The document provides an update on a transformation programme aimed at making a healthcare provider more mobile. The summary includes: [1] The programme will transform the provider into a more streamlined, locally-focused mobile healthcare organization through changes like consolidating emergency control centers, establishing vehicle preparation hubs, and realigning central services. [2] Key goals of the transformation include improving clinical outcomes, increasing the number of patients who can be treated without transport, and enhancing staff career progression and satisfaction. [3] The transformation is already underway with pilots of initiatives like community paramedic teams and a new leadership structure, while future plans include fully implementing operating units and targets.

1. Francesca Okosi
Director of Workforce Transformation
Trust Board
Becoming a Mobile Healthcare Provider
Target Operating Model
Transformation Programme Update
November 2015

2. 1. Our vision, values and objectives: the move to being a
mobile healthcare provider
2. Today's challenges
3. How the transformation programme will help
4. What the changes mean
5. The story so far
2
Content

3. 3
The Vision
A clinical strategy delivering excellent patient care
through an effective workforce and efficient operations
‘Putting patients first, we will match international excellence
through our culture of innovation’

4. 4
The Trust's Objectives
Our staff are the key enabler in delivering successful and sustained improvements
International class in emergency
and urgent care
Providing patients with the right
care, at the right time, in the
right place
Best in class with conveyance
rates (<30% to A&E)
Recognised and remunerated
by commissioners for value
provided
Delivered productivity gains
Maintained response time
reliability
Improved clinical outcome
indicators
An employer of choice:
• Improved staff career
progression;
• Improved staff retention;
• Improved staff
satisfaction; and
• Reduced sickness.

5. The challenges the Trust faces…
• Maintaining a strong reputation both nationally and internationally
• Operating in a very difficult financial environment
• Demand continues to rise at a faster rate than the resources available
• Our ability to deliver on our targets is dependent upon the speed at which we increase
our capability
So…
• We need to change the way we work and redesign the way we organise our services
• We need to be even more streamlined and shift our resources further to the front line
• We need to look at how we devolve power and decision making to local managers,
and design an operating system that will support this
• We need to share the lessons learned from the past and continue to engage with, and
listen to staff so we can achieve our goals and maintain our business
5

6. Rising Demand
6

7. Broader Spectrum of Need
Emergency Care
Stroke, Trauma, Heart
Attacks, Cardiac Arrest
Urgent Care
Minor Illness and Injury,
Long Term Conditions
7

8. What is a high performance operating model provider?
8
• The right resources, at the right time and place, every hour of every day
• Local clinical hubs working with local health economies to appropriately use non-A&E resources
• Improved clinical outcomes and job cycle times for See and Treat, with effective handovers between
clinical hubs and responders
• Increased volumes for Hear and Treat and improvements in the quality of clinical responses
• A single Emergency Operating Centre with dispatch desks aligned to Operating Units
• Individual Operating Units having accountability for the use of resources

9. We will achieve our vision to build a high performance
operating model by developing a programme of
transformation activities that include …
9
• Moving to a local mobile healthcare provider serving a population of 300,000 –
500,000
• Streamlining organisational structures and decision making processes
• Implementing local leadership and accountability at operating unit level
• Ensuring the single point of entry for all 999 calls is an Emergency Control Centre
that operates as a single model, from multiple sites
• Improving the scheduling and management of ambulance resources through an
effective integrated dispatch function
• Central and corporate services proactively supporting local services
• Engaging with staff and stakeholders throughout the programme

10. We will achieve our vision by developing robust plans,
streamlining our decision making processes, learning lessons and
sharing success
10

11. So what do these changes mean?
11

12. Emergency Control Centres now…
12
The three legacy EOC’s provide a quality service to our patients, using the NHS Pathways
system to ensure the most appropriate response is allocated based on clinical need
What works well that we must not lose
• Experienced staff with local area knowledge
• Good relationships between EOC staff, ambulance crews and other health providers
• Team working and training across clinical groups and the Dispatch and EOC functions
What does not work as well as it could
• There are regional variations in the way in which each EOC operates
• Historic operating systems/equipment do not support efficient working
• The working environments and training facilities do not support effective communication
during peaks in demand or meet the needs of a growing workforce

13. A single Emergency Control Centre in the future…
13
• A single way of working, operating from two sites
• Improved co-operation and understanding between teams
• Increased capacity for Hear and Treat in the Clinical Hub
• In turn enabling intelligent Dispatch and improved appropriate clinical responses
Benefits
• Improvements in the working environment for staff
• The relocation of the Banstead and Lewes Emergency Control Centres to a ergonomic
purpose built centre to meet increases in demand and provide system resilience
• On site fit for purpose training, learning and development facilities which in turn benefit
our patients, as we work together to achieve our goals
• Increased retention rates and reduced sickness absence rates

14. Operating as high performance units we will…
14
ü Increase the level of clinical care at the point of illness or injury
ü By improving response times, improve trauma and critical illness care
ü Improve the outcomes for stoke and cardiac patients
ü Improve survival to discharge rates
ü Reduce delays in hospital handovers
ü Improve outcomes for patients admitted to acute hospitals
ü Increase the number of patients we can ‘hear and treat’
ü Increase patient and customer satisfaction

15. 10 Operating Units delivering locally
15
Operating Unit structures aligned to the delivery of the High Performance model
Being held to account for local system delivery
Trust wide structure and
operating model
A Design Authority for
changes
Embedded continuous
improvement process
Centrally set objectives for
each OU
Interdependencies,
opportunities and risks are
centrally managed

16. Ambulance Stations now…
16
Ambulance crews start their shifts by checking the vehicles, stocking and equipping them
and at the end of the shift cleaning the vehicles.
What works well
• Staff have a dedicated team base where they feel they belong
• Interaction and communication between crews enhances team working
What does not work as well as it could
• Cleaning and restocking vehicles takes staff away from front- line patient care
• Clinically skilled staff spend time making the vehicles ready for a shift
• Inconsistencies exist in the vehicle clinical loadings lists and access to critical
equipment
• Vehicles are sometimes not well maintained, and regularly breakdown

17. Make Ready Centres in the future…
17
• A Make Ready Centre (MRC) is a hub from which vehicles are prepared for crews
• Each MRC will be supported by a network of Ambulance Community Response
Posts (ACRPs), which will be positioned in line with historical patient demand
• Specially trained non clinical Make Ready Operatives clean, restock and maintain
the vehicles
• MRCs are operational in Ashford, Chertsey, Hastings, Paddock Wood and Thanet
• Coming on-line in the near future are the Polegate, Gatwick and Chichester MRCs
Benefits
• Ambulance Crews start and end shifts at MRCs, increasing the amount of time they
can spend delivering patient care
• Cleaner, well stocked and equipped vehicles result in improved clinical outcomes
• Improvements in response times to patients
• Infection rates reduce
• Vehicle maintenance costs are reduced
• Establishment of fit for purpose training, learning and development facilities

18. Central Services
Operational units have gone through changes and continue to improve, our
central services now need to align with those changes
18
What could improve
• Strategic development and horizon scanning
• Operation Unit engagement and joint working with local health economy partners
• Access to and flexibility of central services resource to meet the needs of operational services
• Integration between clinical, operational and central services
What we will have in the future
• Operational Units receive a more customer orientated service, with specialist information,
advice and guidance from central services at strategic, tactical and operational levels
• Central Services functions delivered and managed against internal service level agreements
• Central control and governance with a Business Partner supporting local operations
• Efficient and effective transactional services that allow Operational Units to have the capacity
to concentrate on clinical and operational delivery
• Relocation to a more central location and fit for purpose Trust headquarters for all corporate
service functions
• Establishment of fit for purpose training, learning and development facilities

19. 19
Workforce Transformation:
We will align our clinical strategy with our
workforce development plans, so we become the
employer of choice enabling staff to do the job
they were employed, educated (and want) to do.

20. 20
Firstly, we are improving leadership at every level
Restructuring as an enabler to Transformation
Restructuring
Transformation

21. 21
Implement the Clinical Strategy & Improve Workforce Development
Becoming the employer of choice – enabling staff to do the job that they were
employed, educated (and want) to do
• Improved staff career
progression;
• Improved staff retention;
• Improved staff
satisfaction;
• Annual Key Skills & CPD
delivered locally; and
• Improve employee
wellbeing and reduce staff
sickness.

22. Allowing differentiation of Clinical Response
Emergency Care
Stroke, Trauma, Heart
Attacks, Cardiac Arrest
Urgent Care
Minor Illness and Injury,
Long Term Conditions
Spectrum of Need
Whilst delivering Response Time Reliability efficiently
and improving staff satisfaction
22

23. The story so far
23

24. 24
The journey to being a Mobile Healthcare Provider
Design Principles• The CEO and Executive Team are responsible for
operational and clinical performance of the Trust
• The Operating Unit (OU) is our local mobile
healthcare provider serving a population of 300,000
– 500,000. (The EOC, PTS and 111 are treated as
OUs for management purposes)
• The EOC will be the single entry point for all 999
calls
• Central services will be re-configured to support local
delivery

25. The Model
Dynamic Deployment (SSP)
Supporting the Community Paramedic Teams and Operating Units
25

26. 26
Organisational Redesign
• A new Executive Structure was put in place in April
• The Senior Leadership Structure (Band 8s) has been
redesigned and rolled out from October
• Thanet Community Paramedic team go-live January
2016
• The implementation of the OU Leadership Structure
(Band 7) will begin in Quarter 4

27. 27
Implementation of the Operating Units
Six OUs are aligned to a single Dispatch Desk (Model A):
• Ashford;
• Paddock Wood;
• Thanet;
• Chertsey;
• Guildford; and
• Brighton.
Four OUs are aligned to a two Dispatch Desks (Model B):
• Dartford and Medway;
• Chichester and Worthing;
• Crawley and Redhill; and
• Eastbourne and Hastings.

28. 28
Overview of the Operational Target Operating Model
Three Beacons:
• Thanet;
• Polegate; and
• Chertsey (tbc).
Model built on lessons learned from:
• Thanet OU Pilot;
• Community Paramedic Pilot; and
• Paramedic Practitioner Out of the Plan Pilot.
Key Points:
• Higher skilled clinicians as SECAmb’s first clinical responder
• Locally based for local knowledge
• More effective integration with local CFR schemes

29. 29
Closing the Employment Gap
Creating the pipeline for the future
• Associate Practitioners
• Paramedic +
Associate Practitioners
• Work as ECSW in the first year;
• Train to be a Paramedic
Practitioner +
• Paramedic with 3 additional modules to increase scope of
practice.