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North West Ambulance Service: assessing our latest performance review

Source: NHE Jan/Feb 2019

Michael Forrest, interim chief executive of the North West Ambulance Service (NWAS), discusses how his team has implemented best practice methods to achieve its ‘good’ CQC rating awarded last year. 

I am delighted with our rating from the CQC, which I feel reflects the way we deliver services for patients and values the dedication of our staff who work tirelessly for patients living and working in the north west. 

We believe in our staff. They are the ones who know the needs of our patients the best, and we ensure that development opportunities are available to help them progress clinically and to move into positions of leadership in line with their ambitions.

Innovation and improvement is now part of the fabric of the trust. We encourage staff to influence change, particularly within protocols, processes, equipment, and training, and listen to their ideas through research and local and national improvement groups.

I am also delighted with our improved ratings for ‘well-led’ and ‘safe,’ and that the CQC noted staff were engaged with our strategic vision to do the right thing for every patient, every time. 

In terms of ‘well-led,’ the trust has a clear vision and strategy, with quality and safety as our top priority - something which has been developed with our stakeholders.

I feel that a strong vision is key to helping us move from ‘good’ to ‘outstanding’ and will ensure we are constantly focused on achieving our goals, something which I’m really happy has been acknowledged by the CQC.   

The report picked out good examples of improvements in safety: for example, we have placed additional emphasis on ‘hot debriefs’ which means that immediately after a particularly challenging incident, a discussion takes place between staff and senior managers to give feedback on what went well and what can be learnt. Having this debrief straight away also allows everyone involved to process the emotional impact for themselves and their colleagues, whilst identifying key learning opportunities that may have otherwise been missed or forgotten. 

It was noted that processes were in place and followed by staff rigorously to reduce harm to patients, staff, and the public. This follows a review of risk and preparedness within the trust, and the introduction of senior paramedic team leaders who are able to support and advise crews to recognise where a patient may need additional or immediate help.

Organisational change has been challenging, but with the formation of our ‘transforming patient lives’ project team, and the tremendous attitudes of everyone from the board of directors to the frontline, we have successfully put in place a number of initiatives to improve patient care.

For example, we have increased clinical presence within our emergency operations centres, allowing patients to be triaged over the phone by a qualified paramedic or a nurse who can make decisions on the best care, in many cases reducing the need for an ambulance response.

We have now also introduced a successful pilot of a new urgent care practitioner role which sees nurses and paramedics responding to patients who have called 999 but could possibly receive support and treatment in the community, rather than having to go to hospital in an emergency ambulance.

While nurses have been part of the ambulance workforce for a number of years, it is the first time they have been employed in NWAS in a role responding to patients.

The culture of learning has further developed in our emergency operations centres, with the CQC acknowledging the willingness of staff to report incidents and learn from them, leading to improvements in patient safety.

Working together with our stakeholders has also really helped us make some targeted improvements.  We have a close relationship with our lead CCG, who help to review our performance and agree on strategies to improve.

We also engage with hospital trusts on key issues such as improving handover times with a dedicated improvement programme in place to share knowledge and leading practice, as well as implementing and reviewing changes to improve services for patients.

Although we are extremely pleased with this outcome, we never stand still - and the report highlighted some key points to continue our improvement journey, which we are now putting into place.

There’s still a lot of work to do to achieve our aim of becoming the best ambulance service in the country, but this rating assures us, and the people we serve in the north west, that we’re heading in the right direction.

The result of the report is testament to the hard work of our staff, something which I, as interim CEO, am extremely proud of.


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