Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People

Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People
Towards 2020:
Taking Care to the Patient
Improving Access   Improving Care   Improving Outcomes
Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People
Contents                                                                                                                 PAGE 36

                                                                                                                         the Vision
                                                                                                                         5 YEAR PLAN

                                                                    PAGE 12

                                                                    Building on
                                                                    Partnerships and
             PAGE 5                                                                                     PAGE 33

             Introduction                                                                               Our People
                                                                                                        DEVELOPING OUR
             FOREWORD FROM
             THE CHAIR AND
                                                                                                        FOR THE FUTURE
             CHIEF EXECUTIVE

             ABOUT US
                                                                    PAGE 20                                              PAGE 38
             OUR VISION FOR 2020                                                                                         Resourcing
                                                                    Towards 2020                                         our Plans
                                                                    OUR VISION AND

                                          PAGE 8                                       PAGE 24

                                          Our Story so Far                             Delivering Improved
                                          WORKING TOGETHER
                                          FOR BETTER PATIENT CARE                      OUR CLINICAL MODEL
                                                                                                                         PAGE 39

2   A Strategic Framework for 2015-2020                                                                                            Scottish Ambulance Service   3
Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People

                                                                                                 Foreword from our
                                                                                                 Chair and Chief Executive

                                                                                                 The Scottish Ambulance Service recognises that         Delivering the ‘2020 Vision’ requires
                                                                                                 it has a significant contribution to make to the       whole system transformation and as a Service
                                                                                                 effective delivery of this strategy as a frontline     we recognise the need to work differently to
                                                                                                 service providing emergency, unscheduled and           deliver emergency, unscheduled and scheduled
                                                                                                 scheduled care 24/7. This five year strategic          care in this context. We cannot deliver in
                                                                                                 framework describes how we plan to do that in a        isolation and will need to work effectively in
                                                                                                 way that supports the national quality ambitions       partnership with NHS Boards, Health and Social
                                                                                                 for person-centred, safe, and effective care.          Care partnerships, patients, communities, and
                                                                                                                                                        other public and voluntary agencies to deliver
                                                                                                 By 2020 we aim to:                                     this vision.

                                                                                                 improve access to healthcare;                          We are committed to continuing to provide a
                                                                                                                                                        Scottish Ambulance Service that is flexible and
                                                                                                 improve outcomes for patients – specifically           responsive, innovative and open to learning,
                                                                                                 cardiac, trauma, stroke, mental health, respiratory,   skilled and resourced to respond to clinical
                                                                                                 frailty and falls;                                     need, and one that can effectively support an
                                                      The Scottish                               evidence a shift in the balance of care by
                                                                                                                                                        integrated health and social care system.
                                                   Government vision:                            taking more care to the patient;                       ‘2020’ is based on the fundamental principle
                                                                                                                                                        that care should be appropriate to need
                                          “By 2020, everyone is able to live longer, healthier   enhance our clinical skills as a key and
                                                                                                                                                        and where that care is delivered should be
                                           lives at home or in a homely setting. We will have    integral partner working with primary and
                                                                                                                                                        appropriate, which may not be in a hospital
                                             a healthcare system where we have integrated        secondary care;
                                                                                                                                                        setting. The Scottish Ambulance Service has a
                                              health and social care, a focus on prevention,                                                            key contribution to make in terms of taking care
                                                                                                 develop our Service as a key partner with
                                              anticipation and supported self-management.                                                               to the patient. Our ability as a 24/7 healthcare
                                                                                                 newly formed Integration Boards;
                                            When hospital treatment is required, and cannot                                                             provider to provide face-to-face assessment and
                                              be provided in a community setting, day case       collaborate with other partners including              diagnostics, to determine need and to treat, route
                                            treatment will be the norm. Whatever the setting,    the voluntary sector and the other blue light          and/or refer patients to anticipatory or definitive
                                              care will be provided to the highest standards     emergency services as part of a contribution           care more effectively is critical in supporting this
                                               of quality and safety, with the person at the     to shared services and public service reform;          approach.
                                             centre of all decisions. There will be a focus on
                                            ensuring that people get back into their home or     build and strengthen community resilience;             This strategic framework “Towards 2020:
                                             community environment as soon as appropriate                                                               Taking Care to the Patient” outlines our
                                                    with minimal risk of re-admission.”          expand our diagnostic capability and use               approach to delivering clinically focused,
                                                                                                 of technology to improve patient care; and             high quality care for patients, and developing
                                                                                                                                                        our future workforce to meet the changing and
                                                                                                 develop a more flexible, responsive and integrated     complex landscape of health and social care
                                                                                                 scheduled Patient Transport Service.                   for Scotland.

4   A Strategic Framework for 2015-2020                                                                                                                                             Scottish Ambulance Service   5
Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People

Our Vision: “Towards 2020: Taking care to the Patient”

    Our Mission                To deliver the best ambulance services for every person, every time

    Our NHS Values             Care and Compassion, Equality, Dignity and Respect,
                               Openness, Honesty and Responsibility, Quality and Teamwork

    Our Goals                  To ensure our patients,     Expand our diagnostic        Continue to develop        Evidence a shift in         To reduce                   Develop a model
                               staff, and the people       capability and the           a workforce with the       the balance of care         unnecessary variation       that is financially
                               who use our services        use of technology to         necessary enhanced         through access              in service and tackle       sustainable and fit
                               have a voice and can        enhance local decision       and extended skills        to alternative care         inequalities delivering     for purpose in 2020.
                               contribute to future        making to enable more        by 2020 to deliver the     pathways that are           some services “Once
                               service design, with        care to be delivered         highest level of quality   integrated with             for Scotland” where
                               people at the heart of      at home in a safe and        and improve patient        communities and with        appropriate.
                               everything we do.           effective manner.            outcomes.                  the wider health and
                                                                                                                   social care service.

    Our SAS Way                Person-centred              Safe & Effective             Quality and                Collaborative               Fair and Equitable          Value driven
                                                                                        Outcome Focused

                                                                                                                   About us
                                                                                                                   The Scottish Ambulance Service     Our air ambulance service           We employ over 4,300 highly
                                                                                                                   responds to around 1.8 million     undertakes around 3,500             skilled staff and operate across
                                                                                                                   calls for emergency and non-       missions and we co-ordinate         the whole of mainland Scotland
                                                                                                                   emergency assistance each          delivery of the ScotSTAR            and its island communities,
                                                                                                                   year and attends nearly 700,000    Specialist Transport and            supporting 14 territorial Health
                                                                                                                   emergency and unscheduled          Retrieval Service for Scotland      Boards. We are helped by over
                                                                                                                   incidents. Of these over 500,000   which transfers 2,300 of the        1,200 volunteers working in
                                                                                                                   are emergencies. We transfer       most seriously ill patients to      roles such as community first
                                                                                                                   around 90,000 patients between     specialised treatment. Our          responders and volunteer car
                                                                                                                   hospitals each year and            Patient Transport Service takes     drivers.
                                                                                                                   respond to over 150,000 urgent     over 1.1 million patients to
                                                                                                                   requests for admission, transfer   and from scheduled hospital
                                                                                                                   and discharge from GPs and         appointments each year.

6   A Strategic Framework for 2015-2020                                                                                                                                                             Scottish Ambulance Service   7
Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People
Our Story so Far

“Working together
for Better Patient Care”

In 2010, the Scottish Ambulance Service               Emergency and Unscheduled Care                         frail and elderly patients who have fallen along     In April 2014, ScotSTAR, (The Specialist
published “Working Together for Better Patient                                                               with the publication of a guidance booklet and       Transport and Retrieval Service for Scotland)
Care” a five year strategic framework which was       A range of improvements in Pre-Hospital                resource tool “Making the Right Call for a Fall”     was launched, bringing together neonatal,
fully aligned to the national NHS Scotland Quality    Cardiac Care have been achieved. By supporting         has improved care for many non-injured elderly       paediatric, and Emergency Medical Retrieval
Strategy. We have made significant progress in        the development and implementation of national         fallers and enabled referral into local health and   Service (EMRS) teams under the co-ordination
delivering the commitments made within this           pathways for Optimal Reperfusion, clinical             social care systems with access to assessment,       of the Scottish Ambulance Service. This provides
strategy and in redesigning the way we deliver        outcomes for patients suffering myocardial             prevention and ongoing care packages. Overall,       a vital road and air service for critically ill
care. The Scottish Government’s 2020 Vision           infarction have improved significantly. In addition,   the percentage of patients over the age of 65        patients, taking the skills of specialist clinicians
builds on the framework set out in the NHS            our work in partnership with NHS Lothian               taken to hospital across the whole of Scotland       directly to patients to enhance their treatment
Quality Strategy.                                     to improve clinical intervention through the           as a result of a non-injured fall has reduced        and ensure patients reach specialist centres
                                                      development of the 3RU model (Rapid Response           from around 80% in April 2012 to around 66%          of excellence first time. Closely linked to this
This next iteration of our strategy, “Towards 2020:   Resuscitation) has enhanced the treatment of Out       in April 2014. We have had notable success           we have been working with regional and national
Taking Care to the Patient”, continues to reflect     of Hospital Cardiac Arrest (OHCA), contributing        in Argyll, Edinburgh City, and Lanarkshire where     planning to develop a major trauma network
those aspirations and positions the Scottish          to an improved survival rate in adults. The rate       our staff have worked alongside community            across Scotland.
Ambulance Service as a key enabler in shifting        for patients arriving at hospital with a pulse         based teams to support management of these
the balance of care away from acute hospitals         following resuscitation from cardiac arrest in         patients at home and identify and refer to the       As a key objective from “Working Together
into local communities and improving patients’        Edinburgh is 29% this year against a national          appropriate services to put solutions in place       for Better Patient Care”, we have invested
experience of healthcare.                             Scotland average of 18%; this is world class           to prevent future falls. This work in partnership    in significant development across our three
                                                      performance.                                           with local community based teams has led to          Ambulance Control Centres (ACCs), including
In “Working Together for Better Patient Care”,                                                               minimal number of patients finding the need          the introduction of 24/7 clinical advisor support
we set out a vision to deliver the best patient       Improving the triage and deployment of                 for further 999 calls.                               and establishing a dedicated specialist services
care for people in Scotland, when they need us,       appropriately skilled staff and vehicles to ensure                                                          and trauma coordination desk improving the
where they need us. Underpinning this aim was         patients suffering hyper-acute stroke get to           In 2013/14, we tested new care pathways for          response to major incidents and major trauma.
to: improve patient access and referral to the        definitive care first time within 60 minutes has       patients with Chronic Obstructive Pulmonary          These developments have dramatically improved
most appropriate care; deliver the best services      also been a key priority and we have made              Disease (COPD) and Mental Health across              telephone answering standards and the
for patients; and engage with our partners and        good progress in achieving this outcome. We            Edinburgh City with evidence of positive             effectiveness of our dispatching of ambulances.
communities to deliver improved healthcare.           have secured funding to enable us to engage            outcomes for patients, reducing avoidable
Since the publication in 2010, we have made           more effectively with local Stroke Managed Care        attendances at A&E and managing treatment of
significant progress and have successfully            Networks, streamlining and improving access to         the existing condition at home with paramedics
delivered a number of key improvements under          specialist care for stroke patients.                   operating as part of an integrated healthcare
the direction of the following five strategic                                                                team. We also continued to develop our
programme boards.                                     We continued to work in partnership with               capability to offer safe and more effective care
                                                      NHS Boards through Community Healthcare                to patients who suffer from dementia. A
                                                      Partnerships (CHCPs) in 2013/14 to further             number of staff have now completed Alzheimer
                                                      embed the national framework for frail and elderly     Scotland’s dementia champions training
                                                      patients who have fallen, which was developed          programme and this was recognised at the
                                                      in partnership with the Long-Term Conditions           Alzheimer Scotland National Award Ceremony
                                                      Collaborative in 2012/13. The development of a         in September 2013. Training for all staff in
                                                      good practice guidance for the management of           dementia will continue during 2015/16.

8   A Strategic Framework for 2015-2020                                                                                                                                                       Scottish Ambulance Service   9
Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People
Our Story so Far

Scheduled Care                                         Engaging with Communities                           e-health

Within Scheduled Care we undertook a national          As part of our Community Resilience strategy        We set out some ambitious aspirations to enhance our use of
redesign and reconfiguration of our Patient            we introduced new and innovative models             technology, and in terms of tele-health and diagnostic capability,
Transport Service, establishing a new direct           of care in partnership with communities to          to be operating at the leading edge.
patient booking line and investing in mobile           enhance resilience, for example, the Emergency
technology across our fleet. We enhanced our           Responder Model in West Ardnamurchan                Over the past five years we have succeeded in:
systems and processes to better understand             and the Retained Service model in Lerwick.
and respond to patient needs, and continued to         In partnership with British Heart Foundation,       successfully developing and testing an electronic patient record
work with our partners in health and social care       dedicated Community Resuscitation Development       interface to transfer patient records to GP practices;
and beyond to improve planning and access              Officers have been established in each of our
to alternatives where an ambulance is not              operational management divisions to support         developing and testing the concept of near-patient testing for
required. We have steadily improved the quality,       the extended use and awareness of community         cardiac patients in NHS Borders and remote diagnostics for
performance and efficiency of this service over        public access defibrillators and to continue        suspected Sepsis in NHS Forth Valley;
the past five years and our patient feedback           to grow and develop the Community First
indicates a very high level of satisfaction with the   Responder Schemes and volunteers across             successfully updating the technology within our Ambulance Control
service provided. There is, however, more to be        Scotland. Our Community First Responder             Centres to enable our three geographically based control centres
done and we will continue to work with patients        Schemes across Scotland have grown from 82          to operate as one virtual centre;
and partners to build on these improvements,           to 127 over the past 5 years with over 1,200
particularly supporting discharge planning,            active volunteers and partners such as RAF          investing in technology to significantly improve the business
greater integration of alternative transport           and Scottish Fire and Rescue Service operating      continuity arrangements within our control centres;
solutions and continuing to improve patient            these schemes. We have worked with British Red
experience.                                            Cross and British Heart Foundation to develop       introducing new state of the art technology in all of our
                                                       training and support for these volunteers.          ambulances and invested in scheduling software to improve
                                                                                                           productivity and efficiency and ultimately provide more responsive,
                                                       Whilst we respond to an emergency almost every      punctual services to patients within our scheduled care service;
                                                       minute of every day and many simultaneously,        and
Doing the Right Thing – Our Organisational             occasionally a more disastrous, complex or
Development Programme                                  hazardous incident occurs, often involving          working in partnership with the Digital Health Institute to develop
                                                       multiple patients, which requires a greater         our future mobile tele-health platform.
Delivering the commitments of “Working                 degree of specialised response and co-ordination
Together for Better Patient Care” could not have       with other emergency organisations. This can
happened without significant development of            include a wide variety of circumstances for which   Whilst we have made considerable progress, we recognise
our workforce. In 2011, the Service moved its          the ambulance service must be prepared, such        the scale of transformation required to deliver the ‘2020 Vision’
training facility to an Academy within Glasgow         as major transport accidents, firearms incidents,   and acknowledge that we cannot achieve this in isolation. 2020
Caledonian University and developed the BSc in         chemical and biological releases, explosions,       requires whole system change and we have a vital role to play
Paramedic Practice and Specialist Practitioner         public disorder situations, pandemic outbreaks,     in supporting that change in partnership with NHS Boards,
Critical Care role initially to support the work of    industrial accidents, incidents at crowded          other care providers, patients and communities. In this strategy,
the Air Ambulance and Retrieval Team. Creating         locations, extreme weather, acts of terrorism and   “Towards 2020: Taking Care to the Patient”, we are aiming to
a culture of Continuous Quality Improvement            many more. Specialist paramedics and support        build on the achievements made so far and to work within an
and Safety has been a key priority and, as a           staff from the Special Operations Response          integrated health and social care system to see and treat more
partner in the Scottish Patient Safety Programme,      Teams (SORT) have been active at many major         patients safely and effectively at home where appropriate to do
we made improvements in the recognition and            incidents, working together in partnership          so, and where this is not the most appropriate outcome, to work
management of deteriorating patients, including        with other emergency services and providing         with others to develop and access appropriate care pathways
the use of early warning scores and screening          care within hazardous environments such as          to ensure patients get access to the right care in the right place
for Sepsis. We also led the development of             collapsed buildings and structures, accessing       first time, every time.
a Paediatric Early Warning Score supported             patients in severe weather including snow and
nationally by Scottish Patient Safety Programme        flooding, and undertaking the movement of
Clinical Fellows.                                      patients with suspected infectious diseases such
                                                       as viral haemorrhagic fever.

10   A Strategic Framework for 2015-2020                                                                                                                                         Scottish Ambulance Service   11
Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People
on Successful
Partnerships and                           “I am delighted with the service
Collaborations                             provided by the ASSET team. Being
                                           an older lady I am very reluctant
                                           to go into hospital so was relieved
                                           when my GP informed me of this new                       Developing an                      face-to-face assessment with
                                                                                                                                       patients, participating in a
                                           service. All involved from the initial GP                ASSET based                        ‘virtual’ ward, referring patients
                                           phone call to the Paramedics, nurses,
                                           physiotherapist and consultant were                      approach                           directly to the team where a trip
Taking more care to the patient                                                                                                        to hospital is not appropriate,
                                           attentive and caring. Being cared for in
by 2020 will require Scottish                                                                                                          and treating and monitoring
                                           the comfort of my own home without a                     The Scottish Ambulance
Ambulance Service to continue to                                                                                                       patients in their home. Already
                                           doubt helped my recovery. My family                      Service has been working with
strengthen existing partnerships                                                                                                       the ASSET pilot is demonstrating
                                           and I were most impressed by the                         NHS Lanarkshire to support
and to collaborate effectively as                                                                                                      real benefits for patients and
                                           service which felt like a virtual hospital               the development of their Age
part of an integrated health and                                                                                                       improved multi-disciplinary team
                                           ward in my own home. I am extremely                      Specific Service Emergency
social care system to design new                                                                                                       working.
                                           grateful for this and thank ALL the                      Team (ASSET) model for frail
innovative models of care designed
                                           NHS staff involved. I am sure others                     and elderly patients (over 75s)
around patient needs. The learning                                                                                                     Our aim by 2020 is that our
                                           will find this service beneficial also.”                 in North Lanarkshire.
from recent pilot projects and                                                                                                         Paramedic Practitioners are able
collaborative work across Scotland                                                                                                     to work as a key component
                                                                                                    The ASSET team aims to
will continue to be tested, and                                                                                                        of integrated multidisciplinary
                                                                                                    manage patients care at
evaluated. Where there is evidence                                                                                                     teams, but also as autonomous
                                                                                                    home and avoid unnecessary
of success and improved outcomes                                                                                                       practitioners where appropriate,
                                                                                                    admissions to hospital. This is
for patients, plans will be developed                                                                                                  supporting care in local
                                                                                                    done by a team of practitioners,
to spread this good practice across                                                                                                    communities. They will be
                                                                                                    including Paramedic
Scotland where safe and appropriate                                                                                                    experienced in Care of the
                                                                                                    Practitioners, with consultant
to do so.                                                                                                                              Elderly and will be educated
                                                                                                    support. The team accepts
                                                                                                                                       and trained in areas of minor
                                                                                                    referrals directly from GPs
The following examples highlight                                                                                                       ailment and minor injury.
                                                                                                    and from Scottish Ambulance
some recent joint initiatives that are                                                                                                 They will be able to carry an
                                                                                                    Service following a 999
already beginning to demonstrate                                                                                                       extended range of medications
                                                                                                    response. Thereafter patients
the effectiveness of new ways of                                                                                                       including antibiotics, painkillers
                                                                                                    are assessed at home, treated
working in partnership with others                                                                                                     in the appropriate circumstance
                                                                                                    and monitored where it is safe
and support our vision for 2020 to                                                                                                     prescribe, avoiding many
                                                                                                    and clinically appropriate to
take more care to the patient.                                                                                                         unnecessary journeys to
                                                                                                    do so. ASSET will also review
                                                                                                                                       hospital. They will also provide
                                                                                                    patients admitted to hospital
                                                                                                                                       internal professional-to-
                                                                                                    to identify those that can be
                                                                                                                                       professional decision support
                                                                                                    treated appropriately at home
                                                                                                                                       for other ambulance clinicians
                                                                                                    managing their early discharge
                                                                                                                                       supporting staff to see and treat
                                                                                                    and follow up care. Scottish
                                                                                                                                       more patients presenting with
                                                                                                    Ambulance Service has two
                                                                                                                                       minor injuries and illnesses.
                                                                                                    Specialist Paramedics working
                                                                                                    as part of the ASSET team,

                                                                      Mrs Rose Gillespie (centre)

12   A Strategic Framework for 2015-2020                                                                                                                                    Scottish Ambulance Service   13
Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People
Building on Successful Partnerships and Collaborations

Making the Right                                         most frequent single ‘diagnosis’
                                                         presenting to the Service for
Call for a Fall                                          this group of patients, and,
                                                         typically, we take 80% of them
The needs of patients across                             to hospital due to a lack of
Scotland are changing, with                              easily accessible alternative
the population of over 75 year                           pathways. Over the last three
olds in Scotland due to increase                         years we have been working
by approximately 25% over                                in conjunction with Health and
the next 10 years, and the                               Social Care services to develop
number of people with multiple                           integrated pre-hospital pathways
and complex conditions also                              to make sure frail and elderly
continues to grow. Many elderly                          patients are provided with                                                 We aim to build on this
patients have a combination                              the right care at the right time                                           collaborative approach
of physical, cognitive and                               following a fall.                                                          and to develop better
functional impairments that                                                                                                         access to more local care
increase their risk of a fall.                           The introduction of a number                                               pathways and services for
This situation can be caused                             of specialist falls teams across                                           those frail elderly living at
by common and reversible                                 Scotland means we are now                                                  home with multiple and
problems such as a chest or                              able to refer patients into                                                more complex long term
urine infection, side effects                            alternative pathways either at                                             conditions.
from medicines, or by a flare                            the point of taking the call or
up of another condition. Whilst                          following ambulance attendance      “Over the last six months I have
some of these issues may                                 and help them get the care          fallen three times. The ambulance
require prompt assessment                                they need. All of this has been     was called to attend as I was unable
and treatment, often this can                            supported by an increase in         to get up myself. My experience
be done quickly by integrated                            the amount of intermediate          has been that I received excellent
teams visiting patients in their                         care services across Scotland.      attention from the ambulance staff
own home rather than a patient                           Ambulance Clinicians can now        that checked me over for injuries
having to attend an acute                                access alternative pathways to      before lifting me up using an air
hospital.                                                community health and social         cushion device. After this they
                                                         care services in many localities,   referred me to the local community
We have recognised that we                               with those services covering        based falls team to reassess my
play a key role in making sure                           both immediate interventions        needs, help manage my diabetes
that when providing high quality                         and follow up assessment. This      and support me to stay at home.”
clinical care to elderly patients                        approach clearly demonstrates
                                                                                             Mr Harold Gillespie
who have fallen, we help them                            the benefits of an integrated
to access the care they require.                         health and social care response.
We respond to around 45,000
calls each year where people
aged 65 years or older have
fallen. This represented the

14   A Strategic Framework for 2015-2020                                                                                                           Scottish Ambulance Service   15
Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People
Building on Successful Partnerships and Collaborations

                                           Supporting NHS
                                           Lothian’s Discharge Hub
                                           In 2011, during the early stages of implementing
                                           the Scheduled Care Programme, we embarked on
                                           a collaborative programme of work to support NHS
                                           Lothian with the development of a Transport Hub to
                                           coordinate all ambulance transport services across
                                           NHS Lothian hospital sites for patients returning back
                                           to a homely setting, following discharge from hospital,
                                           or being transferred to other hospital sites for ongoing
                                           care. This collaboration has provided a mutual benefit
                                           for Scottish Ambulance Service and NHS Lothian. It
                                           has supported us to improve the effectiveness of our
                                           scheduled care service in delivering a high quality
                                           and patient-centred service to those patients with a
                                           clinical and medical need for ambulance transport,                                                                          “We aim to grow this
                                           and has supported NHS Lothian to improve the flow                                                                           model by 2020 to support
                                           of patients through their hospital sites.                                                                                   unscheduled care in the
                                                                                                                                                                       community particularly in
                                                                                                                                                                       the out of hours period.”

                                                                                                      Specialist Paramedic Model
                                                                                                      Scottish Ambulance Service has been working with NHS
                                                                                                      Western Isles for a number of years developing the
                                                                                                      Specialist Paramedic model. Specialist Paramedics are able
                                                                                                      to see and treat patients both as part of the out of hours
                                                                                                      community team and working within the minor injuries unit
                                                                          “We aim to continue         at the local hospital. The enhanced skills of the Specialist
                                                                          to support this model       Paramedics means they can operate more autonomously
                                                                          in NHS Lothian and          and are able to access alternative care pathways directly.
                                                                          across Scotland to          Because they carry an extended range of medicines,
                                                                          ensure we are able to       they are able to offer a greater range of treatment and
                                                                          support the effective       interventions directly for patients, resulting in fewer
                                                                          flow of patients in and     avoidable A&E attendances. These Specialist Paramedics
                                                                          out of acute hospitals.”    are engaged with the GP community, are able to access
                                                                                                      decision support from GPs and request follow up visits to
                                                                                                      the patient from the GP. There are clear benefits to patients
                                                                                                      with this model, increasing likelihood of being treated safely
                                                                                                      at home but additionally, freeing up hospital resources and
                                                                                                      enhancing the skills of paramedic staff.

16   A Strategic Framework for 2015-2020                                                                                                                                        Scottish Ambulance Service   17
Towards 2020: Taking Care to the Patient - Improving Access Improving Care Improving Outcomes - Aspen People
Building on Successful Partnerships and Collaborations

The Ambulance of 2020                                                                       The future of Ambulance Technology

                                                                                            ePRF                              On-board                           Mobile Broadband
                                                                                                                              Communications Hub                 Communications
                                                                                            Modern, app-based, electronic
                                                                                            Patient Reporting Form. Hosted    Provides all routing for data to   Array of antennae providing
A mobile Health Facility                                                                    on the on-board tablets, with
                                                                                            automatic data input from
                                                                                                                              and from the ambulance. Acts
                                                                                                                              as a wi-fi router for peripheral
                                                                                                                                                                 2G, 3G and 4G mobile and
                                                                                                                                                                 wi-fi signals. Provides fast
                                                                                            medical devices through the       devices and aggregates cellular    mobile communications to
                                                                                            Communications Hub. Capable       signals to provide increased       ACC and other healthcare
                                                                                            of being shared at a multi-crew   bandwidth.                         facilities, enabling video
The ambulance of the future                              Our aim is to evaluate the         incident.                                                            streaming and web access.
aims to give our staff access                            electronic transfer of patient                                                                          Physically connected to the
to: key patient information                              records to acute and primary                                                                            Communications Hub.
(such as the Key Information                             care services and to work with
Summary, Anticipatory Care                               Health Boards across Scotland
Plans, Palliative Care Plans etc.);                      to roll this out.
clinical guidelines; integrated
diagnostic devices; and the                              This facility will be beneficial
capability to exploit advances                           in transferring clinical
in decision support which                                information for those patients
rely on technology, (e.g. video                          requiring urgent care on arrival
conferencing, electronic access                          at hospital, such as stroke,
to patient records).                                     cardiac arrest or major trauma,
                                                         but also in communicating with
These developments will                                  GPs where patients with multiple
enable us to work together                               long term conditions have been
with health, social care and                             seen and effectively treated in
emergency service partners to                            their home by our paramedic
deliver the best outcomes for                            practitioners.
patients in terms of improved
care and safety.                                         Our aim is also to explore and
                                                         exploit remote diagnostics,
During 2014 we tested the                                near patient testing and the
transfer of the electronic Patient                       use of tele-health within our
Report Form (ePRF) from the                              ambulances. Recent testing of
ambulance to GP practices                                troponin levels in patients with
in NHS Greater Glasgow and                               suspected myocardial infarction
Clyde. We also trialled the                              within NHS Borders will be
process of transferring the                              evaluated and a range of other
record from the ambulance                                diagnostic equipment such as
to the receiving Accident and                            ultrasound will be assessed for    Rear Tablet                       Medical Devices                    Front Tablet
Emergency department as a                                use in a mobile environment
                                                                                            Used by crew to access            Situated in the rear of the cab,   Primarily used for satellite
pre-alert prior to the arrival of                        as part of an integrated model
                                                                                            incident information, ePRF,       providing analysis tools for       navigation and providing
the patient.                                             supported by senior decision
                                                                                            web, ECS/KIS and back office      Clinicians. Linked to ePRF via     incident information for
                                                                                            systems (Intranet, workforce      the Communications Hub so          allocation and mobilisation of
                                                                                            planning, incident reporting).    that data from the device will     the vehicle. Also allows crew
                                                                                            Linked to medical devices         auto-populate the ePRF.            to update the CAD using status
                                                                                            via the Communications Hub.                                          messages and access a range
                                                                                            Integrated SIM providing data                                        of other software.
                                                                                            communications when out of
                                                                                            wi-fi range.

18   A Strategic Framework for 2015-2020                                                                                                                                  Scottish Ambulance Service   19
Towards 2020

Our Vision and Aspirations

The Scottish Ambulance Service recognises the key role it has          Achieving these aims will require investment in       developing the capability and skills within
to play as a frontline service, in supporting the effective delivery   our staff, in new technologies and innovation to      our workforce, fit for the future role of the
of the Scottish Government’s 2020 Strategy.                            realise our ambitious aspirations, including:         Service within an integrated approach, flexible
                                                                                                                             and sustainable and with the right leadership to
This strategic framework aims to set out our vision for the            working with our partners across health and           drive a culture of innovation, co-production and
development of our service as we move towards 2020 and                 social care to develop alternative care pathways      improvement;
describes the key actions required to deliver that vision. There are   which reflect Scotland’s commitment to shifting
some core over-arching principles which underpin all our work.         the balance of care towards communities. The          continuing to develop our scheduled care service
                                                                       overarching principle is to improve outcomes and      in partnership, recognising the expectation on
In summary we aim to:                                                  patient experience ensuring those pathways direct     NHS Boards to transform the delivery of outpatient
                                                                       patients towards the most appropriate definitive      services, support effective discharge and transfer
enable a tangible shift in the balance of care away from acute         care first time and prevent avoidable hospital        of patients, to support patient flow across the
hospitals by equipping the Service to deliver more care at home        attendances and admissions;                           whole healthcare system, and deliver a better
or in a community setting where safe and appropriate to do so;                                                               experience for patients.
                                                                       aiming to use our status as a 24/7 mobile
deliver care that ensures high quality outcomes for patients,          healthcare provider to enhance our contribution       building on our strengths as a national
is person-centred, safe, and improves experience;                      to wider NHS as part of an integrated health and      organisation to offer “Once for Scotland”
                                                                       social care service, delivering the highest quality   solutions to particular challenges such as
enhance decision support further to ensure effective, safe decision    of emergency, unscheduled and scheduled care          demand management, resource deployment
making at all stages of the patient journey;                           for patients;                                         and primary care; and

develop a workforce educated, trained and enabled to deliver the       striving to improve safety and effectiveness          adopting an integrated approach to transport
service model;                                                         and to support our staff with clinical assessment     to healthcare ensuring that patients with a clinical
                                                                       and decision making skills appropriate to meet        need are able to access ambulance transport
work in partnership to achieve a service model that is integrated      the needs of those patients with complex long         to hospital. However, it is vital that patients who
with communities and with the wider health and social care service;    term conditions and multi-morbidities, supported      do not require our help are still able to access
                                                                       by access to enhanced senior clinical decision-       appropriate alternative transport provision. We
fully engage our staff, our partners and the people who use our                                                              recognise that we have a role to play in ensuring
                                                                       support and technology solutions to make safer
services to design models of care that meet the needs of the people                                                          that access is as seamless and straightforward for
                                                                       decisions with and for patients;
of Scotland and reduce health inequalities; and                                                                              patients as possible. We will continue to work with
                                                                       embracing the shared values of the NHS in             our partners in NHS Boards, Regional Transport
develop a model that is sustainable and fit for purpose in 2020.
                                                                       Scotland in everything that we do to ensure           Partnerships, and others to support the improved
                                                                       our service is designed to deliver care and           co-ordination of health and social care transport
                                                                       compassion, dignity, equality and respect,            resources and, where appropriate, explore
                                                                       openness, honesty and responsibility, quality         opportunities to link systems and technology to
                                                                       and teamwork;                                         facilitate this.

20   A Strategic Framework for 2015-2020                                                                                                                 Scottish Ambulance Service   21
Towards 2020

                                           Building on the achievements made during the         prioritise investment in enhancing the clinical
                                           lifetime of “Working Together for Better Patient     decision support available to our frontline staff, in
                                           Care” our aims going forward are to continue         technology solutions and advanced clinical skills
                                           to build on the strong foundations laid between      within our Ambulance Control Centres to support
                                           2010 and 2015 and to:                                safer, more effective, person-centred decision
                                           make further improvements in pre-hospital
                                           cardiac care by leading a national programme of      work in partnership with NHS Boards to provide
                                           improvement for out of hospital cardiac arrest and   an efficient and effective ambulance service for
                                           in doing so continue to improve survival outcomes    those patients with a medical need for ambulance
                                           for patients;                                        transport and to work in partnership with other
                                                                                                community transport providers to improve access
                                           work with external partners and the national         to alternative transport solutions within localities
                                           Stroke Managed Care Network to improve               where the need is social and geographical;
                                           outcomes and access to specialist care for stroke
                                           patients;                                            strengthen the expertise and support provided by
                                                                                                our Specialist Operations Response Team and
                                           work with the newly established Integrated Joint     support the wider NHS by sharing this specialist
                                           Boards to embed the guidance for frail and elderly   expertise.
                                           patients who have fallen with an aim to improve
                                           outcomes for people who have fallen and help         develop our education model further, to provide
                                           prevent people falling in the future;                more comprehensive care at the point of contact
                                                                                                for our patients and offer new role opportunities
                                           continue to develop access to local services         for our staff alongside other Allied Health
                                           and intermediate care services through the           Professionals and nurses;
                                           development of new care pathways with a focus
                                           on respiratory disease and mental health as          extend our work with partners in local communities
                                           two of our top priorities for further care pathway   to build stronger safer communities and strengthen
                                           development work in 2015/16;                         resilience particularly in those hard to reach
                                           continue to provide an improved person-centred
                                           response to those patients suffering from            invest in technology to develop enhanced
                                           dementia and requiring care from the Service         diagnostic capability and where necessary a
                                           within our scheduled, unscheduled and emergency      reliable interface to share clinical information to
                                           care service;                                        enable our Service to operate as an effective
                                                                                                integrated provider of unscheduled care; and
                                           further develop ScotSTAR as a national service
                                           to improve outcomes for those patients requiring     contribute to the national Scottish Patient Safety
                                           a specialist response and implement new trauma       Programme with a focus initially on developing
                                           pathways;                                            diagnostic testing on scene for patients with
                                                                                                Sepsis and Chest Pain, but moving to a holistic
                                                                                                patient safety programme that covers all
                                                                                                of our activity.

22   A Strategic Framework for 2015-2020                                                                                     Scottish Ambulance Service   23
Our Clinical Model

Delivering Improved

The operational environment                development of specialist           The Scottish Ambulance             The Scottish Ambulance               every time, we need to do a           the focus towards providing
for the Scottish Ambulance                 centres of care for specific        Service is an integral part of     Service has historically delivered   number of things over the next        the most appropriate response
Service is changing in response            clinical conditions, such           the healthcare system and, as      a traditional ambulance service      five years to:                        based on clinical need,
to the wider strategic context             as stroke, PPCI (specialist         such, we are developing our        model with a bias towards                                                  including;
and there are a number of key              cardiac treatment) and major        clinical model to reflect the      taking patients to hospital          create the right conditions for
drivers for change that are                trauma, which affect traditional    need for greater integration       and delivery of response             change and equip our clinical         an aim to increase the level
determining the design of our              boundaries and patient flows;       with key partners, and to seize    time targets. In recent years,       workforce with the skills, capacity   of ‘hear and treat’ through
future model of care, including:                                               the opportunity to develop         however, we have looked              and capability to deliver more        improved telephone triage,
                                           public sector reform and the        and utilise the full breadth of    to develop new roles and             care at home;                         clinical intervention and referral
demographic challenges of an               drive for efficient and effective   enhanced paramedic practice        models of working; to date                                                 to alternative pathways at the
increasingly elderly population            use of NHS resources and            along with the opportunities       these have been small scale          work in partnership to develop        point of the initial telephone call;
living at home with multiple               sharing services across public      technology affords to better       and predominantly focussed           integrated care pathways,
and more complex long term                 sector particularly collaborating   manage, diagnose and treat         around local initiatives. The        supported by senior clinical          an aim to increase the level
conditions;                                with other emergency services,      patients in an out of hospital     current service model is largely     decision support and access to        of ‘treat and refer’ following
                                           i.e., police and fire;              environment.                       weighted, with the intention of      alternative pathways for those        face-to-face assessment by an
the clearly stated aims of                                                                                        being risk averse, to delivering a   patients who do not require           appropriately skilled paramedic
the ‘2020 Vision’ to redesign              the need for a flexible and         Whilst demand for our services     response based on an 8 minute        emergency care within an acute        or other healthcare professional
emergency, unscheduled and                 responsive workforce working        continues to increase, we          Category A target, with a desire     hospital environment; and             with access to enhanced
scheduled care services across             across an integrated health         recognise the role we can          to secure a timely response to                                             decision support and alternative
the NHS to shift the balance               and social care environment;        play in influencing the flow       patients in cardiac arrest or in     ensure we have the right              referral pathways;
of care away from traditional                                                  of patients across the system      an immediately life threatening      mix of skills and resources
acute hospital environment to              developments in technology                                                                                  across Scotland to deal with          an aim to ensure patients are
                                                                               through integration with wider     condition. That model does
community based, day case                  which facilitate remote                                                                                     increasingly complex needs of         treated in the right place first
                                                                               health and social care services.   not support our future strategic
and increasingly planned and               diagnostics and enhanced                                                                                    patients, including specialist        time and in doing so reduce the
                                                                               The challenges of providing        vision. Current analysis shows
anticipatory care;                         decision support and information                                                                            teams and fulfilling our statutory    number of patients unnecessarily
                                                                               sustainable services can only      that only 5-10% of patients who
                                           sharing to improve patient care;                                                                            responsibilities under the Civil      taken to Accident and
                                                                               be met through increased           call 999 have an immediately
greater health and social care                                                 integration and effective          life threatening condition and       Contingencies Act.                    Emergency and improve value
integration in designing and               opportunities to work more                                                                                                                        through greater integration of
                                                                               partnership working. As a          therefore require that 8 minute
delivering services that are               closely in partnership with                                                                                                                       services, skills development and
                                                                               national service operating 24/7,   response.
sustainable and person-centred;            communities and voluntary                                                                                   At its heart, this new clinical       access to more appropriate care
                                                                               we are ideally positioned to
                                           organisations; and                                                                                          model seeks to place quality          pathways; and
                                                                               support the change necessary       In addition under the current
challenges to the sustainability                                                                                                                       outcomes for patients at the
                                           a need to work with partner         across the whole system and        clinical model only 3 or 4
of traditional services and                                                                                                                            heart of its decision making.         a commitment to delivering
                                           organisations and communities       to deliver frontline emergency     patients out of every 10 require
operational models, not least                                                                                                                          This means that engaging              some services “Once for
                                           to address health inequalities.     and unscheduled care in an         the services of Accident and
GP out of hours, across the                                                                                                                            with patients, carers and             Scotland” where there is tangible
                                                                               increasingly responsive, person-   Emergency or require admission
NHS, most acutely in rural                                                                                                                             other providers of health             evidence of benefit and value to
                                                                               centred and efficient manner.      to hospital yet 8 out of every
Health Board areas;                                                                                                                                    and care services to deliver          the system as a whole.
                                                                                                                  10 are conveyed to hospital.
                                                                                                                                                       outcomes that matter to people.
                                                                                                                  In order to redress the balance
                                                                                                                                                       Our emerging clinical and
                                                                                                                  and ensure patients get to the
                                                                                                                                                       operational model aims to shift
                                                                                                                  most appropriate care first time,

24   A Strategic Framework for 2015-2020                                                                                                                                                               Scottish Ambulance Service   25
Our Clinical Model

SAS Clinical Model                                                                                                               Immediately Life Threatening
                                                                                                                                 Patients whose condition is potentially life-threatening and a
                                                                                                                                 fast response is vital. This accounts for less than 10% of 999
                                                                                                                                 calls received. These patients will be responded to by skilled
                                                                                                                                 paramedics and will normally be taken to A&E or specialist
                                                                         IMMEDIATELY LIFE                                        care. An example would be a patient in cardiac arrest.

                                                                                                                                 Urgent and Emergency
                     SAS TRIAGE                                          URGENT & EMERGENCY                        HOSPITAL      Some emergency and urgent calls will also require a quick
                     & DISPATCH                                          NON LIFE THREATENING                                    response and conveyance to hospital i.e. GP calls and non life
                                                                                                                                 threatening emergencies.

                                                                                                                                 Hear, Treat & Refer
                                                                                                                                 Patients whose condition is not serious enough to require
                                                                                                                                 an ambulance to attend or likely to result in any need to go
                                                                         HEAR, TREAT & REFER                  SPECIALIST/        to hospital. These patients can safely be given telephone
                                                                                                              ADVANCED           advice by a paramedic, referred onto NHS24 for further advice
                                                                                                              PARAMEDIC          or referred onto another service, such as a GP. An example
                                                                                                                                 would be a person with flu like symptoms.
                                                                                                              ALTERNATIVE CARE
                                                                                                                                 See, Treat & Refer
                                                                         SEE, TREAT & REFER                                      Patients whose condition requires face-to-face assessment
                                                                                                              COMMUNITY CARE
                                                                                                              TEAMS              by a skilled paramedic but, in many cases, may be safely and
                                                                                                                                 effectively treated by that paramedic at scene without any need
                                                                         ANTICIPATORY CARE                    PRIMARY AND        to go to hospital. Alternatively, these patients may be referred
                                                                                                              SOCIAL CARE        directly to more appropriate services. An example would be
                                                                                                              EMERGENCY          an elderly patient who has fallen but is uninjured who could be
                                                                                                              AMBULATORY         referred onto a specialist community team and their care could
                                                                         ROUTINE                              CARE               be managed at home.
                                                                         DISCHARGES                           INTERMEDIATE
                                                                                                              CARE               Anticipatory Care
                                                                                                              MINOR INJURY       Patients living with one or more long-term conditions whose
                                                                         SCHEDULED CARE
                                                                                                              UNITS              care can be managed proactively at home, where a package
Figure 1: SAS Clinical Model
                                                                                                                                 of care has been put in place to support patients to stay
                                                                                                              GP OUT OF HOURS    at home. Specialist paramedics can help deliver this care
                                                                                                              OTHER HOSPITAL     package working alongside colleagues in health and social
                                                                                                              SERVICES &         care. An example would be a patient living with Chronic
Figure 1 illustrates the key components of the new clinical and offers some examples within                   DIRECT ACCESS TO   Obstructive Pulmonary Disease whose acute exacerbation
each of the identified patient flow groups.                                                                   SPECIALIST CARE    requires urgent care.

Our developing clinical model better reflects the needs of patients and aims to ensure we send the right                         Non-Emergency (Scheduled Care)
response to meet that need. Our aim is to improve how we assess and triage patients’ condition on the
telephone. We may take a little more time to do this once we have established the patient’s condition is                         Patients who require to be admitted or discharged from
not immediately life-threatening, to ensure we send the right staff with the most appropriate skills. Where                      hospital, or transferred between hospitals for further treatment
patients do not need to go to an emergency department, our skilled paramedics may treat them at home                             and patients attending hospital for a scheduled outpatient
or access a more appropriate care pathway. In some cases, we might refer patients directly to specialist                         appointment. These patients do not normally require the skills
services. We will work as part of an integrated health and social care system to access the right care                           of a paramedic and are in a stable condition. An example
first time for patients.                                                                                                         would be a patient admitted for elective surgery or attending an
                                                                                                                                 outpatient appointment where ambulance transport was required.

26   A Strategic Framework for 2015-2020                                                                                                                                    Scottish Ambulance Service   27
Our Clinical Model

Building this model by                     developing our paramedics          effectively supporting the flow
2020 will require:                         to operate confidently at the      of patients both in unscheduled
                                           full scope of their practice,      and scheduled care, where the
more effective triage of all               making the best possible           right response will be determined
calls, including those from other          clinical decisions with and for    by the needs of patients and the
healthcare professionals and               patients, which will result in     traditional demarcation between
agencies. We must continue                 fewer avoidable attendances at     emergency, unscheduled and
to ensure rapid identification             accident and emergency, where      scheduled care services will be
and response to immediately                safe and in the patient’s best     removed within the concept of
life-threatening calls and those           interest to do so;                 ‘one ambulance service’;
requiring a specialist operational
response, whilst recognising               increasing the number of           development of our mobile
that these account for less than           patients treated at home,          tele-health infrastructure to
10% of demand for our service.             including those with minor         increase capacity and capability
Nevertheless, it is vital that our         injury and illness;                for near patient testing and
response is fast and a crew with                                              remote diagnostics; and
a paramedic present is available           increasing direct conveyance
to respond and convey the                  to specialist departments          all of these actions will be
patient to the most appropriate            such as trauma, stroke and         developed within a robust and
healthcare facility. Alternatively,        orthopaedics and linking in        effective governance framework,
where the call is not immediately          with other services across         ensuring that patients are
life-threatening, that we are able         primary care and community         protected and that there is
to determine the level of clinical         based teams and networks           evidence for the safe and
response more effectively;                 to route patients to more          effective implementation of
                                           appropriate care;                  these new ways of working.
effective clinical supervision
and senior decision making                 working with NHS Boards and
in our Ambulance Control                   partners to develop better and
Centres to strengthen decision             more consistent access to
making, call management and                professional-to-professional
response and, more especially,             senior clinical decision support
to provide clinical telephone              and direct access to local care
advice or onward referral to a             pathways and intermediate
more appropriate service to                care services where clinically
patients who do not require an             appropriate;
                                           embedding specialist and
                                           advanced paramedic practitioner
                                           roles within integrated and
                                           multi-disciplinary teams working
                                           effectively in partnership with
                                           colleagues in primary care, out
                                           of hours, secondary and acute
                                           care and in the community;

28   A Strategic Framework for 2015-2020                                                                          Scottish Ambulance Service   29
Our Clinical Model

Responding to                              Patient Flows                                                         Acuity                         Response/skills
                                                                                                                                                                                 Figure 2: Responding to Patients’ needs

Patients’ needs
                                           Immediately Life Threatening                                          Immediately life threatening   Paramedic/Specialist paramedic
Delivering this clinical model             These patients need a rapid paramedic response. We will
will require a fundamental shift                                                                                 8 minute response              Conveying resource
                                           dispatch an additional paramedic responder and an ambulance
in how we respond to calls and             to these patients as evidence shows additional support saves
significant development of the             lives as does getting to hospital as quickly as possible. An
current and future workforce in            example would be a patient in cardiac arrest. We may also
a way that is more responsive              deploy specialist teams to retrieve some patients or deal with
to the needs of patients and               major or hazardous incidents.
the severity of their condition.
Being sophisticated enough
to deploy the right resource to            Serious but not Immediately Life-Threatening                          Time-critical                  Conveying resource
those patients based on more
effective clinical triage is also          These patients require a paramedic response and will generally
                                                                                                                 Urgent GP admissions           Paramedic plus support
required.                                  need to go to hospital. We will dispatch an ambulance with a
                                                                                                                 and hospital transfers
                                           paramedic on board. Whilst their condition is not immediately
Our response to patients aims              life-threatening, time can still be important and make a difference
to always dispatch the right               to the outcome. An example would be a patient having a hyper-
skills to deal with the severity           acute stroke who needs to be at a hospital with a CT scanner
of the patient’s condition                 within an hour.
based on improved triage.
We are therefore moving from
a response which is biased                 See, Treat & Refer                                                    Non time-critical              Specialist paramedic/Paramedic
towards hospital attendance to             These patients require a paramedic response but our aim would
one where our staff are skilled to                                                                               Face-to-face assessment        Enhanced minor injury/illness
                                           be to treat as many of them safely at home as possible. We will
treat patients at home and refer           dispatch a paramedic, with advanced assessment skills and in
directly to more appropriate               some cases a specialist paramedic, able to treat minor injuries
services as part of an integrated          and minor illness and if necessary access appropriate care
health and social care system.             pathways as an alternative to hospital. An example would be a
This model will be supported               diabetic patient or a patient with an exacerbation of an existing
by a number of specialist teams            long term condition.
able to deal with complex
or hazardous situations and
stabilise and retrieve critically          Hear, Treat & Refer                                                   Low acuity 999 calls           Clinical advisor in
ill patients. We will also continue                                                                                                             Ambulance Control Centres
to develop our network of                  These patients do not require an ambulance to attend and are
                                                                                                                 Calls passed to NHS24
community first responders and             unlikely to need to go to hospital. We may transfer some patients
                                                                                                                                                Paramedic level
work with volunteers, including            to NHS24 or to our paramedic clinical advisors who will offer
other healthcare professionals,            advice, telephone assessment and directly refer patients to a
to build and strengthen                    more appropriate service. An example would be a patient with
community resilience.                      a minor ankle injury which could be seen by their GP. On some
                                           occasions, where circumstances or patient vulnerability require it,
                                           we may still dispatch an ambulance with a paramedic on board.

                                           Non-Emergency                                                         Scheduled care                 Conveying resource
                                           These patients need to be admitted to, discharged from,
                                                                                                                 Low acuity urgent-discharge/   Enhanced Ambulance Care
                                           or transferred between hospitals. This will also include some
                                                                                                                 transfers                      Assistant, Basic Life Support,
                                           scheduled care outpatient and day care activity. These patients
                                                                                                                                                oxygen, Automated External
                                           do not require a paramedic and will generally be responded to
                                           by a scheduled care ambulance.

30   A Strategic Framework for 2015-2020                                                                                                                                                 Scottish Ambulance Service   31
Our People

                                                                                                 Developing our
                                                                                                 Workforce for the future

                                                                                                 As we move towards 2020, the Scottish Ambulance Service
                                                                                                 faces a number of challenges which influence the future workforce
                                                                                                 required to deliver the 2020 Vision. In developing our strategic
                                                                                                 workforce plan, we have sought to align our commitments with
                                                                                                 those set out in the 2020 Workforce Vision below, and to ensure
                                                                                                 we develop a workforce capable of delivering the highest levels
                                                                                                 of quality service and clinical, person-centred care, in line with
                                                                                                 the NHS Quality Strategy.

                                                                                                 The emerging model of care described above clearly requires
                                                                                                 development and re-profiling of our current workforce and
                                                                                                 investment in new roles and enhanced skill sets. It is also clear
                                                                                                 that the challenges faced in some areas of Scotland may require
                                                                                                 us to develop a flexible workforce model that better supports
                                                                                                 person-centred care and reflects those specific needs, for
                                                                                                 example, by adapting local pathways or developing an urban
                                                                                                 and a rural model, recognising that one size may not fit all.

                                                                                                 Our aim is that by 2020, the workforce within Scottish Ambulance
                                                                                                 Service will provide:
                                                    Everyone Matters:
                                                  2020 Workforce Vision                          all staff working to their full scope of practice, skills, knowledge and
                                                                                                 experience, supported by Personal Development Plans and enhanced
                                                                                                 learning opportunities;
                                            “We will respond to the needs of the people we
                                           care for, adapt to new, improved ways of working,     increased levels of specialist paramedics, many
                                           and work seamlessly with colleagues and partner       of whom will operate as part of an integrated health and social
                                            organisations. We will continue to modernise the     care team, managing patients, primarily with long-term conditions
                                             way we work and embrace technology. We will         in the community, able to provide treatment at home with direct
                                            do this in a way that lives up to our core values.   access to alternative pathways if required, and able to provide
                                           Together we will create a great place to work and     additional face-to-face assessment for those patients without an
                                            deliver a high quality healthcare service which is   immediately life-threatening condition who do not require to go to
                                                      among the best in the world.”              hospital; and

                                                                                                 appropriate number of specialist critical care paramedics able
                                                                                                 to respond to critically ill or injured patients and provide support
                                                                                                 to specialist retrieval teams and seriously unwell patients with
                                                                                                 a life-threatening condition;

32   A Strategic Framework for 2015-2020                                                                                                                                    Scottish Ambulance Service   33
Our People

appropriate number of specialist paramedics            The transformation of our workforce will be
and support staff able to respond to patients          aligned to the career framework that is familiar
requiring clinical care in hazardous or difficult      to the wider NHS. This framework will enable
access environments, including confined spaces,        us to have discussions about what essential
collapsed structures, entrapment; including at         skills are needed at each level to provide good
height, inland water operations and similar to         clinical decision-making and to provide safe and
provide decision making, advice and direct             appropriate care in all settings. New roles will be
clinical care;                                         grouped according to their level of complexity
                                                       and responsibility in practice and the level of
an appropriate level of conveying resources for        experience and learning required to carry them
emergency and unscheduled care, ensuring that          out. The framework will demonstrate how different
patients can be taken to hospital when required,       jobs build on one another to allow progression
meet expectations for planned scheduled work,          up and across the paramedic career ladder.
and manage the increasing demand for transfers
and discharge;                                         Our Strategic Workforce Plan “Delivering Our
                                                       Future Workforce” will support this strategic
enhanced clinical decision support in the              framework by providing clarity about how many
Ambulance Control Centres (ACCs) through               of each level of staff we will need by 2020. This
increased impact of clinical advisors; for example,    will be supported by training, education and staff
continuing the practice of appointing nursing          development of our existing workforce and will
staff to this role; providing access to more senior    guide our recruitment of new staff. The career
clinical decision support from medical staff           framework also aims to makes it clear that we
through a professional-to-professional support         will develop our existing workforce through the
network; and through development of our call           various levels as well as recruiting directly into
handlers and dispatchers to make most effective        each level.
use of our triage tool and referral pathways;
                                                       Finally, aligning the career framework for
more tailored models specific to the needs             paramedics to the national framework in place
of local communities, such as the Retained             across the wider NHS provides scope for
and Emergency Responder models, involving              understanding the roles of other clinical staff from
ourselves, NHS Boards and the voluntary sector         nursing and other allied health professions within
supported by appropriate tele-health facilities and    the delivery of the 2020 Vision. This provides an
decision-support;                                      opportunity for a richer mix of clinical skills and
                                                       builds on the good practice established in Angus
enhanced skills and development of scheduled           with the paramedic/nurse co-responder model.
care staff, within our control centres and those
delivering care on the frontline development of
corporate and support staff;

significant development of leadership and
management capabilities, building on the
development of a ‘just culture’ where staff feel
supported to learn from mistakes and near-misses.

in essence, the Scottish Ambulance Service
workforce of the future will be more highly skilled,
operating across traditional boundaries, accessing
improved decision-support, more clinically
focussed, but with sufficient capacity to manage
the movement and flow of patients through the
wider system effectively.

34   A Strategic Framework for 2015-2020                                                                      Scottish Ambulance Service   35
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