinical acuity of the patient will dictate the level

Step 1 –Help me to

choose

Step 2 –Answer my call

Step 3 -Come to see me

Step 4 –Give me

treatment

Step 5-Take me

to Hospital

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of transport. For critical care patients or patients requiring ongoing treatment, EAs

will be utilised. All other patients will be transported by a combination of Urgent Care

Services (UCS) and non-emergency patient transport services (NEPTS).

The Trust is clear that the new service model/ model of care will deliver the following

benefits:

The sickest patient will always be treated first

The centrality of patient and public safety will maintained at all times

Patients will receive care which meets their clinical needs rather than wants

Delivery of the best clinical outcome for each and every patient on every

occasion and optimal patient experience

A reduction in overall clinical risk within the ambulance service model by

offering a range of treatment options, once the patient‟s need has been

identified.

Implementation will be enabled by:

The development of a robust demand and capacity model

Reconfiguration of the CCCs to provide the optimum level of control room

resource, consistency of operation and site interoperability

Implementation of the new Computer Aided Dispatch (CAD) system

Investment in new vehicles and the associated clinical equipment.

Continued development of clinical frontline staff described in the workforce

and OD section of the plan.

Enhanced clinical audit to evaluate the outcomes of the clinical model

Emergency medical services

Actions 2015/16 Timescale Interfaces

Help me choose:- Quality Impact

Assessment

Evaluation of Cwm Taf FC Model

Agree WAST National FC Policy

Top 10 Frequent callers

in each HB

Agree improvement plan with each LHB

Embed in Health Economy by April 2016

28 May 2015 31 August 2015 31 August 2015 31 August 2015 30 November 2015 31 March 2016

Engagement with

patients/service users, partners and the community

CCC review Commissioning

Framework performance requirements

WODI programme Business case

development

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Identify dataset

&template for monitoring

Produce first draft report for call & case mix

Finalise call & case mix monitoring report

Answer my call:-

Quality Impact Assessment

Review of MPDS code set

Review of response configuration

Revised process for management of Card 35 calls

Training plan fully developed

Governance arrangements confirmed

Training rolled out to all staff

Alignment of CAD

Go live Come to see me:-

Quality Impact Assessment

DRAFT Response matrix (RED; AMBER; GREEN)

Training Plan & Technical Plan (pending Welsh Government approval for new dispatch processes)

Changes to Card 35

30 June 2015 30 September 2015 31 December 2015 3 June 2015 30 June 2015 30 June 2015 30 September 2015 30 September 2015 31 October 2015 TBC (dependant on ministerial approval) TBC (as above) TBC (above) 11 June 2015 June 2015 (RED matrix already completed) 30 November 2015

IMT programme

WODI programme Service change

proposals to QAIP Digipen

implementation WODI programme QAIP submissions Engagement with

patients/service users, partners and the community

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script / call handling

„Roll Out‟ plan for Card 35 planned transport

Give me treatment:-

Costing of PP and CA&ED structures

Approval by executive team

Revised digipen PCR completed

Quality Impact Assessment

Implementation of PP and CA&ED structures

Roll out of digipen/ICT hardware

Formalise Lead link with MTG & NAEUCG

Clear backlog of paper PCRs

Develop analysis and reporting processes for

o current CIs

Full implementation of digipen

Completion of PP training

Commencement of all Wales clinical audits

Develop a phased plan for additional CIs

Development of user friendly reporting tools

Take me to hospital:-

30 September 2015 July 2015 - April 2016 22 May 2015 29 May 2015 31 May 2015 18 June 2015 6 August 2015 31 August 2015 31 August 2015 1 September 2015 1 September 2015 14 September 2015 28 September 2015 1 October 2015 1 November 2015

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Implementation of CPAGG process

Approval of TOR for CPAAG

Quality Impact Assessment

Review PP tools and TTA disposition matrix

Review out of hospital mental health practice

Review of APP practice model

Clinical Leadership:-

Confirm Project Lead, Staff Rep Lead and Project Team and Project Team to meet and agree full action plan with timescales by

Action Plan developed to embed scope of practice

Definition of Clinical Leadership and behaviours

Map of Clinical Accountabilities

Sustainable Model of Clinical Supervision and Appraisal

Workforce:-

Data collection and analysis

Clinical Conference (springboard to scenario planning workshops)

scenario and service

31 December 2015 06 August 2015 11 June 2015 25 June 2015 31 August 2015 28 September 2015 01 October 2015 30 June 2015 30 June 2015 31 July 2015 30 September 2015 31 December 2015 31 July 2015

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planning workshops

Consultation process

Training implications and costing

Enabling plans (training etc)

Completed Strategic Workforce Plan

31 July 2015 August – Oct 2015 Nov / Dec 2015 31 January 2016 31 March 2016 31 March 2016

The rollout of the Clinical Model and the delivery of the milestones referenced above

will be via the first of four change programmes being initiated by the Trust; The

Clinical Modernisation Programme.

This programme represents a continuation of some key actions originally within the

Trusts Strategic Transformation Programme (STP). Plans on a page for the

constituent projects of the programme are shown in annex 1

Non-Emergency Patient Transport Services (NEPTS)

The NEPTS programme aims to deliver significant improvements for patients

through a refreshed operational and management model for non-emergency patient

transport services in Wales, drawing heavily on a model of integrated transport

provision with the local government and voluntary sectors.

The current challenges being faced by the service include:

Meeting the contractual obligations and key performance indicators required

of it by its commissioners

Meeting the disparate needs of those commissioners, including differing

quality and timeliness standards

Meeting the understandably high expectations of patients, many of whom

have chronic and debilitating long term conditions, and regularly use

transport, as opposed to emergency patients, for whom transport via

ambulance is often a unique event

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Clear eligibility criteria understood by all

Developing new service model in co-production with service users

WAST has sought to bring together staff, trade unions, Welsh Government,

commissioners, voluntary sector providers and patient representatives in an

inclusive approach to change management, with a view to agreeing a revised model

of delivery which has credibility and the support of stakeholders.

The foci of the project include:

Agreeing the actions WAST will need to take to improve current NEPTS

performance

A generic specification for NEPTS in Wales that provides clarity in terms of

the quality and KPIs being commissioned

How NEPTS and other publicly funded/subsidised transport services (Social

Service, Special Educational Needs and Community Transport Association)

could be delivered in the future, the emphasis being to improve user

experience within a reduced financial envelope.

How a new way of delivering these services might be organised.

Expected outcomes include:

Improved current NEPTS operational performance

New specification providing clarity of KPIs, providing an increased opportunity

to monitor accurately and, therefore, measure provider services performance

Transference of low acuity NEPTS activity to alternative, more appropriate

transport provision

A blue print depicting how all partner organisations might work together.

Improved overall user satisfaction and experience.

A NEPTS model that can support the modernisation of the EMS and other

related services.

An organisation that holds the dedicated capacity and capability required to

lead the field in delivering efficient, effective and responsive services.

The programme has made significant progress in creating dialogue with

stakeholders about the future shape of NEPTS services in Wales and work

continues to develop a model for the future.

Understanding that the existing NEPTS model of service delivery may change

following the introduction of a new service specification, WAST is keen to progress,

with minimum delay, service development opportunities that we believe will help

modernise current service provision, improving operational performance,

relationships with stakeholders, new partners and, above all else, patient

experience.

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Non-emergency patient transport service

Actions 2015/16 Timescale Interfaces

Completion of NEPTS Service Specification

Production of Generic Development Plan

Rollout of Generic Development Plan

Agreement of preferred Commissioning Model

Completion of financial impact assessment

Production of business case

Submission of Business Case to CEO Group

31 May 2015

31 May 2015 31 May 2015

30 June 2015

30 June 2015

30 September 2015 31 October 2015

Clinical modernisation programme

Financial plan WODI programme

The NEPTS programme represents the second of the Trusts four strategic change

programme. It is also a continuation of the work which initiated under the Trusts

previous STP. A plan on a page for taking the NEPTS programme through to

completion is shown in annex 1.

Given that the programme is scheduled to end in September 2015, engagement and

governance arrangements with commissioners are to be put into place to ensure the

programmes products, namely the Business Case and the new specification, are

progressed in a timely fashion post September.

From October 2015 to March 2016, the Trust will continue to deliver the actions in

accordance with the timescales contained within the Generic Development Plan,

whilst also, identifying any further service developments for inclusion in the 2016/17

– 2018/19 IMTP.

Transition from NHS Direct Wales to 111 service

The Trust has submitted a proposal to host the future 111 service. Should this be

successful robust governance arrangements will be put in place to reflect the nature

of the hosting arrangement and the responsibility of the Trust in fulfilling this role.

The transition arrangements relating to NHSDW will be developed appropriately

during this time, although it is already recognised the work will have a close inter-

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dependency with the Trust‟s Clinical Contact Centre (CCC) re-configuration

workstream (see Strategic Efficiency Programme).

IMPROVING THE QUALITY AND RESPONSIVENESS OF OUR SERVICES The Trust uses the principles of prudent health care, the requirements set out in the

NHS Wales Quality Outcomes Framework and assessment against the Health and

Care standards as a backdrop to the development and implementation of its quality

improvement strategy.

The Trust‟s Quality Improvement Strategy, Quality Delivery Plan and Quality

Improvement Assurance Framework incorporates the learning from local and

national reports including the Abertawe Bro Morgannwg University Health Board

“Trusted to Care” report and the Francis Report (2013) reviewing the care delivered

at Mid Staffordshire NHS Foundation Trust. This identified five key themes,

underpinned by the requirement of a fundamental quality improvement culture and

the adoption of common values across organisations focusing on:

fundamental standards;

openness, transparency and candour;

compassionate, caring and committed staff;

strong, patient-centred healthcare leadership; and

accurate, useful and relevant information.

One of the Trust‟s key strategic aims is to improve quality and safety: WAST‟s focus

- first, last, always – will be quality and safety.

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The purpose of the quality improvement strategy is to support the delivery of this vision and our objectives to be a high quality clinically led service that:

Delivers high quality, cost-effective and sustainable health care services; Provides a working environment that is underpinned by our values and

behaviours; Is committed to patient-centred care and Treats staff and service users with dignity and respect.

This section sets out how this ambition will be realised. It describes in turn:

The structures and systems supporting quality management and improvement

The Trust‟s approach to infection prevention and control The Trust‟s approach to service user engagement The core elements of the emerging Quality Improvement Strategy together

with related quality improvement actions and activities How the Trust will progress the research and innovation agenda.

Year one of this strategy will focus on determining our position, strengthening our

foundations and developing and improving our indicators and measures. Years two

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and three will be implementing, monitoring and reviewing, whilst making appropriate

changes.

Priorities for 2015/16 are:

Safeguarding

Infection Prevention & Control

Mortality reviews

Strengthening the Putting Things Right (PTR) process.

Structure and systems

The Trust Board has overarching accountability for the quality of services. The

Medical Director and Director of Quality & Nursing share joint accountability for

quality improvement at Executive Director level.

The portfolio of the Medical Director includes:

Clinical governance

Clinical/professional leadership of paramedicine

Putting Things Right

Clinical audit & effectiveness

Medical equipment

Public Health

Medicines management

Research & development

MPDS software – governance arrangements

Caldicott Guardian Executive lead

The portfolio of the Director of Quality & Nursing includes:

Quality & quality improvement plans in conjunction with the Medical Director

Implementation & monitoring of the Health and Care Standards

Service User Experience – Partners in Healthcare Team

Commissioning standards

Professional nurse leadership and nurse regulation/supervision of nurses

Executive lead for Infection Prevention & Control, Prudent Healthcare

Safeguarding / Mental Capacity Act / Deprivation of Liberty Safeguards

CAS software governance arrangements relating to NHSDW

The portfolio of the Director of Operations includes:

Frontline emergency medical services, non-emergency patient transport

services, Clinical Contact Centres and NHSDW

Specialist units (e.g. HART, HEMS, SORT)

Support services (e.g. fleet)

Civil contingencies/ emergency planning.

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Quality Governance

In line with The Good Governance Guide for NHS Wales, the Board recognises that

a robust governance framework for quality is essential to deliver Trust-wide quality

services and to provide the Board with assurances over the effective and

sustainable management of quality across the organisation.

Through the medium of the Integrated Performance Report, each meeting of the

Trust Board includes scrutiny of a range of quality indicators and the extent to which

operational performance, HR and finance issues affect quality, safety and the patient

experience. The IPR is being redeveloped by June 2015/16 to support the

monitoring and management of the implementation of this IMTP, respond to

Commissioner requirements and provide meaningful performance information that

will support the delivery of services at all levels of the organisation.

The work of the Trust Board is currently supported by the Quality Patient Experience

and Safety Committee (QuEST). QuEST is a Board Committee with delegated

responsibility for all aspects of quality and safety and is chaired by a Non-Executive

Director. The IPR and Patient Experience Report / patient stories are standing

agenda items. In addition, reports relating to quality issues are included on the

annual work programme. The Committee reports to the Board following each

meeting (currently monthly).

The annual review of governance arrangements is currently in progress. This

includes:

a review of the terms of reference and minutes of the groups / committees

a review and defining of the reporting relationships between groups /

committees

information flows including appropriate escalation

implementation of the recommendations during 2015/16 from the review

monitoring during 2016/18 and actions taken accordingly.

Infection prevention and control

The Trust has adopted a zero tolerance of preventable healthcare associated

infections (HCAIs). Significant improvements in reducing HCAIs have been made in

recent years. However, more can and will be done to protect service users and our

staff to achieve world class standards of service user safety.

Key priorities for 2015/16-2017/18 include:

an agreed Code of Practice for Infection, Prevention and Control

development of an underpinning operational plan which will be monitored

through the Integrated Performance Report

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an annual report on IPC reviewing progress, actual and potential risks and

informing future operational plans and staff development requirements.

The Trust quality strategy

The Trust aspires to be a quality driven organisation and an early priority is

developing a Quality Improvement Strategy (QIS) for the three years of the IMTP,

supported by a strong delivery plan for 2015/16.

The QIS will align with the requirements of the Quality Delivery Plan for Wales and

Safe Care, Compassionate Care, the NHS Delivery Framework and underpinning

delivery plans.

The QIS, the delivery plan and the performance management system will be based

on the following seven quality domains (as per the NHS Wales Quality Outcomes

Framework) below:

Domain / Theme Outcomes

Staying Healthy People in Wales are well informed to manage their own physical

and mental health

Safe Care

Prudent Healthcare

‘Do no harm’

People in Wales are safe and protected from harm and protect

themselves from known harm

Dignified Care People in Wales are treated with dignity and respect and treat

others the same

Effective Care

Prudent Healthcare

‘Carry out the

minimum appropriate

intervention’

People in Wales receive the right care and support as locally as

possible and are enabled to contribute to making that care

successful

Timely Care People in Wales have timely access to services based on clinical

need and are actively involved in decisions about their care

Individual Care

Prudent Healthcare

‘Promote equity & co-

production’

People in Wales are treated as individuals with their own needs

and responsibilities

Our Staff & Resources

Prudent Healthcare

‘Organise the

workforce around the

'Only Do, What Only

You Can Do’’

People in Wales can find information about how their NHS is

resourced and make careful use of them

Person Centred

Governance, Leadership & Accountability

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The QIS will be refreshed on an annual basis and, in the first two years of the

planning cycle, will incorporate the following:

The outputs of the outcomes based internal assessment of the Standards for

Health Services in Wales 2013/14 and 2014/15, development of quality

indicators and a monitoring process for the key approved documents

associated with the Health and Care Standards.

development of „early warning quality triggers‟ & safety thermometer at Trust

level, then health board level, and progressing to locality / ambulance station

level with local ownership

using our information more intelligently in our reports, triangulating hard and

soft information, to provide a more informed picture of the quality of services

we provide e.g. incidents, complaints, internal and clinical audit reports,

service user feedback, staff feedback and external reports / visits

strengthen the clinical audit capability in terms of timeliness of data and scope

development with pace of the functions and outputs of the Organisational

Learning Group

introduction of Quality Impact Assessments (QIAs) incorporating the

principles of Prudent Healthcare for projects, cost improvement programmes

and service transformation / reconfiguration, including initial screening and

monitoring of quality indicators for medium or high risk schemes

introduction of mortality reviews

strengthen the process for reviewing and addressing external guidance and

recommendations

strengthen peer review and benchmarking with other NHS ambulance

services

continued implementation of the 1000 Lives + programme and use of

improvement methodologies including statistical process charts and other

measurements tools

walk around schedules covering all health board areas to obtain feedback

from staff to focus priorities

meeting the quality standards agreed with our commissioners using the

CAREMORE Framework.

Alongside the development and execution of the QIS, there are a range of other

actions and activities which the Trust will progress to improve quality. These include:

taking forward the priorities and actions identified in the Annual Quality

Statement including:-

o continued work to improve care for the frail elderly including working with

local dementia training groups to educate our staff

o supporting patients who fall to stay at home if appropriate

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o an increase in the number of alternative care pathways

o improved working with Primary Care/GP and out of hours to better

manage patients within primary and community care

o improve the management of calls from Health Care Professionals (Card

35) to improve the flow of patients needing transport to hospital

the Partners in Healthcare Service User Engagement Strategy 2014-2016 to

inform our priorities on a rolling basis

membership and active participation in the NHS Wales National Quality &

Safety Forum

reviewing our process for responding to and learning from Putting Things

Right during 2014/15

the outcomes from reviewing our safeguarding processes during 2014/15.

Improving the quality and responsiveness of our services

Actions 2015/16 Timescale Interfaces

Draft Quality Improvement Strategy, Delivery Plan & Assurance Framework outlines

Incorporate QuESt Inputs Incorporate Executive

Team / Board inputs Revisions & costings

Undertake Public & staff consultation

Development of measures and performance indicators

Finalise documents following engagement

Obtain QuESt approval Obtain Board approval

30 April 2015 31 May 2015 31 May 2015 30 June 2015

31 July 2015

31 August 2015

30 September 2015 30 September 2015

Clinical modernisation programme

Engagement with patients/service users, partners and the community

Collaborative commissioning quality and delivery performance measures

Trust planning and performance framework

Financial plan Managing risk

Research and Innovation

The Medical Director is the Executive Lead for Research & Development and the

Trust has an established Pre Hospital Emergency Research Unit (PERU) linking into

the National Institute for Social Care and Health Research (NISCHR).

Alongside this, the Trust has a dedicated service redesign team also reporting to the

Medical Director.

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As part of the Clinical Modernisation Project within the STP, the Trust developed a

draft research & development strategy for the period to 2019. An early priority for

the Trust is to review this strategy in order to ensure ‟fit‟ with the IMTP.

Consideration in Y1 will be given to bringing PERU and the service redesign team

together to ensure joint working.

MANAGING RISK

The Trust has continued to develop and embed its approaches to risk management as set out in the 2014/15 Annual Governance Statement. The Trust sees active and integrated risk management as a key element in the

successful delivery of its business and remains committed to ensuring staff

throughout the organisation are trained and equipped to assess, manage, escalate

and report risks.The Trust also understands that effective risk management

processes must run in parallel with its clinical governance arrangements to ensure

the delivery of sustainable quality services and effective assurance mechanisms. In

order to strengthen our current risk management systems and processes during

2015/16, a risk management strategy (supported by an implementation plan) will be

developed and will include:

development of a revised Board Assurance Framework

a baseline risk maturity assessment with milestones for improvement

clear authorities for the management of risk

revision of the risk register framework

strengthening of the reporting / escalation mechanisms

a definition of our risk appetite

strengthening of the systems in place for policy & guideline development and

monitoring including archiving arrangements

an increase in incident reporting with a reduction in the severity of incidents

a baseline safety culture survey and planned reviews to test resilience (see

diagram below).

Risk Management Framework

The Trust has a Risk Management Policy and Strategy that describes the arrangements for the management of risks within the Trust and clarifies the roles of

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individuals and committees. The risk assessment and risk register procedures provide for the identification and assessment of all categories of risks including clinical, financial and corporate risks. The Corporate Risk Register is available on the Trust intranet site for staff, managers and Board members to review. Risk Appetite The Trust recognises that effective risk management is a key component of corporate and clinical governance and is integral to the delivery of our objectives in service provision to the public. Whilst risk is inherent in many of our activities, the Trust will not accept risks that materially impair the ability to deliver services to a high standard of safety and quality. As such, the Trust will not accept risks that materially impair its reputation or cause any disrepute with stakeholders. In common with other NHS providers, the Trust is limited in the extent to which it is permitted to use public funds to reduce/eliminate risks. This is a major influence in determining the risk appetite of the Trust. Risk Profile The risk profile of the Trust is subject to ongoing in-year revision but, as at March

2015, there were eleven strategic risks on the Trust (High Level) Corporate Risk

Register. The risks and mitigation is detailed within the Trust Annual Governance

Statement and is subject to review by the appropriate committee.

Control framework The Trust uses the Health and Care Standards as its framework for gaining assurance on its ability to fulfil its aims and objectives for the delivery of safe, high quality health services. This involves self-assessment of performance against the standards across all activities and at all levels throughout the organisation. The Trust has recently completed its self-assessment against the standards and this demonstrates that there needs to be a greater maturity in respect of managing risk across the organization. This will be addressed through the action plan developed for 2015/16.

Managing risk

Actions 2015/16 Timescale Interfaces

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Review risk management and assurance framework

Ensure corporate governance structures are embedded and ToR are reviewed

Develop and agree Annual Governance Statement

Produce Annual report

30 June 2015 31 July 2015 30 June 2015

30 September 2015

Improving quality and responsiveness

Planning and performance framework

MANAGING RESOURCES

Workforce and Organisational Development

The purpose of this section is to:

Set out key challenges currently facing the Trust in respect of the workforce

and the plans in place to address them

Provide a profile of the Workforce, OD and Improvement Project within the

Trust‟s Transformation Programme

A profile of the current WAST workforce and relevant KPIs

As assessment of the factors determining the future shape and size of the

workforce required to support delivery of the new clinical model for EMS and

an initial revised profile

Outline the changes expected to the education and training of paramedic staff

and the support needed to implement that change

The current WAST workforce

On the 1st April 2015, the Trust successfully transferred its HCS service and staff

(approximately 118 people) across to the NHS Wales Shared Services Partnership.

The Trust‟s workforce (as the end of April 2015) now totals 3,106 members of staff

broken down as follows:-

Directorate/ Service Headcount

CHIEF EXECUTIVE & CORPORATE SERVICES 20

CLINICAL 48

FINANCE & ICT 69

31

QUALITY & NURSING 30

OPERATIONS 2760

STRATEGY, PLANNING & PERFORMANCE 36

OTHER 2

WORKFORCE & OD 98

BANK & SESSIONAL 34

TOTALS 3,106

The table below profiles the Trust‟s workforce by ethnic origin:

In 2014/15 the Trust raised the profile of its Equality and Diversity work through a

number of activities, including:

roll out of the „Treating People Fairly‟ e-learning module as part of corporate

mandatory training,

engaging with local communities at Women‟s Day events to encourage

female applicants into the service,

work to develop standardised reporting procedures for workforce data with

respect to our reporting against our statutory equality duties,

Ethnicity % at 31 December 2014 – Welsh Ambulance Service NHS Trust

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participation in Pride events across Wales, gaining positive feedback from

LGBT service users,

developed „transgender guidance‟ for call handlers and paramedics,

embedded within mandatory training (CPD) programmes,

work with Assistance Dog users across Wales to develop procedures and

guidance for the conveyance of assistance dogs.

2015/16 will see us review of our Strategic Equality Plan „Treat me Fairly,‟ through a

process of evidence gathering, literature review and staff and public engagement.

This will also include a review of our Strategic Equality Objectives. We also plan to

develop a Gender Action Plan, which will include working with the Women Adding

Value to the Economy (WAVE) toolkit, and working with Swansea University on

improving the gender split in paramedic education. We also intend to continue, and

increase where appropriate, our presence at relevant events across Wales such as

Pride, the development of staff networks, and action to embed a robust process of

Equality Impact Assessment (EQIA) across the Trust.

Reproduced below are our workforce and OD KPIs with accompanying commentary,

reported within the Trust:

Key Performance Indicator

WAST Indicator

Commentary

Turnover Period turnover rate covering 01/10/14 to 31/12/14 equates to 1.89%. Current year to date (31/12/14) turnover percentage is 5.52%

This is above the KPI <5% and further analysis work will be undertaken to identify reasons for staff leaving.

Sickness absence The figures for March and April are as follows; March – 6.66% ( 7.04% in Operations) April – 6.73% ( 7% in Operations)

By April 2015, the Trust has overachieved against the 6.75% WG Target. A data analysis group has been created to target trends in sickness absence, which includes DATIX information and Occupational Health data. This has enabled targeted work to commence in areas where sickness is at its highest in order to support managers with tools and strategies to target and reduce sickness absence. It is envisaged that the recent changes to Unsocial Hours payments will lead to a further reduction in

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absence.

Return to Work interviews completed within 4 days

In April 2015 our % rate of RTWs completed had risen to 43.59%

100% compliance of all RTW interviews conducted within 4 days. This will now become a reportable measure following the roll out of Employee/Manager Self Service, completed by 31/03/2015.

Performance and Development Reviews (PADRs)

In April 2015 the rate of PADRs completed was approx. 30%.

Target to achieve 95% compliance by the end of March 2016.

A reduction in sickness absence has been a priority for the Trust throughout

2014/15, and will continue to be so through 2015/16. The sickness absence rate in

WAST is high compared with other Welsh LHBs. Benchmarking against other UK

ambulance Trusts will continue and November 2014 data suggested a range from

4.3% to 8.3% in those rates. The Trust believes that other ambulance providers

represent a more robust comparator.

The Trust has a target to reduce absence levels by 1% by end of March 2016 and

then further 1% reductions in the following two years. Sickness rates experienced a

downward trend in the latter part of 2014/15, achieved through a range of

performance measures and supportive actions to address the reasons for absence

and support staff to return to work. In April 2015 the sickness rate was 6.73%, an

overachievement against the Welsh Government target of 6.75%. We will set a

target of 5.75% for 2015/16.

Some examples of actions taken in 2014/15 to reduce sickness included targets to

improve return to work interviews (see above graph), and opportunities to offer staff

appropriate alternative duties whilst they are not able to return to their substantive

roles. In April 2015, the mobile Occupational Health Units were commissioned,

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offering an innovative mobile service to staff for health screening and checks,

increasing access to early interventional support for staff.

Improving the wellbeing of our staff and achieving a continuous reduction in absence

rates remains a key priority for us through 2015/16. In order to do this, we will be

taking action to gain a deeper understanding of the reasons for sickness absence

and refreshing our annual action plan as part of the work of a sickness task and

finish group established to drive forward this agenda within our Workforce, OD and

Improvement Programme.

„Our People‟ Strategy

Our People Strategy will ensure that we have a clear understanding of the strategic,

organisation, economic and demographic context within which we operate, and an

evidence based approach to developing and implementing innovative workforce and

OD (WOD) activities.

The illustration below provides a simple model of four key stages in the employment

journey around which WOD activity will be focussed.

Through a combination of getting the focus right, ensuring clear linkage between

WOD actions and organisation outcomes, and maximising use of our people and

their full capabilities, we will help make the Trust a great place to work for our staff,

and have a positive impact on patient safety, care and user experience.

The Trust has already made good progress towards addressing some of the

underlying issues of concern and in 2014/15, took positive action to improve the

health and wellbeing of staff and their working conditions. These can be summarised

as follows;

Significant leadership development support for colleagues across the

Trust at all levels of the organisation

•Planned deployment, safe staffing and future workforce

PLAN

•Right person, right behaviours, right job, right time

RECRUIT•Skills and Knowledge

to excel in the Job

DEVELOP

•Creating a Great Place to Work

RETAIN

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Recruitment of 119 additional staff

Establishment of an in house Occupational Health service

Achievement of the bronze and silver Corporate Health Standards

Updating and approval of key workforce policies

Improving working relationships with Trade Unions partners.

Organisation development plan focussed on changing mind-sets and

behaviours to address previously identified issue of the bullying culture

Staff long service awards ceremonies

However, there are still significant ongoing operational challenges to be addressed,

alongside the need to deliver sustainable, long term culture change;

The need to identify and fill vacancies more swiftly

To complete the review of rotas in EMS, PCS and the Clinical Contact

Centres, and identify opportunities to increase efficiency and productivity

among the workforce

To improve retention rates and create a culture where the Trust is an

employer of choice in Ambulance Services

Further reduction in levels of absence and improved health and

wellbeing of our staff

In 2015/16 we will move into another phase of workforce, OD and improvement

transformation across the Trust, with the development of an ambitious programme of

activity (WODI Programme) that will enable the Trust to achieve its aspiration to

become a high performing organisation, and underpin delivery of all IMTP priorities,

and operational priorities highlighted above.

This WODI programme represents the third of the Trusts four change programmes.

Outstanding activity from the Trusts STP will be picked up here.

The Operational Workforce Plan 2015/16

The workforce plan supports delivery of the 2015/16 Integrated Medium Term Plan

(IMTP). Approximately 76.5% of total expenditure is on pay costs. Ensuring that

workforce numbers and skill mix are appropriate for the services being provided, is

key to delivering both service and financial plans, and essential to ensuring the Trust

has the right workforce in place to support the delivery of high quality patient care.

Our workforce plan headlines for 2015/16 are:

Identified savings from workforce of approximately £1.9m to be delivered

from a reduction in variable pay and improved efficiency,

A planned increase in our whole time equivalent workforce numbers across

the year by 24 wte.

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Work to identify opportunities to reshape the workforce and change service

models in line with the developing new clinical model, and the consequent

impact on workforce numbers will be progressed through this coming year, as

we develop our strategic future workforce plan.

The required reduction in variable pay expenditure will be delivered through a range

of actions designed to reduce sickness absence by a further 1% to a target rate of

5.75%; action to fill existing vacancies to full establishment levels and streamlined

recruitment process with quicker time to hire, and through identified opportunities to

increase efficiency and productivity within teams – particularly within the Clinical

Contact Centre.

In 2014/15, the Trust took action to recruit an additional 119wtes (a mixture of UCS,

PCS and EMS posts). These new posts were intended to be additional to the

existing whole time equivalent establishment, with the intention of reducing reliance

on and need for overtime. This uplift in the fixed establishment has been factored

into the baseline establishments for 2015/16, shown in table 1 below. These new

staff will be fully operational from June 2015.

Table 1 shows our budgeted wte establishment at the beginning of the 2015/16

financial year.

In 2015/16 we are expecting to see our budgeted whole time equivalent

establishment increase by 24 wtes. This includes investment in additional resource

with our new in house Occupational Health team, targeted at improving the health

and wellbeing of staff.

Table 2 shows the planned funded increases to the establishment by staff group and

directorate.

Funded Establishment 2015/16 as per Month 01 Budget Reports

CE Office

Board

Secretary Operations

Finance

& ICT Strat Dev

Quality &

Nursing W&OD Clinical Total

Funded Funded Funded Funded Funded Funded Funded Funded Funded

WTE WTE WTE WTE WTE WTE WTE WTE WTE

Chairman & Non Execs 8.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00

Executive Board 1.00 0.00 1.00 1.00 1.00 1.00 1.00 1.40 7.40

Senior Manager 1.00 4.00 58.91 29.30 9.80 3.00 25.80 19.91 151.72

Admin & Clerical 1.00 6.67 177.82 45.60 4.85 16.68 38.18 18.24 309.04

Other Staff 127.31 14.48 7.60 4.00 153.39

Ambulance Staff 2,343.12 2.00 2,345.12

Total 11.00 10.67 2,708.16 75.90 15.65 35.16 72.58 45.55 2,974.67

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Table 3 shows the forecast funded establishment by March 2016. It is worth noting

at the time of writing, a number of proposals for additional investment in posts to

support to delivery of the Trust‟s Strategic Transformation Programme are pending

approval. The impact of hosting the new 111 Service has also not yet been factored

into our workforce numbers pending a decision on the Trust‟s bid.

In the early part of 2015/16 we will be undertaking urgent work to revise and

implement a systematic process of operational workforce planning, aligned to

finance, with robust vacancy control mechanisms. This will ensure effective control

of wte establishments and forecasting of vacancies, enabling early action to fill

critical frontline vacant posts. This will be monitored through monthly performance

meetings with each of the Heads of Operations and their teams.

The Strategic Future Workforce Plan

The future size and shape of the WAST workforce will be determined by a range of

factors, the most important of which are

Funded Developments

CE Office

Board

Secretary Operations

Finance

& ICT Strat Dev

Quality &

Nursing W&OD Clinical Total

Funded Funded Funded Funded Funded Funded Funded Funded Funded

WTE WTE WTE WTE WTE WTE WTE WTE WTE

Chairman & Non Execs 0.00

Executive Board 0.00

Senior Manager 0.00

Admin & Clerical 4.00 4.00

Other Staff 0.00

Ambulance Staff 20.00 20.00

Total 0.00 0.00 24.00 0.00 0.00 0.00 0.00 0.00 24.00

Narrative

UCS Recruitment 15/16 from 119wte increase (17wte, 8 AB, 7 CT, 1 CV, 1 ABM) - 15 Qtr 1, 2 Qtr 2

CFR Recruitment 15/16 (1wte A&C Band 7, 3wte A&C Band 3 and 3wte Band 5 Para) - assumed all Qtr 2

Forecast Funded Establishment 2015/16 as per Month 12

CE Office

Board

Secretary Operations

Finance

& ICT Strat Dev

Quality &

Nursing W&OD Clinical Total

Funded Funded Funded Funded Funded Funded Funded Funded Funded

WTE WTE WTE WTE WTE WTE WTE WTE WTE

Chairman & Non Execs 8.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00

Executive Board 7.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7.40

Senior Manager 1.00 4.00 57.91 29.30 9.80 6.81 25.80 17.10 151.72

Admin & Clerical 1.00 6.67 181.15 45.60 4.85 17.68 38.18 17.91 313.04

Other Staff 0.00 0.00 127.31 0.00 0.00 16.48 7.60 2.00 153.39

Ambulance Staff 0.00 0.00 2,363.12 0.00 0.00 0.00 0.00 2.00 2,365.12

Total 17.40 10.67 2,729.49 74.90 14.65 40.97 71.58 39.01 2,998.67

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The new clinical model for emergency ambulance services falling out of the

STP clinical modernisation project

The workforce requirements of the 111 service together with management

arrangements for that service

The outputs of the Strategic Transformation Programme‟s Non-Emergency

Patient Transport Project

Commissioner requirements in respect of EMS/UCS workload and the

affordability of any additional investment required in WAST capacity

The impact of changes in flows and journey times resulting from the South

Wales Programme, The Mid Wales Healthcare Collaboration and the ongoing

review of acute services in Betsi Cadwaladr University LHB

Turnover, age profile and the impact of working longer hours

The move to paramedicine becoming a degree profession with the first intake

to the degree programme in Wales expected to be in 2016.

The Trust has the tools and skills to model the future size and shape of the WAST

workforce. The model can be flexed to accommodate - to a degree - the uncertainty

inherent in the above list of variables. This work will be informed primarily by the new

clinical model, commissioner requirements and the supply of suitable trained staff.

The 5-step clinical model will bring changes to the make -up and skills of the

workforce from 2015 onwards. The current shape of the EMS workforce as at end of

April 2015 is shown below;

Good work has already taken place to look at the potential impact of the new clinical

model and there are a number of key factors within the different steps which will

impact on the workforce;

Step 1 – Help me choose

39

This will require staff to have the necessary skills to be able to educate and inform

the public at every appropriate contact opportunity. It will require strengthening the

management of local Community First responders so they become the local

community experts, particularly in rural areas. The Trust will use the examples of

community champions established by other agencies and not seek to duplicate but

work closely with other partners in those settings.

The web based Directory of Services will be enhanced and there will be an increase

in clinical staff within the Clinical Contact Centres (CCCs) to inform callers on the

correct pathway. The outcome of the decision on the hosting of 111 will inform the

shape of the service going forward and the staffing numbers.

Step 2 – Answer my call

The main workforce impact of this will be within the CCCs as more calls are dealt

with by clinical staff and callers directed to the correct pathway. It is envisages that

this will see an increase in the number of band 6 staff but the final shape of the

workforce will be impacted by the decision on the 111 service and the future

arrangements for the staff currently in NHSDW.

Step 3 – Come and see me

This requires the most appropriate clinician to attend and deal with life threatening

issues or make decisions on the appropriate pathway. It is envisaged that the

requirement to see and treat will require an increase in the numbers of staff qualified

at a higher clinical level; band 8 and 7 advanced skills practitioners, band 6

“specialist” practitioners. There will, over time, be a reduction in the number of band

5 and 4 staff but an increase in band 3 staff who will provide the back-up transport to

clinicians but also to manage the Card 35, Health Care Professional calls. The

numbers of staff in this group will also be determined by the outcome of the non-

emergency patient care review.

Step 4 – Give me treatment

In terms of the current staffing model of the Trust, it is this area which will see the

biggest changes. The intention is that only those patients who need to attend an

Emergency Department will be taken there having been assessed on scene by

skilled clinicians operating within their scope of practice. These staff will be able to

provide disease specific care and make decisions on referral to other services. This

role will predominately be delivered by staff and bands 6 and 7.

Step 5 – Take me to...

This will require suitably competent and trained staff to transport patients who are

deemed by clinicians to require transport, to a hospital or other facility.

40

It is important to stress that the above model will still mean that patients who require

a time critical emergency response will receive that response from the right staff with

the right skills and will be taken to the appropriate centre for care.

Further work is needed through 2015/16 to assess current capability and resource

against anticipated future skill mix and role requirements, aligned to the developing

clinical model and changing population need. This work will also enable us to identify

and plan for future training and professional development needs, and consider the

issue of affordability.

To achieve this we plan to hold a number of scenario planning / workforce planning

events through the year, involving key partners and stakeholders to enable us to

develop our Strategic Future Workforce Plan.

The Trust will be supported in this by the Workforce, Education Development

Service.

The development of the future workforce will also be supported by a series of

technological advances which WAST intends to implement to streamline and

transform processes. These include

The roll out of ESR Manager Self Service & Business Intelligence

The procurement of a single roster system.

Developing an Integrated service, workforce and finance plan

Development of a Strategic Workforce Plan is an integral part of detailed cross

directorate modelling in order to create an integrated service, workforce and finance

plan for the Trust. Delivery of the overall plan will be driven and owned by the

Strategy, Planning and Performance Directorate. An outline timetable for delivery of

this plan is shown below.

Integrated service, workforce and finance plan

Actions 2015/16 Timescale Interfaces

41

Strategic Priorities Away Day

Local Delivery Plan Template Issued.

Clinical Conference – W/force planning

Local Deliver Plans drafted

Budget bids and savings submitted

Workforce scenario/modelling complete

SMT Away Day – consider LDPs/rank bids

Consultation on workforce planning

Budget approval at F&RC

15 July 2015

16 July 2015

31 July 2015

30 Sep 2015

30 Sep 2015 31 October 2015 31 October 2015 31 December 2015 29 February 2016

LDP development process

Clinical Modernisation programme

WODI Programme

Future supply & retention of staff

Turnover in WAST has traditionally been around 5% but 2014 saw an increase in

turnover of paramedics who left WAST to work in the private sector. The main

reasons cited were flexible working and better work life balance. A number of staff

have since returned to WAST and we will collect the reasons for staff returning and

use this information, along with the reason for leaving, to address the issues which

created the turnover and build on the positive reasons which encouraged staff to

return.

All UK ambulance services are experiencing shortages of paramedic staff and

WAST will need to compete in this market. Conversations have started with

Education Commissioners to inform education provision going forward as part of

workforce planning. This includes preparation for the three year degree programme

expected to commence in academic year 2016/17 and a plan to ensure that there is

no fallow year in the move from Diploma to Degree.

There are a high level of applications for paramedic courses and an increase in the

places in Wales for both conversion courses, the diploma programme and the three

year degree programme.

The Trust is able to recruit staff into Unscheduled Care posts which require a basic

level of educational attainment but all the training for the role is delivered in house.

This provides a pool of staff who are able to move into EMT roles and potentially

then to convert to paramedics in the future.

42

We will continue to advertise to fill existing vacancies through NHS Jobs, using

social media and linking with the military careers services to attract military medical

personnel who may be leaving the armed forces and are interested in working in

WAST. Over the next year, our Recruitment Task & Finish Group will be exploring

opportunities to change the way in which we attract and recruit new staff, looking at

one stop shop bulk recruitment events targeted at students due to complete their

studies, and developing our employee value proposition to ensure we are the

Ambulance Service employer of choice.

Retention of staff is also a key piece of this jigsaw. There is a considerable body of

research evidence and knowledge that supports the link between employee

engagement, motivation and organisational success, with engagement impacting on

key performance indicators such as absenteeism and turnover rates.

Building a highly engaged, responsive and agile workforce will be critical as we enter

a period of unprecedented change and development. Creating a framework for the

engagement and recognition of our people, that is evidence-based and grounded in

research, will be the starting point for developing a programme of activities aimed

specifically at increasing levels of staff engagement. Research shows that a focus

on this agenda will positively impact on patient experience and the delivery of high

quality, safe care for all.

The development of this framework and the collection of staff stories to inform and

shape our future actions and behaviours will be a key output of Project 2 WODI

Programme, aimed at delivering sustainable culture change.

Education and Training

The move to paramedicine becoming a degree profession with the first intake to the

degree programme in Wales in 2016 brings with it a number of issues which the

Trust and its partners will need to work through in 2015/16:

The release of EMTs to convert to paramedics using the one year +

programme

Sufficient hospital and other clinical placements for students

University support for training additional numbers

Sufficient internal resources to support students

Development of a one year programme for diploma/IHCD paramedics to

become degree paramedics

The impact of the banding of newly qualified paramedics from 2019 onwards

(potentially Band 6 rather than the current Band 5).

The Trust currently provides induction and CPD for all clinical and non-clinical staff

in-house through the National Training College based in Swansea which is an IHCD

43

accredited centre. For all other non-medical clinical groups in Wales, all basic and

post basic education (including all CPD) is provided by the HEI sector through

service level agreements with LHBs and Trusts.

Discussions are at a very early stage about the potential transfer of the CPD

provision for registered clinical staff into HEIs with the Trust retaining the training

and development of other clinical groups, CCC staff and managerial staff in house,

working with LHB partners.

It is vital that the CPD programmes for clinical staff reflect the changing nature of

clinical practice for paramedicine and that HEIs are part of that work going forward.

The outcome of the review of Education Commissioning established by the Minister

for Health and Social Services will be an important influence on how the Trust takes

forward its ambition to be a provider of clinical services across Wales and implement

the clinical model. There are a range of different disciplines who work in

communities with some common but many different skills. The Trust will work with

other partners to avoid duplication but there is a need for support to enable easier

transfer of skills across disciplines. At the present time a nurse who wishes to

become a paramedic has to undertake the full two year diploma. The ability to better

transfer and recognise skills within an appropriate governance and regulatory

framework is a key piece of work for the future.

Workforce, Organisation Design and Improvement (WODI) Programme

Underpinning all of the above activity and enabling delivery of the Trust‟s broader

OD strategy and IMTP priorities will be our WODI Programme of work. This

programme will provide the means to ensure pace, discipline and momentum to

delivery of our workforce, OD and improvement objectives.

The programme has been scoped through a process of stakeholder discussion and

review of existing organisational commitments and risks. This is a dynamic and

ongoing process. It identifies an ambitious programme of workforce, organisational

design and improvement activity that distinguishes key business as usual activities,

and focuses delivery on two projects, with a number of workstreams, designed to

underpin delivery of the Year 1 priorities, and those designed to deliver sustainable

organisational and cultural change.

Project 1: „Year 1 Priorities‟ aims to deliver us the following benefits;

a sustainable reduction in sickness absence rates of 1% across the Trust

a streamlined recruitment process and reduced time to hire

44

a refreshed (TU) partnership working infrastructure, and robust, positive

partnership behaviours and relationships across the Trust

completion of the current rostering project, and identification of further

opportunities to increase workforce efficiency and productivity

completion of the “roster centre review“ which represents a legacy piece of

work from the Trusts previous Strategic Transformation Programme.

successful achievement of the Gold Corporate Health Standard

Project 2: focusses on delivering our (expanded) OD strategic objectives, with

multiple, interdependent workstreams (which commence now) aimed at delivering

sustainable organisational and cultural change. Benefits will include:

a refreshed set of agreed values and expected behaviours, and agreed

common principles which represent the WAST „way of doing things.‟

reinforcement of leadership and clinical leadership behaviours

continued development of a „Future Leaders Pathway‟ as a mechanism for

succession planning and talent management,

clear decision making and accountability framework

a stronger team and team working ethos (and skills) across the Trust

a sustainable model and strategy for service improvement

a training needs analysis and plan to ensure a safe, skilled and sustainable

workforce

* Note that Clinical Leadership development will formally sit as part of the Trust‟s

Clinical Modernisation Programme, as will the development of a Strategic Future

Workforce Plan aligned to the new Clinical Model.

Successful delivery of the Programme will be contingent on ensuring all these factors are in place:

The right attitude, determination and will to deliver change

A clear and shared vision for the future

Ensuring projects and plans aligned to organisational strategy

Focus and execution, with the capacity to deliver

45

Plans on a page for the two projects within the WODI programme are shown in annex 1.

Workforce, Organisational Development and Improvement Programme

Actions 2015/16 Timescale Interfaces

PROJECT 1 Recruitment:-

Streamline recruitment pathways, reducing time to hire

Develop the WAST Employee Value Proposition – to improve profile and attractiveness to potential new hires

Absence management:- Overall reduction in

absence by 1% Set and communicate

SMART targets across the service - Executive ownership and drive

Develop an improvement plan based on diagnostic workshop approach

Partnership development:- Develop Go Together,

Go Far action plan Implement a revised

Partnership Working Infrastructure at local and trust level (WASPF),

Implement a programme of development and agreed set of operating principles for TU colleagues

Workforce Efficiency:- To complete the current

rostering exercise To complete roster

centre review Scope opportunities for

further workforce efficiencies and

30 September 2015

31 December 2015

31 March 2016 30 June 2015

30 September 2015 30 June 2015

30 September 2015

30 September 2015

31 August 2015*

31 October 2015

31 March 2016

Clinical modernisation programme

Improving quality and responsiveness

Planning and performance framework

Financial plan

Engaging with patients/users, partners and the community (*note outcome of Cwm Taf Explorer Pilot will impact on this timeline)

46

productivity through a workshop approach and benchmarking

Employee wellbeing:- Achieve Corporate

Health Standard Gold PROJECT 2

To develop a set of common principles that will articulate the „WAST way‟ of doing things

An identified plan of engagement and recognition activities

To agree and communicate refreshed organisational values and behaviours,

To identify current skills and training levels, a review of CPD provision and gap analysis – and development of training plan to address any shortfall in skills linked to future workforce plan

To identify the talent pipeline and aspiring leaders and managers – establish a Future Leaders Pathway

A sustainable model for service improvement

To empower and develop the leadership teams through a programme of development for the Executive Team, Senior Management Team and Head of Operations Team

To achieve the target of 95% compliance with PADR, ensuring quality discussions, opportunity to reinforce desired behaviours and accurate reporting

To ensure the Clinical

31 March 2016

30 September 2015 30 September 2015 31 October 2015

30 November 2015

31 December 2015

31 January 2016 31 January 2016

31 March 2016

31 March 2016

47

Team Leader role is effective, and supported by a clear development programme

MANAGEMENT OF RESOURCES

The financial outlook for the Welsh Ambulance Service in the financial year 2015/16

is significantly better than in previous years. This is primarily due to the following

three things:

1. The recurrent investment of £7.5m to support the underlying infrastructure of

the Trust; this is predominately the recruitment of additional front line staff

and the introduction of a clinical desk in the Clinical Control Centre. This

funding is being used alongside reductions in overtime, reductions in

sickness and better alignment of rotas;

2. The investment of a further £8m (see below for details);

3. Knowing the level of income at the start of the financial year.

There are, however, risks associated with the ability to continue to improve

performance against the 65% target and breakeven financially. Improvement

initiatives in place at the start of the financial year are not affordable within the

current financial envelope for a sustained period of time. This includes, but is not

limited to, the additional resources being used to support the „Explorer Project‟ in

Cwm Taf, continued use of private providers to increase capacity and paying double

time for overtime worked by frontline EMS staff.

Income assumptions for 2015/16

The Trust Board has approved the budget set for 2015/16 as per the income detailed on the table below. This reconciles with the income schedule (RE4) contained within the National Collaborative Commissioning: Quality & Delivery Framework Agreement. It should, however, be noted that not all of the income received by the Trust and included in the table below comes via the Emergency Ambulance Service Committee (EASC). The key income assumptions for 2015/16 are as follows:

48

Income from the Emergency Ambulance Service Committee (EASC), for Emergency Medical Services and NHS Direct Wales services will be maintained at the outturn for 2014/15. This includes an additional £8m that is currently being spent as part of the overall service delivery but in the future additional efficiencies will need to be made such that this funding can be re-invested into developments to support delivery of the 3 year IMTP and the Quality and Delivery Framework. The table shows the anticipated funding included within the Trust budgets:

INCOME

£000

Budget 14/15 ( 122,177)

Less non-recurrent (pay award) 530

Recurrent base 14/15 (121,647)

Transitional funding ( 8,000)

Less VERS funding 471

Depreciation increase 15/16 ( 3,629)

Other income including NHS/WG ( 26,793)

Budget 15/16 ( 159,598)

The Hazardous Area Response Team (HART) service will continue to

receive funding in line with the expenditure profile agreed with WG officials;

Capital Charges will be funded by WG at £16.118m. No definitive advice has yet been received on the level of baseline depreciation funding. It is assumed depreciation will continue to be “ring fenced” by WG with under spends clawed back and agreed increases as a result of capital investment funded, therefore assuming no underspend or overspend;

The cost of Personal Injury Benefit cases (PIBs) and other provisions movements will continue to be funded directly by WG at the same level as 2014/15. Both Income and expenditure are budgeted at £1.5m, thus assuming overall revenue neutrality to the Trust;

49

Capital funding will be in line with the indicative expenditure plans submitted to WG with any consequential in-year increase in depreciation also being funded;

The cash allocation settlement from other Welsh Health Partners, including LHBs, will be at the same level as last financial year i.e. flat cash with adjustments only for agreed activity variances;

Income and costs for the Non-Emergency Patient Transport Service (PCS) has been included at historic rates;

Following discussions, HCS was transferred to NWSSP as of 1st April 2015; as such, the income and expenses valued at £4.62m will be transferred over to Shared Services. The terms of the transfer assumes no net financial impact to WAST;

It is assumed that WAST will continue to receive the same level of service provided by HCS in 2014/15 at no additional cost and HCS will continue to receive the same access to WAST facilities and support at 14/15 baseline levels at no additional cost other than where a transfer of relevant identifiable HCS overheads to NWSSP has been agreed enabling costs to be recharged.

Using a zero based budgeting approach, Directorate Accountants have worked with their Directorate Managers to produce budgets for the 2015/16 financial year within the framework of the Trust‟s overall anticipated resource envelope. Detailed proposals were presented at the Finance and Resources Committee (FRC) for full scrutiny on April 21, 2015 and commended for Board approval. The Trust Board subsequently approved the full, detailed proposed budget on 8th May 2015 having previously approved a very high level summary budget at the end of March 2015.

Revenue 2015/16

The Trust is required to set expenditure budgets within the total resource income available i.e. achieve financial balance in line with the Trust‟s statutory break even duty as set out in WG circular WHC (2007) 049. The revised 2015/16 financial plan delivers a forecast breakeven position; however, this assumes that the full 3% savings will be achieved. Below is a table which shows the current forecast position.

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The Executive Team has reviewed the cost pressures that have emerged as part of the budget setting process and have agreed to fund £9.170m which are to be included within this year‟s budget. The cost pressures have been identified through the zero based budgeting approach and are considered to be unavoidable costs that must be addressed in order for the Trust to move to a position of sustainable financial balance. Not all of the identified pressures have been funded at 100% as it was felt some elements could and should be managed within individual directorate areas e.g. incremental drift has been funded at 50%. The Trust has committed funding for service improvements, operational and corporate delivery to the value of £1.343m. The areas covered by this investment include: Investment in the new CFR structure; Investment in the management structure to deliver the PCS service; The Advanced Technicians‟ role supports clinical development; Occupational Health development of service provision.

Funding in corporate areas includes, but is not limited to, the previously unfunded Strategic and Planning Directorate; posts have been recruited to without identified recurrent funding. The service improvement investments that have been supported are a combination of developments that are essential to support performance, transformation as included within this one year plan and improved service delivery.

Expenditure Budget Income Variance £ ' 000 £ ' 000 £ ' 000

Pay & non-pay

Baseline 135,850

Cost Pressures 9,170

Committed Service Improvements 1,343

Transformation Fund (bids value £4.4m) 1,654

Total Pay & non-pay 148,017 -135,850 12,167

Depreciation 16,118 -16,118 0

3% savings achieved -4,537 0 -4,537

Adjustment for VERS 0 471 471

Interest receivable 0 -101 -101

Sub-total 159,598 -151,598 8,000

Transitional Funding -8,000 -8,000

Retained (surplus/deficit) 159,598 -159,598 0

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Additional investment has also been identified which equals a full year effect of £4.385m. A „Transformation Fund‟ fund of £1.654m has been created which will allow the highest ranking, currently unapproved, investments to be funded based on an agreed prioritisation methodology. However, it should be noted that the level of funding available is insufficient to cover all requests. It should also be recognised that this funding will not be utilised, except in exceptional circumstances, until the remainder of the savings have been identified and agreed. The additional £8m funding received into the Trust is, at this stage, being used to fund the current cost pressures which include the on-going initiatives that are in place to support continued improvement in performance. However, it is the view of Commissioners and WAST that this funding should ultimately be used to support service change. This will be an iterative process over a period of time and will require the Trust to become more efficient at service delivery such that the funding can be re-invested in service change that deliver improvements to the whole unscheduled care system in Wales. It has been agreed that unachieved savings from the previous year are funded via cost pressure investments in 2015/16; however, this will not happen in future years. Any unachieved savings from 2015/16 will remain with the individual directorate. It is, therefore, essential that all areas identify recurrent savings throughout the year. Directorates are required to identify a 3% financial efficiency; this is included within the budget submission. The table below shows that £4.167m of the savings have been identified with a net total of £0.370m currently unidentified.

The net total of £0.370m currently unidentified is comprised of unidentified Directorate savings offset by overachieved savings of £0.489m on Finance Directorate budgets and £0.528m on Central expenditure. These over-achievements respectively relate to profit on asset disposals in excess of plan and the procurement savings target to be achieved for the Trust by NWSSP.

3% Saving Savings identified Unidentified saving schemes Percentage identified

£'000 £'000 £'000 %

Service Delivery 3,793 2,717 1,076 72%

Chief Executive 16 0 16 0%

Board Secretary 14 9 5 64%

Workforce & OD 108 57 51 53%

Clinical 76 0 76 0%

Finance 77 566 -489 734%

ICT 148 84 64 57%

Estates 116 18 98 15%

Health Informatics 38 38 0 99%

Capital Planning 0 0 0 0%

Strategy Development 29 29 0 100%

Director of Quality & Nursing 49 49 0 100%

Central Expenditure 72 600 -528 833%

TRUST TOTAL (excluding Depreciation) 4,537 4,167 370 92%

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A planned saving of £0.5m on Clinical Contact Centre -led modernisation of operational services is currently being taken forward by the Head of Operations with timescales for achievement yet to be finally confirmed. All savings schemes have been developed by Directorate teams in conjunction with finance managers. There is a phasing plan for each scheme and this will be monitored through the monthly performance management meetings. Given the Directorate of Operations consumes the majority of the resources, it follows that the largest element of the savings requirements falls in that area. A significant facet of the plan is delivered through a reduction in the cost of sickness. The savings target has been calculated at an individual health board area level using the average cost of sickness in 2014/15 as a baseline. Where areas are currently below the national level required, no additional target has been applied. The reduction in cost of sickness equates to a c.2% reduction; this is a stretch target but takes into account that many areas have reached the 1% target as at 31 March 2015. This is thought to be as a result of the new National terms and conditions that have removed the unsocial hours uplift from sickness payments. An investment of £133k in the Occupational Team has been supported to enable delivery of the Trust wide sickness reduction plan.

Financial Plans 2015/16 to 2017/18

The table below provides an overview of the estimated financial outturn position for

each of the following three years; this assumes the additional £8m is funded

recurrently.

As can be seen from the table, given the assumptions made, the Trust is forecasting

a balanced financial position for all three years of the plan. This is based on the

assumption that WAST will deliver recurrent savings of 3% over each of the years;

the savings plans are not yet fully developed but will cover the following areas:

Sustainable savings linked to reduced sickness levels;

Sustainable savings and improved operational effectiveness following the

implementation of the rota review;

Longer term savings in relation to work currently underway to rationalise the

estate;

Corporate and support services efficiencies.

In order to balance the financial plan on a recurrent and sustainable basis, there will

need to be agreements in place to cover the additional cost of the added capacity as

described at the start of this section.

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Activity assumptions on growth and demand management

Emergency Service activity is forecast to increase at c.4% per annum, this is

estimated to lead to a 2.5% increase in baseline revenue costs.

Annual Annual Annual

2015/16 2016/17 2017/18

Revenue/Income (positive entries) £'000 £'000 £'000

1 Revenue Resource Limit

2 Dental Patient Charge income

3 Other Income from WG 552 552 552

4 WHSSC income 130,375 136,887 141,933

5 Income from other Welsh NHS bodies 20,329 20,329 20,329

6 Income from English NHS bodies 382 382 382

7 Injury Cost Recovery Scheme

8 Non NHS patient income

9 Local Authorities

10 Education, training and research

11 Capital Donation / Government Grant Income

12 Other income 8,430 8,430 8,430

13 Non cash limited income

14 Total Revenue/Income 160,068 166,580 171,626

Operating Expenses (positive entries)

15 Primary Care Contractor (excluding drugs)

16 Primary Care - Drugs

17 Pay 112,214 114,613 114,641

18 Non Pay (excluding drugs & depreciation) 31,736 32,270 32,842

19 Secondary Care - Drugs

20 Healthcare Services Provided by Other NHS bodies

21 Non Healthcare Services Provided by Other NHS bodies

22 Continuing Care and Funded Nursing Care

23 Other Private & Voluntary Sector

24 Joint Financing and Other

25 Depreciation 16,118 19,698 24,143

26 Other

27 Total Operating Expenses 160,068 166,580 171,626

28 Forecast Surplus/(Deficit) 0 0 0

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Cost Improvement Programme (CIP)

A summary of indicative recurrent savings requirements based on 3% of the spend

that can be influenced i.e. excluding depreciation, is shown in the following table.

Detailed savings programmes will be developed as part of the medium to long term

financial planning process going forward.

Fixed assets

Fixed assets includes capital expenditure of £15.448m incurred during 2014/15, this

includes replacement vehicles, medical equipment and ICT assets. The investment

in fixed assets is off-set by depreciation costs of £12.4m

Public Sector Payment Performance

The Trust continues to forecast that it will meet its target of paying 95% of non NHS

suppliers within 30 days.

Capital Plan

The Trust‟s current Capital Plan provides for gross capital expenditure of £159.6m

over the next 5 years, including new estate developments of £63.5m and vehicle

replacement programme of £45.6m, as shown below. There are a number of capital

proposals that the Trust believes will be essential to continued service provision and

service improvement but as yet are unquantified in terms of cost. Other entries on

the capital plan are detailed below.

The items on the table below relating to improvements in the estate are taken

directly from the estates Strategic Outline Programme (SOP) which is currently with

WG for consideration.

Year

Savings Plans

Non Pay 1,134 1,172 1,213

Pay 3,403 3,517 3,640

Total Savings Plans 4,537 3.0%

4,689 3.0% 4,853 3.0%

2015/16 2016/17 2017/18

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Projected all Wales Capital Programme - Capital Resource Limit

Year 1 2 3 4 5 Total

Financial Year 2015/16 2016/17 2017/18 2018/19 2019/20

£m £m £m £m £m £m

Wast Discretionary Capital 3.884 3.884 3.884 3.884 3.884 19.42

0

Operational Requirements

WAST Ongoing vehicle replacement 13.588 4.223 6.661 11.854 9.261 45.587

Clinical Equipment 0.5 0.5 0.5 0.5 0.5 2.5

Defibrillators 0.705 0.965 0.965 2.635

ICT Developments 0

WAST North control - Estimate 1 2 0 0 0 3

CAD/CFR Virtual Control 2.5 0.025 2.525

Global Rostering System replacement 0

Workforce manager 0

Paramedic Pathfinder/APPs

Access to Clinical Records and national info (eMPI/IHR etc) 0.1 0.1

ESMCP 0.35 0.35

ARP - Mobile Data Solutions 0.1 0.1

ARP - Control Room Solutions 0.1 0.1

NEPT Project 0

ECR 1 10 11

Control Room Configuration - Infrastructure requirements 0.05 0.05

Infrastructure development 0.35 0.25 0.3 0.15 0.25 1.3

WAN (PSBA) refresh 0.5 0.25 0.75

EUD refresh inc mobile working 0.1 0.25 0.2 0.1 0.1 0.75

Business Continuity 0.05 0.05 0.05 0.05 0.05 0.25

Patient self service - eg. NEPT renal kiosks 0.1 0.05 0.15

PSN compliance 0.05 0.1 0.1 0.25

Subtotal 24.027 13.547 22.66 16.538 14.045 90.817

Estate Development Programme 2014 - 2020

St Asaph Headquarters Relocation 0.05 2.2 2.25

Wrexham ARC 5.592 5.592

Cardiff ARC 0.26 3.407 4 7.667

Swansea ARC 0.2 4.685 3.269 0.05 8.204

Bangor ARC 0.5 3.4 3.36 7.26

Newport MRD 0.925 2.85 3.775

Tier 5 MRD's 0

YSTRAD MYNACH 0.875 2.63 3.505

ABERYSTWYTH 0.25 1.58 0.85 2.68

BODELWYDDAN 0.05 1 1 2.05

HAVERFORDWEST 0.5 1 1.5

POWYS 0.25 1.1 1.05 2.4

BRIDGEND 0.25 1.4 1.65

CARMARTHEN 1.45 1.6 0.17 3.22

ABERGAVENNY 0.08 0.9 0.98

LLANTRISANT 0.1 1.55 1.65

MERTHYR TYDFIL 0.2 2.75 2.95

0

RUG - Additional Floor Area at VPH 0.1 1.1 1.2

Swansea Regional Headquarters Relocation 0.25 2.95 3.2

Control Room Configuration - All Wales tbc tbc tbc tbc tbc 0

Expand SE control room accommodation VPH 0.1 1.1 1.2

SDP'S - Social Deployment Points 0.112 0.112 0.112 0.112 0.112 0.56

Other points of presence tbc tbc tbc tbc tbc 0

Estate Dev.Prog.Total 7.414 17.444 25.332 11.391 1.912 63.493

Capital Receipts 0.185 0.324 0.964 0.976 2.826 5.275

Overall Capital Programme 31.626 31.315 48.956 28.905 18.783 159.585

WAST Proposed Outline Capital Plan 2015/16 to 2019/20

56

Balance Sheet

The indicative forecast Trust balance sheet based on current capital plan

assumptions is shown below:

Balance Sheet - Welsh Ambulance Services NHS Trust Forecast Forecast Forecast

2015/16 2016/17 2017/18

£000s £000s £000s

Non-Current Assets

Property, plant and equipment 79,007 76,257 94,273

Intangible assets 500 500 500

Non-Current Assets sub total 79,507 76,757 94,773

Current Assets

Inventories 1,600 1,600 1,600

Trade and other receivables 10,000 10,000 10,000

Other financial assets - - -

Cash and cash equivalents - - -

Non-current assets classified as held for sale 600 600 600

Current Assets sub total 12,200 12,200 12,200

TOTAL ASSETS 91,707 88,957 106,973

Current Liabilities

Trade and other payables 5,899 6,037 6,037

Borrowings 1,373 1,373 1,373

Other financial liabilities - - -

Provisions 8,000 8,000 8,000

Other liabilities - - -

Current Liabilities sub total 15,272 15,410 15,410

NET ASSETS LESS CURRENT LIABILITIES 76,435 73,547 91,563

Non-Current Liabilities

Trade and other payables - - -

Borrowings 5,310 3,310 3,310

Other financial liabilities - - -

Provisions 5,638 2,000 2,000

Other liabilities - - -

Non-Current Liabilities sub total 10,948 5,310 5,310

TOTAL ASSETS EMPLOYED 65,487 68,237 86,253

FINANCED BY:

Taxpayers' Equity

PDC 67,663 70,413 88,429

Retained earnings 9,681- 9,681- 9,681-

Revaluation reserve 7,505 7,505 7,505

Other reserve - - -

Total Taxpayers' Equity 65,487 68,237 86,253

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ENABLING STRATEGIES

Estates strategy

The Trust operates from 113 buildings across Wales (either owned or leased). This

total includes 2 Area Ambulance Centres, 6 Control Centres, 75 ambulance stations,

4 fleet workshops, 17 social deployment points and 7 administration centres.

The National Estates Strategy

Currently, the Trust continues to implement its ten year National Estates Strategy.

For the period 2015/16-2017/18, the focus of the strategy remains:

Maintaining the Trust‟s estate to the statutory minimum standard, recognising

that most of the 113 buildings owned/operated by the Trust are operationally

outdated, attract significant backlog maintenance and require rationalisation

through the Estate Strategy

Completion of the following major projects

o Ambulance & Fire Services Resource Centre (AFSRC) Wrexham

o Relocation of Headquarters (North)

o Review and ensure appropriate numbers of Clinical Contact Centres

and Points of Presence across Wales

o ISO 14001 accreditation for Trust ( 2016)

Development of proposals for

o Ambulance Resource Centre (ARC) Cardiff

o ARC Bangor

o ARC Swansea

Development of outline proposals for Make Ready Depots.

The outline proposals for the further development of Make Ready Depots will seek to

maximise the benefits of the concept:

Improved operational performance

Improvements in vehicle cleaning processes, stocking and washing.

Estate rationalisation –operational estate which is fit for purpose and in the

right location

Enhanced Status Plan Management - centralisation of staff rosters.

Improve synergy with other services – collocation and collaboration for

Social Deployment Points

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The capital costs of the schemes within the National Estates Strategy total c.£59m.

This figure is significantly in excess of the Trust‟s overall discretionary capital

allocation for that period covered by the Strategy.

The estate implications of the strategy, set out above, will need to be assessed and

the National Estate Strategy reviewed and updated accordingly. This review/update

will incorporate plans to rationalise the Trust‟s estate.

Given the pressure on capital, the updated estate strategy may also need to address

alternative funding/ financing arrangements (perhaps drawing on the experience of

NHS England).

Operating Costs

The annual operating cost of the Trust estate which comprises 113 buildings is

£3.79m.

The Trust maintains its estates in accordance with the NHS backlog methodology

and the latest backlog maintenance position is set out in the table below:

Risk Category £(m)

High 3.1

Significant 6.1

Moderate 3.0

Low 2.0

TOTAL 14.2

The key areas of risk associated with the Trust‟s estate are age, obsolescence and

inferior property condition particularly in plant/equipment and roofs.

Vehicles

The Trust will continue to configure its fleet, ensuring alignment to the Workforce

Plan and the Clinical Response Model, to deliver the Trust strategy. This will include

the provision of Emergency Ambulances (EAs), Rapid Response Vehicles (RRVs)

and the procurement of appropriate Patient Care Services (PCS) vehicles.

The table below profiles vehicle types and numbers

Type Number

EMS 227

RRV & 4X4) 116

HDS 29

PCS 252

HCS 74

Specialist 38

TOTAL 736

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The investment objectives for the fleet re-procurement programme are detailed

below:

Improve service performance through reducing planned vehicle

downtime by 2% and unplanned vehicle downtime by 1%, thus

increasing vehicle availability after commissioning of new vehicles.

Reduce pre-hospital acquired infections following the commissioning of

new vehicles by considering emerging advancements in ambulance build

technology, thus improving the quality of vehicle build and aiding the

cleaning of vehicles.

Reduce the number of reported vehicle defects by 10% following the

commissioning of new vehicles by procuring vehicles built to the agreed

WAST build specification.

Reduce vehicle operating revenue by 3% over the 5-years (proportionate

to this investment) through the introduction of new and reliable vehicles.

Reduce CO2 emissions from our vehicles year on year through the

introduction of cleaner greener vehicles that are compliant with current

European Emissions Standards, as per European Parliament Directive

1999/94/EC.

Accordingly the Trust has initiated a strategic efficiency programme- the final of

the Trusts four strategic change programmes. The programme encompasses

two projects (one of which was outstanding from the previous STP);

Resource Utilisation (CCC re-configuration, Points of Presence review,

Administration review)

Capital Planning review

Hosting of services of strategic alignment

Strategic Efficiency

Actions 2015/16 Timescale Interfaces

Hosting of Services with strategic alignment:

Assuming timely decision the following will be completed:

- Establish WAST project team

- Project team meeting schedule

- Confirm WAST Executive Lead

- 111 & WAST project team workshop

31 May 2015 31 May 2015

31 May 2015

highly dependent on decision regarding 111 - Detailed timescales cannot be confirmed until hosting decision/ and Pathfinder project launch date are confirmed.

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- Staff engagement events - Transition of NHSDW

staff - External staff transfer - Governance

arrangements and establishment of Governance/Assurance Committee

- Telephony platform fully developed & tested

- Completion and sign off of SLA

- Service launch

Resource Utilisation:

Points of presence review; report will be presented to the IMTP Portfolio Board

Administration baseline review; A report will be presented to the IMTP Portfolio Board

CCC re-configuration ( Assuming timely decision on 111) in Q1 following will be completed:

- Reconvene Project Team - Review current position - Re-establish baseline

requirements to reflect 111 capacity requirements

- Develop options appraisal criteria

- Gap analysis and options appraisal completed

- Recommendations submitted to Trust Board

- Submission of SOC / OBC to WG

„pause, review and recalibrate‟ by the Portfolio Board /

TBC- dictated by timing of final decision

31 August 2015. 31 July 2015 Qtr 2,3,4

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Executive Team to provide further direction on the way forward depending on contents of commissioned reports.

Capital Planning

Review current position

Re-establish baseline requirements

Develop action plan, timeline for any changes

Where appropriate seek mandate to implement changes and/or initiate changes.

Qtr 3 Qtr 3,4

A plan on the page for these three projects are shown in annex 1

Health Informatics and Information Communication Strategy The Trust‟s current health informatics (HI)/ ICT strategy Working Together – Working

Smarter 2011-2016 remains on track but will require review and updating to ensure

that future developments and investment align with the requirements of WAST‟s

strategy for the next three years. This review/ updating will ensure the necessary

links with the updating of the national eHealth Strategy.

Crucially, that review and updating will follow on from a zero based analysis of the

information requirements of the organisation as it defines more closely the

constituent elements of the process of stabilisation, improvement, reorientation and

transformation.

That said, priorities for the period 2015/16 and actions are set out below.

Delivery of all proposals is, however, subject to securing of the necessary funding.

Priorities areas

Priorities are as follows:

The maintenance and improvement of ICT infrastructure

Resilience of all systems

The improvement of critical and business information systems

62

Working with partner organisations in the health, other emergency services

and other sector(s) on the sharing of information and potentially sharing

facilities

Supporting improved staff access and patient engagement

Enhancing Business Continuity

Improving ICT operational service delivery

Developing the professional skills of ICT staff

Develop the organisation‟s commissioning dataset

Strengthen the Trust‟s Information Governance Standards to maintain our

information‟s confidentiality, integrity and availability

Increasing our range of internet-based and mobile services

Consolidating our information systems to provide internal and external-facing

portals for Trust statistics and management information

Further developing our data warehouse by incorporating clinical and

business-support data streams

Developing a Records Management framework which outlines how we treat

each type of information, ensuring classification, retention and disposal

guidelines are adhered to

Developing the approach and plan towards achieving ISO/IEC 15489-1 and

ISO9001.

The primary focus during the first part of 2015-2016 will be to consolidate all ongoing

works to build a resilient, robust and highly available ICT infrastructure which will

provide the foundation to support the vision for delivery of HI and ICT services for a

21st century ambulance services. This will also place the ICT department in a strong

position to support the IMTP projects proposed in the transformation programmes

such as Clinical Modernisation, as they develop.

Whilst very much out of sight for the majority of users, nonetheless the Trust will

continue with the maintenance of the network, server and storage infrastructure,

ensuring the Trust meets is legal obligation for licensing of servers and end user

devices (EUD), i.e. desktop, laptop, tablet computers and Smartphones.

The Trust will need to complete the work to replace computers that are incompatible

with Windows 7 in order to mitigate the security risk of Windows XP from June 2014.

In so doing, it is hoped to upgrade the heavily ageing computer population currently

in use within the Trust.

During this period we will also work with colleagues within the trust on

implementation of solutions namely, Digi Pens, a demand and capacity modelling

system, CFR application and a replacement CAD. We will also look to enhance the

capability of current systems. An early opportunity exists with PCS where, as a first

63

step, we can look to provide secured access to patients, thorough dedicated kiosks

at treatment centres to electronically book transport.

WAST will also work with NWIS to provide access to national information resources,

such as the Master Patient Index (eMPI) and Individual Health Records (IHR) as well

as investigating options to provide Trust information into national repositories, such

as Welch Clinical Records Service (WCRS). We will also look to work with

colleagues in LHBs on local initiatives to exploit ICT in order to improve the patient

experience.

The Trust will contribute to the work of national projects such as USC, 111, ARP and

Emergency Services Mobile Communication Programme (ESMCP) ensuring the

Trust requirements for these services are included and the Trust is well positioned to

take advantage of future developments delivered by these programmes and to adopt

them into its future operational model. An ESMCP project team will be established

as preparatory work will be required in 2016

The Trust will look to enhance our Wi-Fi service by extending it across our buildings.

This is an essential component to support an increase in mobile computing thereby

providing easier access to staff.

Improvement in ICT service delivery will continue as the current Service

Improvement Plan evolves with the introduction of the Information Technology

Infrastructure Library (ITIL) processes for problem, change and release

management. Further work on pro-active monitoring management of ICT

infrastructure will also be improved through the introduction of System Control and

Configuration Manager (SCCM) as a management tool for both Servers and EUD

In executing all these programmes of work, we will take account of information

security and business continuity requirements and build and develop these into the

delivery of the final solutions, thereby ensuring that the Trust not only meets its

legislative requirements but is well placed to minimise any service disruption through

technical failures.

In order to support the organisation there will be a requirement to ensure that new

models of care are suitably statistically modelled to support strategic decision-

making. This includes co-production modelling to support the South Wales

Programme, the Mid Wales Healthcare Collaboration and the ongoing review of

acute services in Betsi Cadwaladr University LHB, as well as supporting capacity

and service reviews.

64

A key development will be the production of our organisation commissioning dataset

and ongoing information analysis and support. As the roll-out of national and local

commissioning arrangements commence, how we share information with our

partners and regulators will need to change to reflect this.

The Trust will develop and update our plans for our SQL Server estate and our Data

Warehouse, ensuring that short term recommendations are addressed as a priority.

We will document a long-term plan to incorporate additional data streams such as

clinical, fleet, HR and risk management information. We will upgrade our information

portals such as Launchpad and ensure that our information systems have a modern

interface that people are used to in their private lives. Part of this upgrade will be

simplified access to our information systems through the use of a single sign-on

process.

Central to our informatics delivery will continue to be modern, fit for purpose

technological solutions in the form of internet and mobile technologies. Ensuring

that we use smart applications to support demand management and health

promotion will underpin our organisation‟s Quality plan. We will continue to develop

apps and self-assessment tools to support the self-care agenda in NHS Wales.

We will ensure that a robust records management framework and records retention

schedule is in place. We will undertake a complete records inventory and

information asset owners directory to create a departmental register of information.

We will develop an approach to deliver ISO15489-1 in Records Management for

implementation in the following years.

The Trust will strengthen the Trust‟s Information Governance Standards to maintain

our Information‟s confidentiality, integrity and availability by ensuring our policies and

procedures are fit for purpose. The Trust‟s Information Governance Training &

Awareness programme will be upgraded in-year which will provide further assurance

and protection of our data assets.

We will ensure that our data standards and statistical reporting systems, structures

and processes are continually reviewed by adopting ISO9001 data quality

standards. Immediately, we will upgrade our data dictionary and create information

release grading standards and an Information Classification protocol for the security

marking and subsequent handling of its information assets and documents.

The Trust will conduct a review of the current skills and abilities of ICT staff and

identify any gaps in key technology areas. We will then develop a structured

development programme for each member of staff to ensure they can support the

future developments and technologies while minimising the need to employ external

contractors.

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Health Informatics and Information Communication Strategy

Actions 2015/16 Timescale Interfaces

Maintenance of the network, server and storage infrastructure

Build Windows 7 compatibility within the Trust

Support implementation of service solutions eg digipens, CAD

Contribute to the work of national projects such as USC, 111, ARP and Emergency Services Mobile Communication Programme (ESMCP)

Production of Trust commissioning dataset and ongoing information analysis and support.

Develop robust records management framework and records retention schedule

31 March 2016 30 June 2015 30 September 2015

31 March 2016 30 April 2015 31 July 2015 31 March 2016

Financial plan

Clinical modernisation programme

Capital development plan

NEPTS modernisation plan

National Collaborative Commissioning : Quality and Delivery Framework

MANAGING PERFORMANCE AND DELIVERY

Performance management framework

WAST is developing a Planning and Performance Management Framework which

details reporting arrangements to external stakeholders e.g. Welsh Government,

NHS Wales, EASC, through to operational reporting and individual performance

appraisals. This will be based on a “balanced score-card” model and will be aimed

at addressing all the key domains of the Trust. The performance management

framework will incorporate the reported set of performance measures agreed

through the commissioning framework.

WAST currently provides a formal integrated performance report to managers,

executives and the Board on a regular basis as well as a weekly performance alert

highlighting the key movements in performance over the previous week.

The Trust is rich in performance information which is of high quality, but poor in

performance management i.e. clear what the information is telling us and what

corrective actions we are or should be taking to improve performance at all levels.

66

The first stage in the development of the framework is to embed performance

management through an improved planning mechanism and considerable work is

now being undertaken to developing a performance planning framework that is

“executive led”, engages managers and staff through a decentralised approach (see

Local Delivery Plans below) and is aligned to the financial planning timetable and the

development of the 2016-19 IMTP.

The second key stage is to review the Integrated Performance Report that is

provided to Executive Team and the Board, agree a balanced set of metrics based

on a WAST balanced scorecard and develop and implement a consistent reporting

process.

Draft balanced scorecard

Patient Satisfaction

Patient Perspective (PP)

Help Me Choose (PP1)

Answer My

Call (PP2)

Come To See Me (PP3)

Give Me

Treatment (PP4)

Take Me To

Hospital (PP5)

Internal Process Perspective (IPP)

Demand

Management & Capacity

Management (IPP1)

Clinical Modernisati

on (IPP2)

Governance (IPP3)

Quality & Safety (IPP4)

Business Continuity

and Resilience

(IPP5)

Financial Perspective (FP)

Financial Strategy

(FP1)

Asset

Management

(FP2)

Financial

Management

(FP3)

Financial and Performance

Reporting (FP4)

Value for Money (FP5)

Organisational Development Perspective (ODP)

Stakeholder Engagement

(ODP1)

Workforce Developme

nt (ODP2)

Employee Relations (ODP3)

Commissioning,

Performance Information & Management

(ODP4)

Infrastructure Development

(ODP5)

Staff Engagement

The Trust is reviewing the performance reports that are produced by various teams,

such as Health Informatics, Quality Improvement and Patient Experience to assess

their alignment with the priorities detailed in the IMTP and track their flow within and

outside the organisation. This will enable the development of a much more rounded

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and integrated performance report and result in an agreed suite of reports with a

timetable for their production and reporting.

It will be important to ensure that the Local Delivery Plan process includes a clear

performance “diagnosis” for each operations area i.e. what the particular

performance issues are in each LHB area and the key solutions that then flow from

these.

The Trust is also considering the use of email alerts so that “live” information is

available to the right people, in WAST so that performance on the 5 step clinical

model can be monitored and managed in real time rather than historic information

being reviewed.

Finally, the development of a demand and capacity model, agreed with

commissioners, will inform the development of the performance management

framework and enable benchmarking with other comparable organisations. This is a

significant piece of work, but in the short term the Trust will build its performance

framework based on the principles outlined above.

Programme and project management arrangements

Delivery of the Trust strategy will build on the adoption of formal programme, project

and workstream management originally deployed in support of the Trusts Strategic

Transformation Programme (STP). In line with the activities identified in the original

IMTP a series of plans on a page (PoPs) have been written. This exercise required

officers to address a series of aspects of the work required, which included:

Purpose and Objectives

Background

Required resources

Timescales and key milestones

Scope

Governance structure

Risk and issues including any mitigating action taken

Dependencies

Expected outcomes

Expected benefits and measures of success

This allowed each of the proposed areas of work to be mapped to one of the eight

priorities which have subsequently emerged as part of this IMTP re-fresh to see if

there is continued alignment / justification for the work. Where there was not

alignment it was agreed the work be scheduled for years two or three. Annex 2

details the results of this mapping exercise.

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The suite of PoPs was subsequently taken to the inaugural meeting of the IMTP

Portfolio Board where the robustness of information was scrutinised and an

assessment made as to whether the work in question was:

Routine / low risk / low contention / business development type activity and

could thus be progressed within the business as usual (BAU) environment of

the organisation e.g. handed to the relevant Director for execution within their

Directorate.

Discrete / „new‟ / high risk e.g. reputational / highly specialised type activity

and would thus benefit from being embedded within a dedicated programme

and project management environment.

Annex 3 presents the outcome of this assessment.

Just as when projects and programmes are complete and products are moved into

the business as usual environment of the business it is equally recognised that at

certain points of time some activities will need to move from business as usual into a

formal project and programme management (PPM) environment.

For example, there may be significant ICT and capital projects which once

developmental work (business case preparation, approval etc) has been undertaken

will require moving into a PPM environment in order to maximise the chances of

timely and high quality delivery.

Consequently, WAST has identified four strategic programmes comprising a number

of projects requiring a formal management approach:-

1. Workforce & OD - our people

2. Clinical Modernisation – our services

3. Non Emergency Patient Transport Services – our services

4. Strategic Efficiency & Effectiveness – our resources

The STP has been subsumed within the four programmes and its constituent

projects will be managed through the new programme and Portfolio Management

arrangements. Annex 1 documents the plans on a page for these projects.

Delivery of these four programmes will be through the IMTP Portfolio Board (chaired

by the Chief Executive). This Board will:

Ensure the Portfolio of programmes delivers within agreed parameters

Resolves strategic issues between programmes

Makes resource decisions in regards to delivery of the Portfolio

Gives approval (or not) of key milestone outputs.

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In order for the organisation to retain confidence on the delivery of those activities

which have been deemed suitable for progression within the BAU part of the

business monthly „status reports‟ for these areas will also be required by the

Portfolio Board.

The Portfolio Board will be supported by an IMTP Implementation group which will

be chaired by the Associate Portfolio and Programme Director. The group will

constitute the respective programme leads and other key stakeholders. This group

will:

Manage delivery of the programmes on a day to day basis

Ensure key dependencies, barriers between programmes are identified and

managed.

Portfolio level risks and issues are identified and actively managed.

Allow the Portfolio Board to „manage by exception‟ whilst being able to retain

confidence and a clear line of sight regarding the Portfolio.

The Portfolio structure for delivery is reproduced in full at Annex 4.

Local Delivery Plans

It is recognised that the original IMTP was largely driven by the Executive Team on a

„top down‟ basis. However, this refreshed IMTP and the clear priorities agreed for

2015/16 is expected to help better engage and involve staff in creating an

understanding of the challenges faced by the Trust, the way these are being tackled

and how frontline staff and our partners can contribute to successful delivery over

the coming year. As part of the roll out of the Plan, each LHB based team (together

with other operational units such as HART and the Clinical Control Centres) will work

on the localisation of the IMTP through the development of Local Delivery Plans

(LDPs). These will not only describe the implementation of year one priorities but

will also establish a platform from which staff across the Trust can contribute and

drive the development of the 2016/2019IMTP.

Local Performance & Planning Cells

Delivering improvement in the performance of EMS and NEPTS will require

enhanced joint working with LHBs. This will be supported through the establishment

of Local Performance & Planning Cells (LPPCs) in each LHB area.

Developing the 2016/19 IMTP

Planning the development of the 2016/19 IMTP is a critical element of the continued

transformation of WAST and will signal a shift in emphasis to a “bottom-up”, creative

approach to strategic planning and delivery rather than a “top-down” executive level

document. The timetable for developing the 2016/19 IMTP is below.

Date Forum Purpose End June 2015 Senior Management Team Tier 3 initial engagement in

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strategic planning

End July 2015 Executive Team Away Day

Initial agreement on strategic priorities and budget parameters

Mid August 2015 Trust Board Consideration of strategic priorities and budget parameters

End September 2015 Heads of Operations

Completion of Local Delivery Plans

End October 2015 Director of Strategy, Planning and Performance supported by multidisciplinary planning team

First draft IMTP 2016-19

End November 2015 Welsh Government/NHS

Completion of peer review of IMTP

Mid December 2015 Trust Board Consideration of Draft IMTP

Mid December Finance and Resources Committee

Scrutiny of draft budget

End of January 2016 Trust Board Approval of IMTP 2016-2019

End of January 2016 Welsh Government Submission of IMTP 2016-2019

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ANNEX 2

PRIORITIES FOR 2015/16 AND PLANS ON A PAGE (POP)

No PRIORITIES EMERGING FROM CQDF AND IMTP FOR 2015/16 Activities Identified in Original IMTP Capacity to deliver

1 Developing a community engagement strategy and

implementation plan to enable us to interact with all relevant

stakeholders.

1a. Community Engagement 1b. Engagement in LHB Change

programmes 1c. Engagement with other emergency

services

YES

YES

YES

2 Embedding and sustaining the new clinical model agreed by the

Trust and Commissioners 2a. Clinical Modernisation 2b. Clinical Governance

YES- Subject to development requests being approved

YES

3 Developing and gaining approval of a Quality Improvement Plan

that promotes better patient experience and outcomes

3a. QIS 3b. R&I Strategy

YES

YES

4 Developing a robust performance management framework that

meets the needs of the Trust and Commissioners, is timely and

sufficiently detailed for a range of stakeholders within and

outside the Trust.

4a. Planning and Performance

Management Framework 4b. Commissioning Arrangements

YES

YES

5 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

organization and deliver a reduction in sickness/absence rates by

at least 1% and the cost of absence by 2% in 2015/16

Transforming Business as Usual –

5a. Recruitment 5b. Sickness 5c. TU partnership 5d. Roster Review 5e. Employee Wellbeing (Gold CHS)

5f. Leadership

5g. Values and Behaviours

5h. Teams, Structures and Roles

YES – Subject to development requests being approved

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5i. High Performance Work Practices

(Engagement)

5j. Resource Review

6 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.

6a. Integrated Service, Finance and

Workforce Plan and cost reduction plan

YES – Subject to development requests being approved

7 Developing local delivery plans (LDPs) that minimise demands on

the Ambulance service, promotes choice for patients and

improves the quality of patient outcome

7a. NEPTS 7b. Hosting of services of strategic

alignment (111)

YES

YES – Subject to when ‘hosting’ arrangements are known

adequate support resource is provided

8 Developing the infrastructure required to support the priorities 8a. Resource Utilisation activities

Administration Review

Points of Presence Review

CCC re-configuration

8b. Corporate Governance 8c. Programme & Project Management

Framework

8d. Capitol Planning and delivery

Yes – subject to development requests being approved

(Recognition that Y1 activities only will be delivered.

This work will progress over multiple years)

YES

YES

Yes- subject to successful appointment.

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ANNEX 3 MAPPING YEAR 1 PRIORITIES – PPM or BAU

Plan on a page Mapped to BAU, PPM or to Y2&3 Activity Rationale

Community Engagement PPM High risk / high reputational transformational work

Engagement in LHB Change programmes BAU Core function of S,P&P directorate

Engagement with emergency services BAU Ongoing function of the Op’s Directorate

Clinical Modernisation PPM High risk / high reputational transformational work

Capacity and demand Y2 Requirement for new model to ‘bed in’ first

Clinical Governance BAU Core function of Medical Directorate

QIS BAU Core function of the Quality & Nursing directorate

R&I Strategy BAU low risk

Planning & Performance Mgt Framework BAU Core function of S,P&P directorate

Commissioning Arrangements BAU Core function of S,P&P directorate

Recruitment PPM Part of a high risk and reputational WF&OD change programme

Sickness PPM Part of a high risk and reputational WF&OD change programme

TU partnership PPM Part of a high risk and reputational WF&OD change programme

Roster Review PPM Part of a high risk and reputational WF&OD change programme

Employee Wellbeing (Gold CHS) PPM Part of a high risk and reputational WF&OD change programme

Leadership PPM Part of a high risk and reputational WF&OD change programme

Values & Behaviours PPM Part of a high risk and reputational WF&OD change programme

Teams, Structures & Roles PPM Part of a high risk and reputational WF&OD change programme

High Performance Work Practices PPM Part of a high risk and reputational WF&OD change programme

Integrated Service, Finance and Workforce Plan BAU Core function driven by Planning directorate

NEPTS PPM High risk / high reputational transformational work

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Hosting of Services of strategic alignment PPM High risk / high reputational transformational work

Resource Utilisation PPM High risk / high reputational transformational work

Corporate Governance BAU Core function of Corporate Directorate

PPM Framework BAU Core function of S,P&P Directorate

Innovation, Research & Audit Unit Y2 Requirement for new model to ‘bed in’ first

Capitol Planning and Delivery PPM High risk / high reputational project

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Executive “Strategy” Meetings

Business Development

Project and Programme

Management

Clinical Modernisation Programme

WODI Programme NEPTS ProgrammeStrategic Efficiency

Programme

Step 1

Step 2

Step 3

Commissioning

Finance

Resource Utilisation:CCC Reconfiguration / Admin review / Points of Presence review

Organisational

Step 4

Step 5

Workforce

Clinical Leadership

Hosting of services of strategic alignment

Community Engagement

Engagement in LHB Change programmes

QIS

R&I Strategy

Planning and Performnace Mgt

Framework

Commissioning Arrangements

Corporate Governance

Programme & Project

Management Framework

Engagement with other Emergency

Services

Capitol Planning & Development

Denotes Programme of work

Denotes a project

Denotes BAU activity

This remains at present an indicative structure as this is an evolutionary portfolio of change

Year 1 priorities Project-

Sickness / recruitment / TU Partnerships /

workforce efficiency / Wellbeing

OD Project- leadership / values / structures & roles /

training & development / engagement

Integrated Service, workforce plan

PORTFOLIO STRUCTURE FOR DELIVERY Annex 4