EPÍLEG: EL FUTUR DE LA SINDICATURA DE GREUGES

Strengths

Available 24 hours a day, seven days a week – There are few providers able to offer urgent unscheduled care 24 hours a day, seven days a week. Additionally those that are always available are not always accessible. SECAmb offers a service that is easily accessible at all times. This strength positions us well for increasing our market share in areas where there is a need for more accessible services.

Strong reputation and positive public image – The ambulance service nationally retains a strong reputation and positive public image. Evidence sourced through a large scale research

exercise, conducted by Ipsos MORI on our behalf, into the perceptions and satisfaction levels of patients and the public across the South East Coast region reinforced this, showing that we hold a positive reputation amongst the communities we serve with a satisfaction rating of over 62% – above average in comparison with the NHS nationally. Our focus over the next couple of years will be to increase awareness of our brand so that SECAmb will become synonymous with high quality, timely, efficient services; this will strengthen commissioner support for our business growth.

History of Innovation –Since our constitution in July 2006 we have spearheaded clinical innovation in the ambulance sector through developing and implementing new clinical roles, techniques, equipment and practices. Many of our innovations have been heralded at a national level as best practice models including our FAST-Track stroke care pathway.

Mobile Healthcare Provider – There are few healthcare providers that are able to take care to the patient or are able to provide it in a variety of settings. Patients do not want to travel to hospital unnecessarily and SECAmb has a key role in improving the patient experience and providing a direct access to healthcare advice or treatment.

Historic performance of category A and call taking standards – SECAmb has a strong track record of answering telephone calls quickly and getting to patients quickly. For these reasons SECAmb can play a larger role in the future in providing fast and effective telephone healthcare advice. Our continued achievement of Category A responding will ensure that SECAmb retains its strong reputation amongst the public we serve.

Responsive to clinical change – We are a flexible organisation that not only responds well to change dictated to us, but more importantly, we identify change that is needed to better meet the needs of our local communities. We embrace feedback so we can continue to adapt; ensuring we‟re providing the best service possible to patients and are always considering new ways of working and the implementation of new clinical treatments.

Robust, tested business continuity plans – We are the national ambulance trust lead for business continuity and were integral in the management of the recent Swine Flu pandemic. We were heralded for our effective management of business continuity.

Weaknesses

Higher than average costs – Whilst SECAmb is recognised as being a leader in innovation, it comes at a cost. SECAmb‟s reference costs currently stand at 108% and whilst this has reduced year on year since the Trusts creation it is above average. The significant cost improvement plans detailed in chapter 6 are likely to reduce our reference costs further. Uni-professional workforce (limited skill mix of staff) – Our workforce is our strongest asset in delivering our vision. We have significant expertise within our paramedic workforce but

Page | 47 IBP2010-15_Summary_20100325

must diversify and introduce new skill sets into the workforce; this will most likely include but is not limited to nurses, doctors and therapists.

Staff satisfaction – SECAmb performed below average in the staff satisfaction survey, and accordingly an action plan has been developed to address this. Implementation of the staff survey action plan is monitored through the Workforce Development Committee; it focuses on improving sickness absence, the appraisal process and staff communications.

Environmental impact – By the very nature of the work we undertake, we contribute heavily to CO2 emissions. Our Fleet Replacement Programme, and Lease Car Strategy take into account the environmental impact of our fleet, and have targets in place to reduce emissions. Our service developments plan to reduce the rate at which we convey people to an alternative place of care which is in line with our plans to have a positive impact on climate change.

Opportunities

Urgent, unscheduled care expansion – Access to the most appropriate healthcare service can often be unclear for patients. An opportunity exists for us to further develop the call handling and triage facilities that we currently provide and become a central point of access for the out of hospital healthcare system.

Improving outcomes and experience – As a result of implementing a high performing work model SECAmb will be amongst the best ambulance services in the world. By implementing high clinical standards and achieving excellent clinical outcomes we can be commissioned in this way. Patients within the South East Coast will receive a better service and other

commissioners will want similar quality of care provided in their area.

Diagnostic Technology – There are a number of options for the Trust to use in terms of diagnostic technology. More sophisticated technology will result in our staff being able to provide healthcare advice and treatment to a wider cross section of patients. We have a dynamic, forward thinking information technology support team who will be able to tailor the technology available to best effect for our patients.

Managing demand in the whole health economy – Linked to the opportunity for urgent and unscheduled care expansion is the potential for SECAmb to undertake a coordinating role within the health economy to appropriately manage demand. The Trust already runs a Capacity Management System, a real-time system that enables hospitals to identify pressures, and for resources to be diverted elsewhere as appropriate.

Releasing cost improvements in the whole health economy – As identified in the PEST analysis, the NHS is required to make significant financial savings in the future. It is anticipated that this saving will primarily be achieved by improving care pathways to improve quality and experience and reduce unnecessary waste. This requires a whole systems approach, and we believe the ambulance service is well positioned to take a lead role in this.

Foundation Trust status will increase local ownership amongst patients, public and staff – Increased local ownership and accountability through the development of a membership and Council of Governors will ensure that patients, local people, staff and partner agencies will have more say and involvement in developing future services, ensuring that we are reacting to the changing environment and reflecting the needs of the communities we serve.

Page | 48 IBP2010-15_Summary_20100325

Community Cohesion – The Trust is uniquely placed to play a pivotal role in increasing social responsibility whilst supporting public health. Initiatives such as community first responder schemes have a two-fold benefit in promoting civic responsibility, as well as helping to improve outcomes for patients.

General health management – Through the development of more advanced practitioner roles, the Trust has an opportunity to seek to use these roles across a wider remit, such as in a primary care setting. There is an opportunity to look to increase market share and work in partnership with GPs for basic health management that could be undertaken by a Paramedic Practitioner, such as immunisations and simple healthchecks.

Threats

Payment by Results could result in a disincentivisation to “do the right thing” for patients – The potential for acquiring additional funding within the NHS to support innovation is significantly reduced under the current financial climate, meaning that innovations will have to be largely funded through internally generated funds. We have robust plans to ensure that this is

achievable and does not impede our future developments but Payment by Results (PbR) may be used to reduce our income. Our service plans for the future will result in more activity being managed through hear and treat which is most likely going to be commissioned at a lower rate than see, treat and convey. It will be important that in addition to PbR tariffs there is adequate incentive for SECAmb to progress these plans without being penalised financially.

Competition from alternative providers – The economic downturn will continue to increase competition in the healthcare market. We need to ensure that we are equipped not only to operate within more competitive markets, but to seize the opportunity to lead them.

Contestability is currently strongest in the Non-Emergency care market, where we provide PTS services and commercial services, but this is increasing and is likely to do so further in both the Emergency care and Unscheduled Urgent care markets.

Resistance/ difficulty delivering large scale cost improvement programmes – To support our service developments which will ensure that SECAmb is a market leader significant investment is required. Additionally, cost efficiencies required to be delivered in line with the operating framework further increase the levels of cost improvement savings required over the next five years.