Improving services and measuring progress in the North West Ambulance Service (NWAS).
April 2021 to March 2022
EDS2 Evidence Pack 21-22 (1MB pdf)
On this page
- Introduction
- The goals of Equality Delivery System 2 (EDS2)
- Glossary
- Goal 1: Better health outcomes
- Progress and highlights from 2021 to 2022.
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- What this means to North West Ambulance Service (NWAS) in practice
- Progress and highlights from 2020 to 2021
- Findings from this are being utilised to:
- In regards to violence reduction we have:
- Barriers, challenges and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- What this means to The North West Ambulance Service (NWAS) in practice
- North West Ambulance Service (NWAS) 111
- Progress and highlights from 2020 to 2021
- Barriers, challenges, and difficulties
- What this means to The North West Ambulance Service (NWAS) in practice
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- Screening, vaccination and other health promotion services reach and benefit local communities
- In 2021/2022 campaigns included:
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- Goal 2: Improved patient access and experience
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- What this means to The North West Ambulance Service (NWAS) in practice
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- People’s complaints about services are handled respectfully and efficiently
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- Goal 3: A representative and supported workforce
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- Progress and highlights from 2020 to 2021
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective from April 2021 to March 2022
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective April 2022 to March 2023
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- Progress and highlights from 2021 to 2022
- Barriers, challenges and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- Goal 4: Inclusive leadership
- Progress and highlights from 2021 to 2022
- Barriers, challenges and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- Progress and highlights from 2021 and 2022
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
- Progress and highlights from 2021 to 2022
- Barriers, challenges, and difficulties
- Work being carried out to meet this overarching objective from April 2022 to March 2023
Introduction
The Equality Delivery System (EDS) helps the NHS:
- improve services for local communities
- provide a framework for better working environments, free of discrimination, for NHS staff
As an NHS trust, the North West Ambulance Service (NWAS) we are expected to assess our progress against the EDS outcomes. This is to ensure we are delivering in the best possible way for our people and communities. The EDS2 process allows us to demonstrate our ‘due regard’ for the for Public Sector Equality Duty. This is enshrined by the Equality Act 2010.
Here at The North West Ambulance Service (NWAS), we are aspiring to:
- deliver services in an inclusive way for patients
- provide a supportive, inclusive environment for our staff
This ambition underpins our Equality Diversity and Inclusion (EDI) objectives as a Trust. We are proud to be able to share some of the work we have been doing to deliver to meet those objectives.
This evidence pack highlights the work across the organisation for the benefit of patients and staff. This is to meet the needs and requirements of the diversity of people who we serve and those who work for us.
Will be assessed by a panel of internal and external stakeholders. These people will consider the level we are currently performing at against each of the 18 outcomes within this document. We will share feedback with NHS England as expected.
This document is also helpful for anyone who is interested in our work:
- to address health inequalities within the communities we serve
- aimed at improving the employee experience of staff
We hope to build on our achievements in the coming year and continue to develop in areas of improvement.
This is the final year that we will be using Equality Delivery System 2 (EDS2) process. This is as a new version, EDS 2022 will be operational from next year.
Lisa Ward – Director of People
The goals of Equality Delivery System 2 (EDS2)
This document sets out evidence relating to the four goals of EDS2:
- Better health outcomes
- Improved patient access and experience
- A representative and supportive workforce
- Inclusive leadership
We split each of the goals into outcomes.
This document will provide information about activity and progress in each of those areas.
The grading panel will review, assess and score progress in each area.
We encourage you to think about the different protected characteristics and a range of other vulnerable or disadvantaged groups when making your decision about a score. There is no right or wrong answer. This exercise is to hear your opinion based on the information available to you.
Glossary
- CDSS – Clinical Decision Support System – computer system used by clinical staff
- CMI – Chartered Management Institute
- EOC – Emergency Operations Centres – control centres
- FFT – Friends and Family Test – short survey to patients about whether they would recommend NWAS to a friend
- L&D – Learning and Development
- MDT – Multi-disciplinary team
- MECC – Making Every Contact Count – a holistic approach to care adopted by clinicians to offer individualised care for patients
- PES – Paramedic Emergency Services
- PTS – Patient Transport Service
Goal 1: Better health outcomes
Services are commissioned, procured, designed and delivered to meet the health needs of local communities.
What this means to the North West Ambulance Service (NWAS) in practice.
Patient Transport Service (PTS)
Clinical Commissioning Groups (CCGs) commission The Patient Transport Service (PTS). The PTS contract states that:
“all bookings must comply with the Equality Act 2010 to ensure all patients are protected against discrimination. The Provider must recognise and welcome its legal duties under the Equality Act 2010. It must ensure that interpreting and translation services comply with these legislative requirements.”
Understanding patients’ needs starts with the booking process. We train staff to elicit the necessary information for each patient. This is so that we can respond as necessary. The service line provides help to patients with the full spectrum of needs. This is from the initial booking of the service through to journey completion. We take all patients through the same booking process. We apply an eligibility assessment questionnaire to every booking. We produced a pocket sized information leaflet to help patients. The PTS management team has developed a robust working relationship with the Patient Engagement team. This gives access to feedback from service users used to improve patient experience.
North West Ambulance Service (NWAS) 111
This means that funding is available to be able to deliver a , high quality, safe, patient telephone assessment of health needs via 111.
This means that funding is available to be able to deliver a high quality and safe patient telephone assessment of health needs via 111.
NWAS 111 senior leaders are now working with Integrated Care Services (ICS) leads. This is to ensure services are available regionally for 111 to refer into. We streamlined a continuation of 2020 111 First campaign and direct booking implementation. This has been improving patient experience.
The North West Ambulance Service (NWAS) 111 service is on a journey to become an integrated emergency and urgent contact centre. This is from a communication, system and workforce perspective to better meet the changing needs and demand of the people we serve in the northwest region. We have integrated onto the same telephony platform and all service lines using Avaya phones. This is to aid better internal communication. 111 staff have moved to green ambulance uniforms to appear as a unified organisation. This gives a feeling of inclusivity and an NWAS family. We keep the Directory of Service current to ensure 111 are able to refer appropriately into services. Local services presenting meet the needs of patients.
Progress and highlights from 2021 to 2022.
Patient Transport Service (PTS)
The Patient Engagement Team are a regular agenda item on the PTS Level 2 meeting bi-monthly meeting. The outputs from the Friends and Family Test (FFT) are regularly discussed and reviewed. This in turn contributes to service improvement.
A Task and Finish Group was put together to:
- understand in more detail the results of the Friends and Family Test (FFT)
- identify areas for improvement
The return rate for Patient Transport Service (PTS) is excellent at 33%. More than 90% of patients rate the service as very good or good. The positive feedback to share and celebrate was from patients who said that they were “reassured” and “made to feel special”and received an excellent service.
The language line app was rolled out onto iPads for trial for PTS colleagues in East Lancashire and Merseyside.
NWAS 111
The Directory of Service (DoS) review group was set up to work with key stakeholders. This was to ensure appropriate profiling and service availability across the region. For example, reviewing all mental health provision across the Northwest footprint. This was in readiness for press 2 project relating to better access and collaborative working between:
- North West Ambulance Service (NWAS)
- DoS leads
- service representatives
to ensure shared understanding of processes and ensure accurate and appropriate referrals.
We extended our Early Transfer to Out of hours (ETTO) calls to primary care provider services to:
- reduce delays in patients awaiting a clinical call back
- improve patient experience
We worked with Integrated Care Services (ICSs) to improve the availability of appointment bookings via GP connect.
There were discussions with commissioners around funding gaps for adequate staffing. This included incentivised shifts to maximise operational staffing to meet the needs of the patients. This is especially during the effects of Covid-19 absences amongst call centre staff.
We introduced cleric call pop and safety alerts to support our workforce and enhance seamless care contact episodes for patients.
We supported our Emergency Operations Centre (EOC) colleagues. We introduced 999 staff utilising NHS pathways to telephone triage callers for greater parity of care regardless of calling 999 or 111.
We have commenced a Rota review project. This is due to the shift in demand profile and staffing shift times not matching the changing demand from service users.
Barriers, challenges, and difficulties
Patient Transport Service (PTS)
Some of the feedback from patients through the Friends and Family Test (FFT) is anonymous. When we identify good practice and good patient experience it would help to have more information from the patients.
Many complaints about PTS are about timeliness of collection. The performance in this area is good and often meets the contractual requirement. But it is difficult through the complaints process to manage patients’ expectations.
North West Ambulance Service (NWAS) 111
There is insufficient funding to manage a significant increase in demand from the public to 111.
Due to insufficient staffing 111 is experiencing delays getting through to the service and high abandonment levels of calls.
The contract value does not reflect demand on services such as mental health and emergency dental treatment services that are not fully commissioned 24/7 in all areas of the North West. This is leading to disparity in care across postcodes.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Patient Transport Service (PTS)
Senior managers are working with commissioners on the PTS specification for the future. They are contributing as the Subject Matter Experts (SMEs) for the service. They identify gaps in the current service design and respond to those gaps in future contracts.
The PTS Head of Service sits on various groups as part of the Non Emergency Patient Transport Services (NEPTS) National Review. This is to look at service delivery and improve equity of access for all eligible patients.
We are using partnership working with Patient Engagement Team to review and update the PTS Patient Survey Friends and Family Test (FFT). This is so that the questions are more appropriate for PTS and should then give answers that are more useful.
We are sharing the outputs and data from the PTS Patient Survey and FFT results with taxi and private ambulance companies. This is to ensure that all partners are aware of feedback from patients.
We are using mystery shoppers on taxis to review service provided and patient experience.
North West Ambulance Service (NWAS) 111
We are negotiating sufficient funding for 2022/23. This is to meet new post-Covid call demand Exploring work force management tools to adequately schedule, monitor and support performance optimisation.
- integrating a contact centre model with flexible and adaptable workforces.
- doing a trial of 111 health advisors trained to take 999 call and vice versa
We are introducing New recruitment materials and campaigns. This to attract more staff to NWAS 111, including radio broadcasts and widening access scoping events.
Cloud based azure virtual desktop homeworking is to expand clinical homeworking and capability for health advisor hybrid remote working to attract and retain more employees and support work-life balance and well-being of our staff.
Individual people’s health needs are assessed and met in appropriate and effective ways
What this means to North West Ambulance Service (NWAS) in practice
Paramedic Emergency Services (PES) and Digital
In August 2022, NWAS published a refreshed strategy with the three core aims of:
- providing high quality inclusive care
- being a brilliant place to work for all
- working together to shape a better future
- listen to our patients. Respect their different needs to provide compassionate, inclusive care.
- work closely with our patients and the wider public. We will be listening to their experiences and feedback to make improvements.
- build effective relationships with our communities. This is to understand their needs and make sure our services are accessible.
- make sure we engage with people in an accessible and inclusive way.
- make sure we share feedback from patients and the public at all levels. This is so we can continuously improve how we work with, and provide care for, our patients.
- develop a plan to reduce inequalities in access, experience and health outcomes. Especially for groups of patients considered vulnerable or at higher risk.
- make better use of data.
North West Ambulance Service (NWAS) 111
Assessing the health needs of an individual is an integral part of 111. 111 is a first point of contact for the public navigating through the wider health care system. NWAS 111 and now NWAS 999 use NHS pathways which is a clinical decision support system tool. This enables the assessment of callers to urgent and emergency services and has been utilised at NWAS 111 since 2013, when it replaced NHS Direct.
Demographic data and information is also captured on an individual’s accessibility requirements from:
- ethnicity
- age
- gender
Ensuring the health and needs of our staff as a service has also been at the forefront of improving staff wellbeing.
When we look after our staff, they are able to look after our service users. We have continued with our 111 champions to support the wellbeing and morale of our staff and making the North West Ambulance Service (NWAS) a good place to work, despite the demanding pressures.
Progress and highlights from 2020 to 2021
Paramedic Emergency Services (PES) and Digital
In 2020 The North West Ambulance Service (NWAS) welcomed a Public Health Registrar. Health Education England (HEE) funded this. We became the first, and only, UK ambulance trust to do this.
Public health registrars, advanced paramedics and community specialist paramedics have established pathways into social prescribing services. This is improving the safety net to support the Safe Care Closer to Home agenda. We have also added 13 social prescribing pathways.
An analysis of all out of hospital cardiac arrests by deprivation during 2016-2021 has been undertaken by the Public Health lead. Findings have been reported to the Equality, Diversity and Inclusion sub-committee.
Findings from this are being utilised to:
- make data-informed decision-making for defibrillator locations and CPR training
- support partnership working with cardiac networks/Integrated care systems on cardiovascular disease prevention
- improve ethnicity data collection
- develop a PowerBI dashboard for out of hospital cardiac arrest data
We established a Public Health Delivery Group. This group approved the North West Ambulance Service (NWAS) Public Health Plan. This outlines our ambition to embed public health approaches and prevention in NWAS.
We have Public health aims to improve the physical, mental health outcomes and wellbeing of people within a population. This is by focusing on prevention and reducing health inequalities.
We are analysing and using our data on falls to understand demand. We have also developed a falls dashboard. We are beginning to share data with integrated care systems and other external partners.
In regards to violence reduction we have:
- established links with the Greater Manchester Violence Reduction Unit
- developed a violence prevention programme including embedding referral pathways and hosting youth navigators
- attended at safety roadshows and presentations in schools and colleges
We have worked with the Street Doctors Programme to teach first aid whilst providing young people with leadership experience and careers advice.
North West Ambulance Service (NWAS) 111
We have been supporting our 999 colleagues with the implementation and ongoing updates of versions of NHS Pathways.
We regularly meet with colleagues to coordinate version releases as well as ensure shared learning across service lines.
We have increased numbers of staff who are peer supporters or mental health champions.
We did a trial in October 2021 of increasing after call work from five seconds to 25 seconds between 111 calls. This has dramatically improved staff wellbeing and has been fully implemented.
The North West Ambulance Service (NWAS) has reviewed the flexible working policy. Our people are now able to utilise this from day one of employment.
The review of rotas and festival preferencing will ensure that the shifts our staff work meet the rising demands of the service and allow some preference or influence of key and busy dates during seasons like religious festivals and bank holidays to reduce absence and support surges at peak times.
Barriers, challenges and difficulties
Paramedic Emergency Services (PES) and Digital
We have experienced barriers, challenges and difficulties due to:
- developing and monitoring consistent referral pathways
- limited public health capacity within the Trust
- limited analytical data support and capacity
- negotiating changing landscape around the establishment of integrated care systems.
North West Ambulance Service (NWAS) 111
We have experienced barriers, challenges and difficulties due to:
- Lack of sufficient 111 resources to answer phones. This is due to demand outstripping available resource.
- NWAS 111 Service being underfunded to deliver rising demands and needs of patients.
- gaps in service provision across the North West footprint. This is to signpost patients and address their care needs appropriately. For example, emergency dental or mental health crisis patients.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Patient Emergency Services (PES) and Digital
In 2021, a second registrar joined the Trust. Health Education England (HEE) awarded us funding to appoint a Population Health Fellow. Their fellowship ran from September 2021 to October 2022.
There is currently one Public Health Registrar working on a part-time basis for the Trust. There is a further part-time registrar joining in January 2023.
We have approved a public health workforce plan to extend public health capacity. Plans are in place to recruit a Public Health Manager.
We published The North West Ambulance Service Public Health Plan in April 2021. This was updated in 2022. Public Health leadership embedded in NWAS has begun to highlight existing work and identify opportunities to develop this. It has been co-ordinating across the Trust and linking to wider sources of information and support.
Over 500,000 people in the North West have undiagnosed hypertension. A pilot was conducted to share blood pressure data with primary care. 40% of those followed up received diagnoses of hypertension or change of management.
We have trialled level 3 trauma-informed practice training with 15 North West Ambulance Service (NWAS) staff. We are pursuing how to embed this with all staff to:
- improve our work with vulnerable patients
- manage escalating behaviour
- understand and support workforce trauma.
Our mental health teams have developed data dashboards and share data with external partners. This supports our work with partners towards suicide prevention programmes.
In 2022 we refreshed our strategy. Within it we made a clear and bold commitment to:
- work with partners to prevent escalating harm
- understand and tackle inequalities in access, experience or outcome.
Key statements of intent regarding Better Health Outcomes include that we will:
- work with our partners to improve the overall health of the public
- support initiatives which prioritise the needs of people in the community. Particularly people who are vulnerable at high risk of illness or need to access healthcare services regularly
- make ‘every contact count’ with everyone we care for
- assess all their needs, provide the right treatment and make sure they have access to other health and care services. This to prevent them becoming more ill.
The implementation section commits in year one to:
- providing an equitable response
- working with the wider health care system in the North West to increase referral opportunities.
The North West Ambulance Service (NWAS) 111
The rota review is continuing to align staff to meet the demands of the service. It will also provide an opportunity for better team working and operational management.
We are identifying when a caller is out of area to ensure the most effective care and service transfer. This supports a positive patient experience directory of service reviewing distances by road rather than as the crow flies.
This is to reduce inappropriate long distances for patients and return more local services reducing cross-border difficulties.
Transitions from one service to another, for people in care pathways are made smoothly with everyone well informed.
What this means to The North West Ambulance Service (NWAS) in practice
Paramedic Emergency Services (PES) and Digital
In August 2022, NWAS published a refreshed strategy with the three core aims of:
- providing high quality inclusive care
- being a brilliant place to work for all
- working together to shape a better future
In order to provide better health outcomes for all our patients we will:
- provide outstanding care that is safe, effective, and focused on the needs of the patient
- provide care in the most appropriate setting for each patient’s needs. We will do this by taking fewer people to emergency departments. This will provide safe care closer to home or referring people to other health and care pathways
Clinical Safety
Handover of care for patients into community pathways removes unnecessary triage and unnecessary waiting.
The gold standard from a clinical contact centre perspective is electronic transfer of patient records. This is once we have completed triage. The same would apply from an “at scene” perspective. This means that we can seamlessly transfer an accurate patient care record to the next point of care.
111 and the Emergency Operations Centre (EOC) use NHS Pathways. This means where patients require onward referral to another health service we are able to transfer copies of the patient record to 999 and GP out of hours services and book an appointment where available. Where consent is given, we will electronically share a record of the 111 contact with the patient’s own GP. This is known as a Post Event Message.
Where patients have a special patient note we are able to access those and action accordingly. This may be where a patient is:
- on an end-of-life pathway
- on a do not resuscitate directive
- the subject of a child protection order
Practitioners are also in place to provide specialist support for patients with a Mental Health crisis.
North West Ambulance Service (NWAS) 111
NWAS 111 uses a cleric system to create care records, NHS pathways and Manchester Triage tools to assess patients via the telephone.
On completion of a telephone assessment we use the directory of service. Where appropriate, we signpost patients to the service meeting their health care needs. With the introduction of 111 First, 111 can:
- book appointment slots at various provider locations
- send ITK electronic referrals to that service
making a better patient experience by having joined-up working and seamless journeys.
Where consent is provided the patient’s own GP also receives a Post Event message so that communication is shared about a care episode.
Patients own GPs can upload information on the NHS spine providing valuable information about individual care plans, end of life pathways and child protection orders ensuring enhanced communication and supporting established care plans and pathways.
Progress and highlights from 2020 to 2021
Paramedic Emergency Services (PES) and Digital
The introduction of an electronic patient record form has enabled better data capture and collection. Future developments will enhance data capture in regard to patient referrals.
We have introduced Direct Booking in 111. This has enabled clinicians and health advisors to refer appropriate patients into primary care appointment slots.
A significant number of social prescribing referral pathways have been established. Clinicians are now able to refer patients directly onto appropriate schemes. A feedback loop is being developed. This is to ensure that providers can update on the outcome of referrals. Significant work has been undertaken to develop the Directory of Service. This is so patients can be referred to the right services.
Clinical Safety
We have introduced electronic devices. These are known as GETAC devices, a brand of hard-wearing laptops and tablets. We put these on front line vehicles. This to support decision-making and provide staff with a range of options around alternative care pathways e.g. Service Finder app.
We have made arrangements with primary and urgent care services to promote timely patient handover.
We have organised direct transfer of suitable lower priority 999 calls direct to primary care. This agreed clinical code set is directly transferred to local primary care services. This is for secondary telephone triage. This is rather than triage by the clinical hub followed by referral.
We have introduced NHS Pathways across all Emergency Operations Centres.
We have introduced a “red phone” across maternity units in the North West. This is to improve communication and handover of women in labour.
We are doing ongoing work with system partners to reduce Emergency Department handover delays.
North West Ambulance Service (NWAS) 111
Due to the Unified Communication Programme (UCP), 111 are now on the Avaya phone platform. This is enhancing the ability to communicate internally across NWAS.
Large numbers of primary care outcomes were waiting on our clinical queue for a clinician to call back. We developed an Early Transfer To Out of Hours (ETTO) to send specific diagnosis or outcome codes straight to the primary care services identified. This is if our 111 clinician had spoken to the caller.
As this has been successful, 111 have been working with various providers and expanded this wider.
Barriers, challenges, and difficulties
Paramedic Emergency Services (PES) and Digital
We have experienced barriers, challenges, and difficulties with:
- developing and monitoring data regarding onward referrals
- the limited capacity of external providers to design and deliver suitable referral pathways
- the limited analytical data support and capacity
- negotiating the changing landscape around the establishment of integrated care systems.
Clinical Safety
Community and acute care providers are often on different electronic systems. This is making interoperability challenging. This can also add time and/or the need for further patient triage.
We have experienced capacity issues within primary and urgent care systems. This can inhibit referral of suitable patients from Ambulance Services into those services.
Clinical data sets from Ambulance Services are not linked with other data sets. For example, emergency care, same day emergency care. Ambulance services record episodes of care based upon incident rather than NHS number. This is not well understood across the NHS.
Current delays in handovers to Emergency Departments are impacting on availability of ambulances. This also affects response times.
NWAS 111
The wider health economy is not all on the same systems. As a result, communication and electronic transfer of information is challenged in some areas/ providers.
Many primary care services are on Adastra system. This has been open to cyber attacks. This has caused disruption and inability to electronically transfer care records.
The unified communication programme led to some difficulties. There were difficulties with remote homeworking of our clinical staff. Also we have had connectivity issues. This is as handsets are unable to be accessed by the ICT department remotely.
Many local schemes or services set up don’t meet the requirement standards of larger scale services to be on the directory of service. This meaning that 111 are unable to refer into the service (for example a local falls service).
There is a lack of clinicians and call taking staff to meet the rising demands of the service.
We need to aim towards high attrition and retention of staff in contact centre environments.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Paramedic Emergency Services (PES) and Digital
The triage system for 999 moved to NHS Pathways via the Single Primary Triage programme. All patients will now be triaged via NHS Pathways however they access our services.
The move to NHS Pathways enables our clinical and non-clinical call takers to safely triage patients. It also enables us to refer patients to other appropriate service providers.
The development of specialist end of life care pathways is ongoing. This will focus initially on one area of the trust.
All clinicians now have access to the Directory of Services via NHS Service Finder. This enables them to select from a wide range of onward referral pathways. Plans are in place for the referral process to be made electronic for Paramedic Emergency Services (PES) staff. This is to bring them inline with our 111 provision.
Electronic Patient Record (EPR) phase 2 is in progress. This will include access to patient records and the ability to make referrals to services in the Directory of Service (DoS) from on scene.
Clinical Safety
Ongoing work this year to improve pathways into:
- mental health
- palliative care
- maternity care
North West Ambulance Service (NWAS) 111
We have extended Early Transfer to Out of hours (ETTO) to in hours period. This is in addition to out of hours, enhancing the acceptance of referrals 24 hours a day 7 days a week. This minimises delays in patient care. It does this by effectively cutting out the wait for a clinician call back from 111 to arrive at same place.
- Chorley & south Ribble
- Greater Preston
- Greater Manchester (excluding Tameside & Glossop)
- Blackpool
- Fylde & Wyre
- Morecambe Bay
The NWAS clinical structure is under review. This is along with the flexibility and adaptability of our workforce across emergency and urgent contact centres.
An integration programme between 999 and 111 has begun to dual train non clinical staff to take 999 and 111 calls. This includes review of support and training requirements to become one NWAS. This also includes ability to support patients better. It does this by having the right people, in the right place at the right time.
When people use NHS services their safety is prioritised and they are free from mistakes, mistreatment and abuse.
What this means to The North West Ambulance Service (NWAS) in practice
Patient Transport Service (PTS)
The PTS work with fellow healthcare professionals in the event that staff identify concerns about patient welfare. If appropriate, they raise a safeguarding notification. This is so that further action can be taken where necessary.
Clinical Safety
Staff are able to submit a data report for any patient safety incidents via Datix.
These are reviewed at local level, and if appropriate will be escalated to our Review of Serious Events meeting (ROSE). This is to determine if they meet the serious incident threshold. Learning from incidents takes place in a variety of ways such as:
- learning forums
- through education and training
- changes to procedure or policy
- joint learning with our system partners
Within our clinical areas, there is a clinical leadership framework in place. This is for support and advice. Staff members also have training on vulnerable groups and are able to refer to other services should they need further input.
The 111 service has previously used the NHS Pathways system to respond to calls for care. This year this has been rolled out to our Emergency Operations Centres (EOC). The NHS requires all NHS Pathways’ system-users to undertake prescribed training and pass assessments to a set level. This is before they are allowed to use the system in a live environment. From a monitoring perspective we use the Friends and Family Test (FFT) for information about how patients have found the care provided. We also has a Freedom to Speak Up Guardian to promote staff speaking up about issues.
NWAS 111
The 111 service uses the NHS Pathways clinical decision-making tool. This is to safely assess patients care needs over the telephone. The NHS requires all users of NHS Pathways to undertake national Pathways training. They also have to pass assessments to a set standard before they are licenced and able to use the system.
Calls are regularly audited in line with NHS pathways licencing requirements. This is To ensure the safety of users of the NWAS 111 service. We use a dedicated team of Quality assurance (QA) officers to listen to calls, feedback and provide coaching to our staff either by sitting beside a staff member whilst talking live calls or listening to previous calls.
We train our staff to recognise safeguarding concerns. We have robust practices in place to make referrals via the our support centre. This is to make sure we assess patients who have raised concerns around abuse or mistreatment are and referral processes are in place. This is in case we need the police.
The 111 Clinical Governance Team (CGT) coordinate all patient and health care professional complaints and incidents.
Where possible mistakes have been made, these are investigated and immediately actioned to prevent re-occurrence.
The lessons we have learnt are then shared with the 111-learning forum. This is attended by a cross section or staff, managers, and patient panel members.
- performance
- audit summary
- safeguarding referrals
- complaints and incidents
These are discussed at the 111 Quality Business Group to ensure safety of our patients at all times.
Progress and highlights from 2021 to 2022
Patient Transport Service (PTS)
We identified more managers to undertake Safeguarding training. This is to support staff if any patient safeguarding concerns are raised.
PTS has developed a priorities dashboard. We have aligned this to The Care Quality Commission Key Lines of Enquiry (CQC KLOE). This is to identify the service line priorities in terms of patient and staff safety.
PTS have an Incident Learning Forum which reviews real case studies and informs for safety improvements. Mental health and dementia questions are asked within the eligibility script for every booking. All Dementia patients are allocated to an ambulance only unless travelling with an escort / carer.
Clinical Safety
We give Lessons Learnt/Feedback from incidents either individually via a Team Manager or more widely using:
- Clinical bulletins
- Wall boards
- TV screen messages
We have run Learning Forums across all clinical areas.
We appointed Trust Mental Health staff including Learning Disabilities.
We appointed a dedicated Patient Safety Specialist within the Trust.
We undertook a deep dive of our serious incident data with a review of protected characteristics. This highlighted a need for improved documentation of physical and learning disabilities
We improved access to 111 Mental Health Lead during office hours for complex issues or advice.
- all 111 serious incidents
- incidents
- health professional feedback
- complaints and compliments
supported by the wider NWAS teams.
We provided monthly assurance report to commissioners. We also provided this to monthly Clinical Quality Assurance Groups in all areas relating to 111. Within 111 a Health Advisor assesses all calls. Some calls are either transferred to a clinician if one is available or queued for a clinician call back. We assign a clinical Duty Manager throughout the 24 hour period. This is to risk assess the queue and to manage the higher risk calls appropriately by allocating a clinician to pick them up.
We developed a trust-wide Suicide Prevention Group. We also developed a 3 year programme of work aiming to reduce the number of suicides we are called to.
The North West Ambulance Service (NWAS) 111
The Quality Assurance (QA) officer role has become embedded within the 111 team. We have seen an increase in the number of staff within the team from 28 to 42. This has meant that there has been an increase in the number of audits and support provided. This increases the assurance that the care provided by staff is safe. As well as identification of any themes or trends. This allows for implementation of learning or changes to increase safety.
We have continued completing audits in a variety of different methods. These include side by side, either physically or virtually. This is to make sure staff are receiving real-time feedback to allow for reflection and learning.
Meetings that were set up in 20/21 have become fully embedded as business as usual within 111.
- Quality Business Group
- Incident Learning Forum
- Standard Operating Procedure (SOP) Task and Finish Group
These had good attendance from all staff groups within 111 and patient panel members.
The Introduction of a contact centre Safeguarding Practitioner to support 111 and 999 with safeguarding processes, learning and training has been a welcome addition.
Key stakeholders working alongside our safeguarding teams have developed appropriate training materials and processes. This is for upcoming changes (Project Emerald) to the trust’s safeguarding processes to make sure that they are fit for purpose for 111 staff.
We are able to identify and support individual patients, sometimes with complex needs. This is by working alongside the High Intensity Users team.
We have introduced patient public panel representatives at key meetings such as 111 Learning Forum. This has aided a patients perspective to the developments and improvements we are considering. This makes sure their needs are met.
We established the 111 Development Forum. This allows any staff to raise ideas and suggestions of how we can make improvements in the service line. This is increasing patient safety and also service efficiencies. Working alongside the Emergency Operations Centres as part of the Single Primary Triage project has allowed for shared learning and call levelling of NHS Pathways assessments across 999 and 111
We reduced the amount of handling time typing and confirming a person’s telephone number. We did this by introducing call pop which populates the caller’s number in the system. This decreased human error or inability to recontact a caller.
We introduced of the Directory of Service (DoS) reporting tool. This gives staff the ability to report possible concerns with the referral information for a particular service. This feeds up to the DoS team covering that region. They are then able to liaise with the service in question and support any improvement requirements. Introduction of the Good Sam app technology allows clinicians to use video consultation technology. It does this by sending a link to a caller mobile, enabling the clinician to see the patient. This improves patient reassurance that they have been seen by a healthcare professional. This also reassures them that the assessment is more accurate, further increasing safety.
Barriers, challenges, and difficulties
Patient Transport Service (PTS)
- The ability to report on some elements is very manual to collect the information
Clinical Safety
This year, the increasing delays outside Acute Trusts have impacted patient safety. Harm has been occurring not only outside of Emergency Departments but to patients waiting for a response in the community. There is also a need to improve collation of data in relation to Equality, Diversity and Inclusion (EDI). This is in order for us to identify programmes of work.
North West Ambulance Service (NWAS) 111
Staff attrition continues to present a challenge as waiting time to access the service increases.
We need the Quality Assurance (QA) Officers and operational staff to support with preceptorship of new staff. This is due to increased staff recruitment and training.
- auditing
- staff coaching
- call taking
- advice line support
Despite increasing the Quality Assurance (QA) team there are still vacancies. Despite increasing monthly audits numbers there remains insufficient capacity to deliver 100% audits. We have moved to DatixCloudIQ (DCIQ) from the Trust datix system. This has reduced the ability of the our 111 Corporate Governance team (CGT) and Clinical Duty Team to review or oversee system information in real time. This is as this now goes to a small NWAS Patient Safety Team. This team are not as familiar with NWAS 111 processes and procedures. This has been leading to added touch points and delays in taking action when things go wrong.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Patient Transport Service (PTS)
- Continue to review the PTS priorities dashboard regarding patient safety which is a self-assessment of where the service line is at
- Continue to hold Incident Learning Forums
Clinical Safety
- Improving collation of protected characteristics data within patient safety team
- Introduction of Patient Safety Incident Response Framework as part of NHS Patient Safety Strategy (2019)
- Improved digital systems within safeguarding team
- Ongoing workstreams across Mental Health to include suicide prevention, dementia and learning disabilities
- Public Health Registrars in post to continue work around reducing health inequalities
- Increased patient safety training Recruitment of a Patient Safety Learning Team within the QII Directorate
NWAS 111
We are delivering annual CPR workshops. This is to make sure staff feel confident in the delivery of CPR should they be required to provide this advice.
The Corporate Governance Team (CGT) are working alongside Patient Safety teams. This is around the introduction and access of information to Datix Cloud IQ system. This is to improve patient safety.
We introduced call levelling sessions between 999 and 111 for NHS Pathways audits to ensure shared learning.
Work continued to establish a Contact Centre Governance Group. This is to share processes/learning etc. across the 111 and 999 contact centres.
We continued recruitment to make sure of adequate staffing levels for patient safety.
Screening, vaccination and other health promotion services reach and benefit local communities
What this means to The North West Ambulance Service (NWAS) in practice:
Patient Transport Service (PTS)
NWAS is keen to promote vaccination and screening when possible. PTS are well placed to share information and ‘myth-bust’. This happens when discussing vaccination and other support services with patients. We make use of campaigns, such as the flu campaign, to encourage healthy choices for both staff and patients. Social media is playing an increasing role in supporting this work. We have visible leadership and support for our campaigns. Our senior leaders attend launches and promote the messages as appropriate. Video is also often used as a tool.
Communications
We place patients at the heart of the organisation. We support the delivery of excellent care for our communities. We make sure of the accurate and timely flow of information to the region’s diverse communities. As well as engaging with:
- stakeholders
- partner organisations
- the trust’s own staff.
We endeavour promote vaccination, screening, and public health initiatives when possible. We make use of national NHS campaigns, such as:
- Help us Help You
- Better Health Let’s Do This
- Stay Well this Winter
to encourage healthy choices for both staff and public.
Each year our campaigns are developed to increase awareness and positively influence behaviour. Campaigns provide opportunities to:
- reassure the public
- provide positive health messages
- reinforce facts/”myth-bust”
- profile the trust to build confidence in the services we provide to our stakeholders and the wider public
In 2021/2022 campaigns included:
- NWAS Nurses promotional campaign (linked to NHS 111 services)
- publicity campaign surrounding our BBC Ambulance series
- winter communication campaign to support demand, best use of services and self-help advice
- supporting 111 national messaging
We use targeted public health information bursts with patient, public and community groups to raise awareness of public health support both locally and nationally.
Social media video campaigns continue to support this work. We use these together with use of far reaching channels that engage with all populations such as broadcast TV like the BBC series of Ambulance.
Never has it been more important to understand the needs of patients and their families as well as the communities that we serve.
We deliver both in-house and NHS campaigns, messaging and information via all our communication channels. These are tailored to the needs of our local communities as appropriate.
As pressure has increased on all NHS service we continued to promote how to access alternative health care pathways, for example:
- primary care
- pharmacy
- 111 online.
The trust promoted cultural celebrations and used this opportunity to promote health and safety messages. This made sure all our publication and messages are inclusive and representative of all the communities we serve. We engaged with partner agencies/community groups to share messages to ensure maximum reach.
During 2021/22, we engaged online with several patient and community groups on a range of topics. We talked about the trust’s response during and after the pandemic to reassure communities that they were safe when using Ambulance services.
Another focus for engagement was the importance of using NHS 111 first and talking to groups about the range of options to access that service and the other services that we provide.
- principal speakers
- advisory
- facilitators
Online patient and public community engagement events continued. These looked slightly different to previous years as many of the ‘face to face’ high footfall events were cancelled due to the pandemic. Feedback has demonstrated a general high regard for the ambulance service. In particular people felt they were treated with dignity compassion and respect.
Progress and highlights from 2021 to 2022
Patient Transport Service (PTS)
Highlights and progress included:
- attendance of the Public Health Registrars at PTS Management meetings. This was to raise awareness of their remit and objectives.
- discussions with the Public Health Registrars regarding Social Prescribing group. This was to consider comms for patients via Patient Transport Service (PTS) and information for staff. This was with with simplest possible referral/signposting mechanism. We did this via Community Safety Partnerships (CSPs) or direct to providers via phone call.
- working with Greater Manchester Community Safety Partnership. We also worked with Greater Manchester Fire and Rescue Service. This was around Patient Transport Service (PTS) crews being able to complete a home fire safety risk assessment online.
- involving PTS staff in the Restart a Heart campaign. We supported the delivery of CPR training in the community.
Communications
In 2020/21 feedback from our D/deaf community highlighted the increased barriers to lip-reading communication. This was due to our staff wearing personal protective equipment (PPE). We have procured deaf awareness training for 50 staff members. This has since been expanded. The trust will continue to subtitle any videos that are shown on social media. Our Virtual AGM was signed by a BSL interpreter.
We translated an information booklet on using 999 services and what to expect when accessing services and advice into several languages.
We developed Ramadan 2021 guidance. We develop this annually. It helps support staff to provide the right care for Muslim patients during this fasting period and Islamic holy month. The guide includes information on how clinicians can discuss medical interventions which may break the fast for Muslim patients. The guide shared a reminder that anyone who has COVID-19 does not strictly need to observe Ramadan. This is as daily fasting is not compulsory or advisable for anyone with a medical condition.
Our graphics continue to be accessibly designed and shared on social media. This is ahead of predicted busy dates to reinforce why people should call 999.
We supported a local ‘#Restartaheart’ campaign during October. This was focusing on CPR and automated external defibrillator awareness, providing live online CPR lessons.
We shared mental health information and awareness of support services available in the community. We shared these with our community, patient, public and staff following a rise in cases after the pandemic.
We shared primary care services information with our patient and public stakeholder groups to reassure communities with contacting:
- GP
- dental care
- pharmacy
- optometry
- primary care services during high demand periods.
- of a paramedic overcoming mental health issues
- an EMT who used the pre-employment course which is aimed underrepresented staff groups
- the story of a paramedic with ADHD and Asperger’s
The #WorkWithoutFear national ambulance campaign commenced in January 2022. This remains an ongoing campaign to ensure staff are protected to deliver care safely.
We launched an in-house developed and award winning suicide prevention toolkit.
This was to:
- help, support and educate everyone in the organisation about the risks of suicide within the workplace
- promote good practice
- encourage healthy conversations to remove the stigma often associated with mental health problems and suicide.
We launched a Disability network which is made up of staff from all areas of the trust. This works with the National Ambulance Disability Network to share best practice around supporting staff with disabilities. It also exists to guide the ambulance sector on disability-related issues.
Barriers, challenges, and difficulties
Patient Transport Service (PTS)
Not specified
Communications
Not specified
Work being carried out to meet this overarching objective from April 2022 to March 2023
Patient Transport Service (PTS)
Not specified
Communications
Trust communications and engagement plans for 2022/23 take into consideration a hybrid use of face to face and digital platforms. We use these to relay public health messages and awareness campaigns. We also use there to engage with our communities. We will hold region-based community events and will focus on engaging with the public on their experiences.
Goal 2: Improved patient access and experience
Services are commissioned, procured, designed and delivered to meet the health needs of local communities
What this means to The North West Ambulance Service (NWAS) in practice.
Patient Transport Service (PTS)
Understanding patients’ needs starts with the booking process. We train staff to elicit the necessary information for each patient so that we can respond. The PTS service line provides help to patients with the full spectrum of needs. This is from the initial booking of the service through to journey completion. All patients are taken through the same booking process. We apply an eligibility assessment questionnaire to every booking. To help patients, we produced a pocket sized information leaflet.
In the event that a patient is not eligible for patient transport they are signposted to other community groups. We recognise that vulnerability takes many forms including:
- medical
- physical
- psychological conditions
- communication difficulties›
Paramedic Emergency Services (PES) and Digital
In August 2022, we published a refreshed strategy with the three core aims of:
- providing high quality inclusive care
- being a brilliant place to work for all
- working together to shape a better future.
In order to improve patient access and experience for all our patients we will:
- listen to our patients and respect their different needs to provide compassionate, inclusive care
- work closely with our patients and the wider public, listening to their experiences and feedback to make improvements
- build effective relationships with our communities to understand their needs and make sure our services are accessible for everybody
- make sure we engage with people in an accessible and inclusive way.
The North West Ambulance Service (NWAS) 111
NWAS 111 is a service that conducts primary assessments of patients presenting with urgent care needs. NWAS 111 also provides signposting or onward referral to the appropriate services. Providing access to services for patients is at the forefront of all aspects within 111.
We are able to communicate with patients or their representatives in different formats. While taking the patient demographics we ask an accessible information standard question. The aim of the accessible information standard is to make sure that people who have:
- a disability
- impairment
- sensory loss
get information that they can access and understand. This also means they can get any communication support that they need.
Communications
The trust Executive Leadership Committee has adopted a five year Patient, Public and Community Engagement Framework for 2020/25. This overarches an annual NWAS Patient, Public and Community Engagement Improvement Plan.
- patient
- public
- community interest groups
We only used to meet with them face-to-face. Following the pandemic this has changed to a combination of virtual and face to face engagement.
We elicit feedback on ambulance access initiatives and concerns. We also provide verbal ambulance service updates at these sessions. Other access concern feedback initiatives employed at the trust ensure use of:
- regular information bursts sent to our community groups
- opportunity to feedback on our Talk to Us email inbox and on our trust website Get Involved
- Share Your Experience
- ‘Tell Us How We Did’ Paramedic Emergency Services (PES), Patient Transport Service (PTS), Urgent Care Desk (UCD), and NHS 111 First digital surveys
- Friends and Family Test SMS text messages sent to 1% users of our PES and PTS services
Further support on this is also provided by our Patient and Public Panel (PPP).
Progress and highlights from 2021 to 2022
Patient Transport Service (PTS)
- We continue to use Language Line for non-English speakers in the booking process. We also use Sign Language or Next Generation Text Relay (previously known as Type Talk).
- PTS were involved in a trial of the Language Line App accessible via iPads.
- The Patient Engagement Dashboard is now shared with managers at a monthly L2 meeting.
- Patient Engagement is shared with Third Party suppliers. For example, taxis and private ambulance organisations.
Paramedic Emergency Services (PES) and Digital
- All patients are able to be referred to onward pathways, however they access our service.
- We are able to triage patients who are not registered with a GP or are from out of area and referred onwards if needed.
- Our High Intensity Users team are able to support frequent callers with care plans. We identify more help and ensure any new trends in callers. The team attend multi-disciplinary meetings to make sure of a cohesive approach.
- Clinicians and call takers all have access to Language Line so patients are able to access our services.
NWAS 111
- service Advisors continue to signpost asymptomatic patients to appropriate services
- improvements to 111 Interactive Voice Response (IVR) stream patients. This is including signposting to 111 online in the event of delayed call answering in 111
- introduction of SMS self-care advice
- move to GoodSam app for video consultation by clinicians. This is for improved experience and assessment accuracy.
- continuation of access to primary care appointments for patients requiring them
- continuation of the ability to book arrival times at ED’s as part of 111 first
- introduction of SMS text relay services for those patients that require it.
- improved service with Language Line
- development of Azure remote working kits. These provide a more reliable access to remote staff
- working with 111 Clinical Governance Team and Directory of Service (DoS) teams to make sure services are correctly profiled. Also making sure patients are being directed to appropriate services. This is including listening to healthcare professional’s feedback
- SharePoint posts to educate staff on Directory of Service (DoS) options. This is to increase appropriate selection of services that are presented
- use the information from the Directory of Service (DoS) reporting tool to put in place changes to the DoS
Communications
We attended in a principal speaker, advisor and facilitator, capacity at 84 virtual community patient and public community engagement events.
- Salford Mental Health Forum
- Healthwatch
- Blackpool Learning Disability Group
- Black History Month activities
- Caribbean and African Health Network
- Dementia Café
- Continuity of Care Group (CCG) conferences
Our engagement has looked slightly different to previous years as many of the ‘face to face’ high footfall events that we would usually attend such as freshers’ fairs, disability awareness days and PRIDE were cancelled due to the pandemic.
We maintained a central log to make sure that we capture attendance and feedback. We receive this at online community patient and public community engagement events and we log this for thematic analysis.
At end March 2022 we inducted 213 Patient and Public Panel (PPP) members. Most were already involved in the work of the trust.
We have recruited 44 (22%) PPP members in the younger age bracket (16-24) achieving our 20% target set for the year.
From April 2021 to March 2022, we invited Patient and Public Panel (PPP) members to get involved in 113 opportunities with staff across the trust.
The PPP have been able to get involved in regular high-level meetings such as:
- area learning forums
- learning from deaths
- Q&A sessions with Board members
- Trust Strategy Refresh and Review meetings
- handover improvement sessions
- and a range of PPP personal development events.
94.2% of Patient Transport Service (PTS) and 92.9% of Paramedic Emergency Services (PES) patients stated that they were ‘cared for with dignity, respect, kindness and compassion’.
Trust-wide, we saw 87.8% of responding patients stating that they found their experience of using our services ‘very good’ or ‘good’.
During 2021/22 we fulfilled 37,399 (20,529 in 20/21) language line service requests using 93 (77 in 20/21) different languages across our service lines.
Some examples of access initiatives for our North West Ambulance Service (NWAS) communities include:
- we have procured ReciteMe software to support language and disability access.
- we made a NWAS Faith and Culture Card available with the Directory of Services. This is to support considerations such as end of life patient care when working with different faith groups
- we piloted use of personal protective equipment (PPE) with clear facial screens, to support lipreading when staff are using PPE masks
- we started using of a pictorial handbook with patients having communication difficulties. This includes learning disabilities.
- we introducted a pilot online deaf awareness training programme for staff. The pilot programme trained 125 staff within the trust
- we continue to make sure that our videos or films we produce have subtitles and audio description. This is to support wider access with sensory disabilities
- we have used Microsoft Teams for most of our patient, public and community engagement in 2021/22. Feedback told us that Zoom is much more accessible for those with accessibility needs. As a result of this we have purchased a Zoom licence for use with our North West groups
- we offer SMS messaging to receive Friends and Family Test feedback. SMS is also offered to PTS patients as a booking reminder 3 days prior and on the day of transport
- we used of Language Line and BSL video relay for operational staff PES, NHS 111 and PTS
- we used NHS 111 ‘Co-Sign’ and PES 999 BSL video relay service for deaf patients
- we produced patient stories on how we engaged and what we have learned from our NWAS communities. We did this in relation to BSL translation support, Assistance Dogs Guidance, and Language Line support for operational staff. We produced these and shared them with the Board
- we made sure that advocacy support is available for booking PTS transport, giving feedback or making a complaint
Barriers, challenges, and difficulties
Patient Transport Service (PTS)
Not specified
Paramedic Emergency Services (PES) and Digital
The barriers and challenges we experienced were:
- limited availability of data. This prevents us from understanding the characteristics of the people who use our services
- limited analytical data support and capacity
The North West Ambulance Service (NWAS) 111
The barriers and challenges we experienced were:
- language line interpreter availability remains a challenge for specific languages
- delayed patient call backs from some Our of Hours (OOH) providers referred from 111
- availability of bookable appointments within primary care by 111 Health Advisors. This results in patients waiting for 111 clinician callbacks which delays patient care
- Directory of Services is not owned by NWAS and services report directly to commissioners. There is no on call DoS team to switch services off when a particular service over extends its capacity. This means that 111 can still refer into the service electronically. This then impacts and increases concerns for our patients. The services email NWAS stating long delays and reduced capacity
- it is a manual and time-consuming process supporting patients to navigate the wider health care system or direct them to alternative care
Communications
The trust developed a 2020/25 framework to commit to:
- patient
- public
- community
- engagement
This framework advocates face to face engagement wherever possible. Unfortunately, this approach had been significantly impacted by the Covid-19 pandemic. Patient, Public and Community Engagement Plans during 2020/21 showed alternative channels of engagement. We trialled new approaches with a particular focus on online engagement.
Not all patients, members of the public and community individuals are affiliated with patient or community groups. Many have no access to or are confident enough when engaging with these tools.
There are barriers to online access with:
- confidence of using software for Older persons
- Minority ethnic communities where there are limited opportunities to be part of a community group organisation
- language confidence issues
- D/deaf communities and online communication access
There were wider considerations with social distancing during summer 2021 and public gatherings.
This was a challenge with replicating the positive impact when engaging with our patients, public and communities shown by historical trust attendance at high footfall community events such as:
- Health Melas
- PRIDE
- Windrush
- Disability Awareness Day
Work being carried out to meet this overarching objective from April 2022 to March 2023.
Patient Transport Service (PTS)
Work we are carrying out:
- PTS actively involved in the future design specification
- Patient Transport Service (PTS) actively involved in the Non-emergency Patient Transport Services (NEPTS) National Review
- Patient Transport Service (PTS) actively supporting community events with the Comms team and Patient Engagement Team
- Patient Transport Service (PTS) working with the Widening Access Team at events across the region in order to improve recruitment but at the same time being visible in the community
Paramedic Emergency Services (PES) and Digital
Work we are carrying out:
- The move to NHS pathways enables our call takers to triage patients and for patients to be referred to other service providers.
- We implemented online as well as telephone booking for Patient Transport Service with journey update texts.
- We now have online access to 111, enabling online triage and referral.
- All clinicians now have access to the Directory of Services via NHS Service Finder. This enables them to select from a wide range of onward referral pathways. Plans are in place to make the referral process electronic for Paramedic Emergency Services (PES) staff. This is to bring them inline with our 111 provision.
- Plans are in place to develop dashboards that disaggregate our data more effectively. This will enable us to check that are services are available and utilised by all of the populations we serve.
- We are developing a specialist Autism and Learning Disability plan. This is in collaboration with our service users, their families and other stakeholders. This will outline the actions we can take to ensure this group of patients are able to access our services.
- Electronic Patient Record (EPR) phase 2 is in progress. This will include access to patient records and the ability to make referrals to services in the Directory of Services (DoS) from on scene.
NWAS 111
Work we are carrying out:
- We continue to trial Azure remote working kits with a view to rolling out across all remote workers. Work is ongoing around using sign language interpreters to wider access to patients.
Communications
An annual Patient Public and Community Engagement Implementation Plan 2022/23 supports delivery of this goal. We have developed a draft 2022/23 plan and assume a hybrid engagement impact with face to face and online engagement activities.
Focus areas for the plan in the year ahead
We will focus on continued growth of our Panel membership to include greater numbers of young people (16-24). We also want more representation from our ethnic minority community. Part of this work includes the launch of a new young persons’ ‘Ambulance Academy’ on our website. We developed this in conjunction with existing Panel youth members as well as other youth groups in the community.
We have continued engagement with our North West patient, public and community groups. This is via five specific North West Ambulance Service (NWAS) ‘Back to Basics’ face to face community engagement events. There will be one in each North West area, which will provide reassurance with the safety and availability of ambulance services in our communities post-pandemic.
We provide weekly Patient and Public Panel (PPP) round up Newsletter. Regular info-burst messaging for our North West Ambulance (NWAS) community contacts database. We will combine this with the provision of information that may help benefit their health and wellbeing.
We are doing an ongoing contractual review of our Language Line services. This makes sure of monthly governance meetings with principal leads at the trust. This is for the leads responsible for this area of patient access to trust services.
We have continued use of digital patient experience channels. This is to assure best practice support with obtaining patient survey and SMS Friends and Family Test (FFT) feedback.
We will review of the trust ‘Faith and Culture Card’ in conjunction with the Patient and Public Panel (PPP). This is to support discussions around Ambulance end of life patient care. This is also to support cultural considerations when working with different faith groups.
There is ongoing work on a new pictorial communication handbook which will be co-produced by various groups. This includes: the Patient and Public Panel (PPP), learning disability, deaf and ethnic minority patient and community groups. This is to be more representative of the communities that we serve.
There has been development of patient engagement learning dashboards. These will support the wider circulation and use of patient feedback as a learning opportunity within the trust.
We will share both quantitative and qualitative themed analysis. This is as well as levels of patient satisfaction, Friends and Family Test (FFT) performance and dignity and respect data. We will share this with with operational staff at the trust.
People are informed and supported to be as involved as they wish to be in decisions about their care.
What this means to The North West Ambulance Service (NWAS) in practice
Patient Transport Service (PTS)
PTS have regular contact with renal patients travelling several times each week. This is an opportunity for discussions to take place with regard to the needs of these patients. This is also an opportunity for the PTS staff to actively seek feedback in terms of what the patients’ needs are. This is often related to mobility and accessibility. Through this discussion, the crews can feedback to the despatch teams to ensure that we send the most appropriate transport to patients. This in turn enhances safety for patients and gives them a better experience.
Paramedic Emergency Services (PES) and Digital
- providing high quality inclusive care
- being a brilliant place to work for all
- working together to shape a better future.
In order to improve patient access and experience for all our patients:
- Listening to our patients and respect their different needs to provide compassionate, inclusive care.
- Working closely with our patients and the wider public, listening to their experiences and feedback to make improvements.
- Building effective relationships with our communities to understand their needs and make sure our services are accessible for everybody. We will make sure we engage with people in an accessible and inclusive way
North West Ambulance Service (NWAS) 111
We have embedded person-centred care in our strategy. This is something that we in 111 encourage all staff to consider when assessing patients. Staff are encouraged to listen to patients wishes and to ensure that they inform them around the management of their care episode.
Progress and highlights from 2021 to 2022
Patient Transport Service (PTS)
PTS have regular contact with renal patients travelling several times each week. This is an opportunity for discussions to take place with regard to the needs of these patients. This is also an opportunity for the PTS staff to actively seek feedback in terms of what the patients’ needs are. This is often related to mobility and accessibility. Through this discussion, the crews can feedback to the despatch teams to ensure that we send the most appropriate transport to patients. This in turn enhances safety for patients and gives them a better experience.
Paramedic Emergency Services (PES) and Digital
We train all clinicians in making decisions around capacity of patients. All clinicians are able to support patients to make decisions about their care.
Mental Health specialist clinicians are available in 111 and 999. This is to allow clinicians to get advice to support patients in making decisions about their care.
The North West Ambulance Service (NWAS) 111
Assessments are undertaken with the patient directly where possible. Or we make sure that the caller is with the patient. This makes sure the patient is involved and aware of the outcome and options following assessment.
SMS messaging has been introduced to provide care advice following an assessment.
We are working with our digital teams to develop live information sharing within our service lines. They are also developing access to real time patient records.
We are improving access to clinical support where patients don’t feel their outcome is appropriate. This is to make sure that patients views are considered and understood at all points during their contact with us.
Barriers, challenges, and difficulties
Patient Transport Service (PTS)
Not specified
Paramedic Emergency Services (PES) and Digital
Not specified
The North West Ambulance Service (NWAS) 111
- Insufficient funding and difficulties recruiting clinical staff results in low clinician staffing.
- Low clinical levels lead to delays in patients and their families getting clinical assessments or clinical advice. These calls are consistently outside of the 10 min call back target.
- Often the service(s) the patient would like to attend do not have available appointments available. The next appropriate service commissioned for the care need could also be further distance away than the patient would like.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Patient Transport Service (PTS)
We are continuing to work with the Patient Engagement Team and attend Patient and Public Panel meetings. This is to encourage feedback from the community that use the service. This is also to improve access as appropriate.
Paramedic Emergency Services (PES) and Digital
We are developing a specialist Autism and Learning Disability plan in collaboration with our service users, their families and other stakeholders. This will outline the actions we can take to ensure this group of patients are supported to make decisions about their care.
We are developing end of life care expertise. This is allowing our clinicians to make sure the wishes of end of life care patients are foremost in decisions regarding their care.
We have planned work to deliver joint responses with Mental Health Providers. This is for Mental Health patients in the Emergency Operations Centre (EOC). This is also being done through joint response vehicles.
NWAS 111
We continue to expand the SMS care advice work. This will be by introducing text messaging to say a clinician has tried to call you from 111. This is to increase contact rates.
We are exploring ways in which 111 can use the SMS technology. This is to replace comfort or welfare telephone calls when patients are waiting for a clinical call back. These calls can advise they are in the queue and if anything changes then get back in touch. This is to reduce the number of calls back into the service asking about where the call back is up to.
We are introducing of as the road travels rather than as the crow flies distances. This so that service returning on the Directory of service are more suitable and sometimes less distance for patients. This is especially true for services in Ellesmere port or Wirral for example, where a body of water sits in the middle
People report positive experiences of the NHS
What this means to NWAS in practice
Communications
Targeted patient engagement interventions with protected characteristic patient, public and communities where we use inclusive methods to get patient experience feedback with trust services. This is including in real time.
Progress and highlights from 2021 to 2022
Communications
Progress and highlights included:
Successful delivery of a trust patient experience programme in 2021/22. This was as identified in the PE Annual Report 2021/22.
Data capture and availability which shows a range of methods used to engage different protected characteristics. This is to get positive feedback from our patients, public and communities. 23,284 patients have provided us with feedback on our patient engagement surveys.
The successful establishment of a diverse Patient and Public Panel (PPP). 213 panel members already inducted. This gives patients/the public from all communities a voice in sharing good practice. This also gives them the chance to have their views acted upon by the trust.
PE team attendance at 84 online ‘face to face’ patient, public and community engagement events. This is with our diverse communities from across the North West region.
Availability of both quantitative and qualitative survey feedback information and data. For example high levels of Friends and Family Test (FFT), patient satisfaction and dignity and respect data. 86.9% (- 4% from 20.21) of PES patients felt their overall experience of the service was either good or very good. 92.90% (+4% from 20.21) stated that they were ‘cared for with dignity, respect, kindness and compassion’.
92.7% of NHS 111 First patients and 88.5% of PTS patients also felt their experience of the service was either good or very good. 94.2% (+ 6.7% from 20.21) of PTS patients stated that they were ‘cared for with dignity, respect, kindness and compassion’.
Protected characteristics demographic data capture. We do this with Patient and Public Panel (PPP) membership. We capture survey respondents. We also capture attendance at online ‘face to face’ patient, public and community engagement events.
Learning and service improvement activities undertaken or in train resulting from patient engagement feedback.
Barriers, challenges, and difficulties
Communications
We stopped sending out postal surveys to patients. We also stopped asking patients to complete patient experience surveys online. This was following the COVID-19 pandemic and on the back of national and local guidance. This has provided fewer returns than what we were used to receiving.
There has been a lack of face to face interaction e.g. with Patient and Public Panel (PPP) taster events and inductions. This is where we could physically meet and connect with our prospective PPP volunteers. Those that were digitally excluded were also showing an interest.
We have been unable to attend community engagement events due to restrictions with safe distancing. This limited our ability to meet as many young persons as we would historically. This also included individuals from communities that were digitally excluded such as deaf and ethnic minority communities. This was at events such as health melas, Disability Awareness Day, LGBT PRIDE, family health days etc.
There were challenges and barriers to obtaining perceptions of working in Ambulance services. This was with ethnic minority and underrepresented groups at careers/recruitment fairs. This was due to the national guidance on safe distancing at community events in this period.
There were gaps in engagement due to collective anxieties with meeting in large groups. Also a range of other restrictions. For example funding with patient groups not meeting. This includes communities such as D/deaf communities and ethnic minority communities.
Good practice examples of patient feedback may not always lend themselves to trust learning.
Process restrictions were a challenge, for example 2 hr pick up times. This included Patient transport Service (PTS) safe distancing in vehicles. This also included non availability of appointments/outpatients in hospitals.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Communications
The Patient Public and Community Engagement Implementation Plan 2022/23 supports delivery of this goal. We have developed a 2022/23 plan and assume a hybrid approach with engagement using both face to face and virtual activities.
Focus areas for the plan in the year ahead includes:
Engagement with our North West patient, public and community groups. This is using best practice digital and online tools as well as face to face where practicable. Continued use of digital patient experience channels. This is to ensure best practice support with obtaining patient survey and SMS Friends and Family Test (FFT) feedback.
Continued growth of our Panel membership. This is to include greater numbers of young people (16-24) as well as more representation from our ethnic minority community. Part of this work includes the launch of a new young persons ‘Ambulance Academy’ on our website. We developed this in conjunction with existing Panel youth members as well as other youth groups in the community.
Continued engagement with our North West patient, public and community groups. This is via 5 ‘Back to Basics’ face to face community engagement events. There will be one in each North West county area. This will provide opportunities for attendees to share positive feedback and experiences with our services. Attendees will share this with patient engagement team members.
Development of a patient engagement learning dashboards. These will support the circulation and use of patient feedback as a learning opportunity.
We will share quantitative and qualitative themed analysis as well as levels of patient satisfaction, Friends and Family Test (FFT) performance and dignity and respect data with operational staff at the trust.
People’s complaints about services are handled respectfully and efficiently
What this means to NWAS in practice:
Patient Safety
Acknowledging all people’s complaints within 5 working days. Setting a personalised communications plan with the complainant to communicate updates with them about the investigation into their complaint. This happens at a time appropriate to them, via a communication platform most appropriate for them. Where necessary this uses the most appropriate language through translation services as necessary.
We are providing a fair service and making sure that all communication needs are met and documented.
Progress and highlights from 2021 to 2022
Patient Safety
During the reporting period, the Trust received 2,180 complaints. This equated to 182 complaints per month. We score complaints according to the severity of the issue from 1 (least serious) to 5 (significant harm or death). All complaints which are scored 4-5 are reviewed at the Review of Serious Events meeting.
Complaints can be made by various routes including by telephone, online or by letter. Of the 2,180 complaints 59% were raised online via our website, 39% were raised by telephone and just 1% were raised via letter.
The following table details the number if complaints received by their risk score and by quarter:
Complaints received | Q1 | Q2 | Q3 | Q4 | Total |
---|---|---|---|---|---|
Level 1 and 2 (less serious) | 421 | 469 | 399 | 346 | 1,635 |
Level 3 (moderate) | 88 | 156 | 107 | 76 | 427 |
Level 4 and 5 (serious) | 26 | 26 | 33 | 33 | 118 |
The Complaints Administration team will now capture data relating to ethnicity of complainants and patients. With is particularly with the move from Datix Web to Datix Cloud IQ (DCIQ). This data is captured at data entry level. The data is not readily available to investigators when the case is allocated to them. This is to reduce any risk of bias.
Investigators will capture data related to any protected characteristics to help identify health inequalities and inform reporting. This includes capturing preferred pronouns where applicable.
This is to make sure that we write response letters correctly. The Trust’s Investigation & Case Assessment proforma has a section for capturing demographic data. These sections are collapsible and lockable from view when the document is shared.
The team continue to use the support of Language Line to have conversations with complaints over the telephone. They use interpreters to support face to face visits. They have also commissioned several response letters to be translated into a first language for a complainant. They have also increased font text size for a complainant with visual impairments.
Barriers, challenges, and difficulties
Patient Safety
Capturing protected characteristic information from people who are making complaints can cause conflict. They are suspicious of why they are being asked for that information. The team are working with the Trust’s ICT team to identify a secure online solution for online complaints. This is to capture EDI information by entering it straight into the Datix Cloud IQ (DCIQ) system. This negates the administrators having to have those conversations.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Patient Safety
We will be:
- improving Investigation Quality assurance with the implementation of an Investigation Audit tool
- monitoring compliance with data capturing of ethnicity details of complainants and patients
- triangulating learning data with data captured regarding protected characteristics or disability. This is to identify themes and trends with health inequalities within our communities
- implementing the national Patient Safety Incident Response Framework. This is to further centralise all high-level investigations as collaborative investigations. This is part of putting the patient and/or their families at the centre of everything we do
- creating the Patient Advice and Liason Service (PALS) Service. This is to manage all enquiries into the Trust by a centralised team. This is to improve parity of service and improve access for all service users. All enquiries into the Trust are now coming into one centralised team. These enquiries are being cascaded through the Trust from them. This is as opposed individuals being expected to identify the correct team themselves. The complaints team are keen to identify the quality of complaint handling. They have engaged with our Patient Engagement team to identify a method of capturing satisfaction feedback. We take this from complainants after they have received a complaint response.
Goal 3: A representative and supported workforce
Fair NHS recruitment and selection processes lead to a more representative workforce at all levels
What this means to The North West Ambulance Service (NWAS) in practice
HR Hub
We aspire to be a model employer by attracting the best candidates from all sections of society. When we do this we are creating a workforce which reflects our local community.
We attend events and engagement opportunities. This is to get to know our communities and also our workforce. We pay special attention to groups and communities that are underrepresented in our workplace. We are currently underrepresented by staff with disabilities and from minority ethnic backgrounds.
We have recently had approval from trust Board that we aim to recruit up to 20% of people from minority ethnic backgrounds. This is for the Trust to have a true representation of the diverse communities throughout the North West.
Our policies and procedures are regularly reviewed. This is to make sure that the most efficient and effective recruitment and selection methods are used for each role. We aim to support and encourage job applications from a wide range of backgrounds.
This includes:
- reasonable adjustments for applicants with a disability
- recruitment materials available in alternative formats
- adverts including a statement that we will not tolerate discrimination of any kind
Equality and diversity data is not shared with Recruiting Managers during the recruitment cycle. We target our observations and placement opportunities at a variety of groups to improve their chances of obtaining employment. We take the initiative to promote opportunities to people from diverse backgrounds, engaging with:
- job centres
- recruitment fairs
- universities
- schools
- community groups
- across the region.
Widening participation
We continued to attend many career events across the region. This was to provide essential information advice and guidance to young people. We talked to them about NHS careers and next steps towards their aspiration. This is all vital to engage our future workforce that is representative of the people we serve. Even during the Pandemic we have maintained our presence both in a online realm and face-to-face to ensure that we target harder to reach young people. Over 58 schools/colleges/alternative provisions have benefited from this activity.
- The Department of Work and Pensions (DWP)
- Ingeus
- RESTART
- Growth Company
- Lancs Skills and Employment Hub
- Employability Solutions Liverpool
- Ways to work
- Military organisations
and many more, to bring our roles to the masses. We have enabled these organisations and their clients to look at us as an employer of choice, seeing the variety of roles and support available to progress towards careers here.
This has taken shape in the form of:
- jobs fairs
- referral for 1:1 support
- careers information advice and guidance
- access to pre-employment opportunities.
We gave 1:1 in-depth support to 40 individuals on multiple occasions.
We deliver a pre-employment program to help with the recruitment to Patient Transport Service (PTS) roles. Targeted work within the local communities has been undertaken to promote these opportunities.
We seek feedback from candidates to evaluable and continuously improve our programmes. Four successful programs have completed within this reporting time frame. The individuals involved have now successfully transitioned into employment.
We continue to pledge to the Step into Health. We provided dedicated people for military personnel to talk to about opportunities within our organisation. These are for applicants who are either transitioning or veterans.
- provide more information on our careers
- access to information sessions
- give application guidance
- answer questions on the wider NHS
We have received a total of 76 referrals via this candidate referral system within this reporting timeframe.
Positive Action
Candidate attraction
We aspire to be an employer of choice in attracting candidates from all sections of society. We aim to develop a workforce representative of local communities. The Positive Action team has continued to attend events across the North West.
Departments of Work and Pensions (DWP)
- housing associations, local authorities
- military organisations
- employability organisations
- as well as delivering bespoke Positive Action initiatives.
For example, information with regards careers to:
- the Jewish community in Greater Manchester
- the Muslim community (events at mosques and Islamic centres)
- diverse communities in Liverpool.
We offer information, advice, and guidance alongside one to one support throughout the recruitment process. We also offer bespoke community engagement to promote careers to diverse applicants. We review our recruitment pages to make sure they are inclusive. For example, use of positive action imagery. We invite all staff network members to support events.
Adverts and applications
We regularly review our policies and procedures. This is to make sure that we use the most effective recruitment and selection methods for each role. We aim to support and encourage job applications from a wide range of backgrounds.
This includes:
- reasonable adjustments for applicants with a disability
- recruitment materials available in alternative formats
- adverts including a statement that we will not tolerate discrimination of any kind.
Job descriptions are reviewed to ensure they are inclusive. Trained staff assess new roles via a rigorous job evaluation process. We have added “Recite Me” web accessibility and language toolbar to our website. This to make it accessible and inclusive for as many people as possible, for example people with:
- dyslexia
- sight loss
- English as a second language.
Shortlisting and assessment
We have embedded inclusivity across the shortlisting and assessment processes including:
- implementation of diverse interview panels
- interview questions based on equality, diversity and inclusion.
We do not share equality and diversity data with Recruiting Managers during the recruitment cycle.
We invite all members of staff networks to train in recruitment and selection. Members attend to be representative on interview panels.
Developing workforce understanding
We have reviewed the Recruitment and Selection Masterclass. We are also delivering training in the recruitment process to recruiting managers/staff members.
Progress and highlights from 2021 to 2022
HR Hub
- reintroduction of the recruitment and selection masterclass. This was rewritten by the HR Hub team, the Learning and Occupational Development (L&OD) team, and the Inclusion team. The class is constantly under review with updated processes.
- appointment of staff into the Inclusion and Widening Access teams. Including Positive Action Officer and Widening Access Coordinators
- expanded apprenticeship/job opportunities and Positive Action recruitment
- recruitment tracking for applications from minority ethnic groups.
- monitoring Equality and Diversity (E&D) information throughout the recruitment process.
- highlighting applications that may need further support from unrepresented groups
- adverts include Equality and Diversity (E&D) statement. We have amended this to read at the top of our adverts instead of the bottom to promote inclusivity
- application guidance document attached to all adverts. This is to explain how to apply and what the Trust are looking for in an application
- pre-employment programme provides support to perspective applicants provided by the benefits agency. This offers help applying for the roles of Emergency Medical Advisor roles (999 call taker) and Ambulance Care Assistant
- providing support to those from Armed Forces. We shortlist applications from Armed Forces applicants and their families that meet the minimum criteria
- trust promotion via the BBC programme Ambulance
- rebranding from the Communications team
- promoting mixed interview panels. We promote the training of train staff on the disability and race forums to sit on interview panels
- first batch of international recruitment for the Trust
- we devised a task and finish group to discuss and implement a clear process for career progression
- training provided to management to ensure we complete a fair and equitable shortlisting
- discussions with Higher Education Institutions on initiatives to increase diversity on university courses
Widening participation
- We have four pre-employment programs allowing unemployed individuals to start careers with us.
- The team were asked to assist in the development of the National WEX Quality standard. Team members have been asked to become quality assurers for this national benchmark. Two new members of staff have joined the team to progress this essential work.
Positive Action
- We attended 47 positive action targeted events.
- There are 87 individuals receiving information, advice and guidance.
- There are 34 individuals receiving one to one support.
Positive Action delivered some campaigns focusing on the emergency medical technician role comprising:
- face to face events
- virtual live chats
- online connect sessions
- development of promotional materials using representative images.
We disseminated these to voluntary, community and faith organisations.
We worked collaboratively with the communications team, allowing wider reach using positive action:
- videos
- case studies
- focal posts
- advertising campaigns
The Communications Team made sure recruitment pages on the website were inclusive. This is including positive action imagery and using positive action videos.
We developed promotional materials with representative imagery. These were focusing on raising awareness of non-clinical/support roles.
We delivered an updated Recruitment and Selection masterclass.
Barriers, challenges, and difficulties
HR Hub
- The current recruitment climate is that it’s an applicants job market. There is one applicant per eight vacancies. Our salaries are competing with the private sector.
- New roles in the wider health economy are impacting on turnover rates for clinical staff. We envisage that this will escalate with the GP contract reform and increase the risks.
- We cover the widest geographical area of the eight ambulance services. This adds the challenge of engaging with diverse communities in the remote areas such as North Cumbria.
- Promoting job opportunities to increase diversity in less populated areas remains particularly difficult.
- There is a lack of diversity in those joining us straight from a Higher Education Institute (HEI).
Widening participation
The mass increase of requests into the team to attend careers/job fairs has been a challenge. The launch of the ambassador scheme will assist with this. The demand for pre-employment programs has increased. It is challenging to ensure that the team at its current levels can meet the workforce need.
Positive Action
- We have challenges with capacity. There is one Positive Action Officer covering the whole of the north west. They are the only person raising awareness of us as an employer of choice to diverse communities. The appointment of a second Positive Action Officer will support this.
- Lockdown restrictions affected engagement with communities to raise awareness of roles.
Work being carried out to meet this overarching objective from April 2022 to March 2023
HR Hub
We will:
- review and improve recruitment processes to ensure we are attracting the right candidates
- contribute on behalf of the Trust to an end to end recruitment workshop
- make improvements of on-boarding, enhancing the experience for new staff on joining the Trust
- improve the use of ESR applicant dashboard
- continued delivery of revised programme of Masterclasses in Recruitment & Selection
Widening participation
The pre-employment program model works in line with workforce planning and need. We are using this to support the Emergency Operations Centre (EOC) recruitment and 111 recruitment campaigns. The team are assisting in a recruitment gap within the Patient Transport Service (PTS) control roles. We will also continue to support the PTS Amublance Care Assistant Recruitment via pre-employment.
- We continued work with agencies about roles/careers and information advice and guidance.
- We worked on projects with NHS trusts. This was to provide access to jobs and give information advice and guidance.
- We worked with the SCORE project and Everton in the community.
- We will be launching St John Cadet collaborative scheme in the New year.
The Widening Access team have created an NWAS ambassador scheme to support this work. We have invited the Positive Action Team, Paramedic Emergency Services (PES) recruitment’s lead and practice education team to collaborate on this.
The Widening Access Team are working on projects with Project Search to support young adults with a Specific Learning Difficulty. There will be one with West Lancs Community College.
- all the regions career hub leads
- Health Education England (HEE)
- national leads
to continue joined-up working and sharing of best practices.
the North West Ambulance Service (NWAS) CADETS will relaunch in the New year. There was a meeting with all the further education colleges as part of the first planning stage. This will see our level 3 learners returning into our practice environment. They are getting industry experience to achieve their future career aspirations. This is future-proofing the talent pipeline.
- Colleges/schools and alternative providers
- Insight Days – internal & external
- Careers Fairs – eg Careers Transition Partnership (CTP), British Forces Resettlement Services (BFRS)
- Live Chats
- Department of Work and Pensions (DWP)
- Ingeus
- Restart
- MS Teams Connect Sessions
- Collaboration with other NHS trusts
- Step Into Health referrals platform
- Referrals from supporting organisations
- Drop-in events eg Veterans UK and Seetec
- Future workforce – Military Cadets/healthcare cadets
- One to one support
- Seetec
- Growth Company
- Ingeus
- Department of Work and Pensions (DWP)
- RESTART
- St Johns
- Price Trust
- Project Search
- Partnerships with local barracks
- NHS Employers – Step into Health
- Career Transition Partnership
- NW Reserve Forces & Cadets Association
- Forces Families Jobs
- College of Military Veterans
- Collaborative working and joint events
- NHS trusts
- Careers Hubs across region
- The Pledge
- and many more.
Positive Action
Appointment of second Positive Action Officer to support attraction from diverse communities.
For example supporting with diversity work in local communities, promoting careers and opportunities and working with disadvantaged and underrepresented groups enabling both Positive Action Officers to work together across specified areas.
This will also enable a:
- wider reach with regards community engagement
- wider one to one/Information Advice and Guidance (IAG) support to potential applicants.
Targeted recruitment campaigns to support:
- Emergency Operations Centre (EOC) recruitment
- Patient Transport Service (PTS) Bureau recruitment
- Emergency Medical Technician (EMT) apprenticeships
across the North West and develop relationships with managers to allow collaborative support for Positive Action events.
We are embedding the Positive Action applicant tracking system. We are doing this across all high applicant number recruitment campaigns.
For example:
- Emergency Medical Technician (EMT) apprenticeship
- Ambulance Care Assistant
- Patient Transport Service (PTS) roles
- Emergency Operations Centre (EOC) emergency medical advisor roles
We offer further support positive action targeted campaigns, using positive action. This includes development of promotional materials.
- imagery
- leaflets
- videos
- information
- advice
- guidance
with regards preparing applications, focusing on the supporting information. Ongoing review of recruitment and selection processes.
The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations
What this means to NWAS in practice
Workforce
Having accurate and meaningful data allows the trust to look at where work needs to continue. This is to reduce inequalities and look at areas where positive action has been taken. This will improve representation of staff from diverse backgrounds for example:
- gender
- ethnicity
- disability.
Having accurate data informs us of the work we are doing and allows us to report to places such as the Gender Pay Gap reporting service.
Progress and highlights from 2020 to 2021
Workforce
We are continuing to monitor the disparity ratio. This is in line with the national guidelines for the protected characteristics of staff.
There is an internal process to share the analysis on equality and diversity details. We send this to Equality and Diversity (E&D) team to address any challenges.
We publish Annual Monitoring reports. These identify the E&D trends and patterns for the existing staff.
We identify equality and diversity rates at recruitment stages. It gets published in various internal and external reports like:
- Workforce Race Equality Standard (WRES)
- Workplace Diversity Equality Standard (WDES)
- Annual report
- and others.
We included equality and diversity figures at the sector level. We shared these with operational managers via quarterly wellbeing dashboards.
- retention
- attrition
- analysis and strategies
We keep analysis of equality and diversity information in the internal dashboard system. This is to identify the historical patterns and trends.
Barriers, challenges, and difficulties
Workforce
Bespoke requests for data can take time. The Workforce MI team deals with requests from all over the trust.
Work being carried out to meet this overarching objective from April 2021 to March 2022
Workforce
We are continuing to adapt to changes in reporting.
For example, there were inconsistent Gender Pay Gap reporting bonus calculations across the Ambulance sector.
Our Equality, Diversity and Inclusion (ED&I) advisor raised this with Association of Ambulance Chief Executives (AACE).
The AACE provided us with with unified guidance on how to calculate this. We have completed this for this year’s submission.
Training and development opportunities are taken up and positively evaluated by all staff
What this means to The North West Ambulance Service (NWAS) in practice
Training educators
We deliver a apprenticeship programme for Emergency Medical Technician 1 (EMT1).
The EMT1 programme includes Driver Training qualifications. We have developed assessment frameworks to support these learners. We do this in practice following their classroom education.
We also deliver induction courses for all paramedics who join the trust. This makes sure that all paramedics understand our policies and procedures.
This induction course helps align standards for staff who have joined from elsewhere. It includes clinical pathways, HR policies, values, and behaviours.
We have a training programme for staff joining the Patient Transport Service (PTS). This programme covers areas such as patient care, moving and handling and driving. It also defines NWAS policies and procedures. There is a developmental pathway from PTS to Emergency Medical Technician 1 and through to Paramedic.
We have induction courses for all our Emergency Medical Advisors (EMA) and EMA Support staff.
- computer and triage systems
- call handling techniques
- Trust policies and procedures
We review mandatory training annually. This aligns with the UK Core Skills Training Framework and our recognised needs. We receive feedback for mandatory training via evaluation forms. The learner completes these at the end of the course.
Emails of thanks are often received into the team. These are thanking the Clinical Practice Trainer for the excellent teaching.
We seek feedback from staff across all programmes accessed. This is to assess and continuously improve our programmes. We get feedback online via Microsoft Forms. We provide learners with feedback on what we are doing to improve.
Staff can respond with thoughts or questions about training. Comments of improvements are always welcome.
We evaluate the Learning & Development (L&D) team workshops online via Survey Monkey. We circulate this to participants within the week following their attendance.
We summarise the feedback from these evaluations. This informs developments to the workshop content and delivery.
There are a range of ad hoc opportunities both in person and online available to staff. These are well received.
These include Continued Professional Development (CPD) events ran by Clinical Leaders. Staff attend a lot of these CPD events in their own time. These are usually full, if not over-subscribed, leading to us arranging further events.
Health Education England support CPD for post-registration clinicians. They offer a range of formal modules, both at Level 6 and Level 7.
Learning and Occupational Development (L&OD)
We are continuing our mission to be the best ambulance service nationally. We are committed to being a learning organisation. The trust values drive every member of staff to be at our best and to make a difference. Every member of staff is responsible for their own personal development plans. This is in service of continued growth and improvement. We do this to drive the right care, at the right time in the right way for the diverse communities of the North West.
Widening participation
Apprenticeship opportunities in The North West Ambulance Service (NWAS) continue to grow and diversify.
- 87 Paramedic Degree Apprentices
- 10 Advanced Clinical Practice Apprentices
- 2 Data Technician Apprenticeships
- 1 Associate Project Manager Apprenticeship
- 2 Assistant Accountant Apprenticeships
- 2 Motor Vehicle Service and Maintenance Technician Apprenticeships
- 2 Accountancy or Taxation Professional Apprenticeships
- 2 Digital and Technology Solutions Specialist Apprenticeships
- 3 Business Administrator Apprenticeships
A total of 110 starts.
Gender split:
- 45% female
- 55 % male
Ethnicity:
- 8.2% minority ethnic
- 91.8% white British
Disability:
- 6.3% declared disability
Internally delivered Apprenticeship starts
131 Emergency Medical Technician Apprentices.
Gender split:
- 61% female
- 39% male
Ethnicity:
- 3% minority ethnic
- 97% white British
Disability:
- 11% declared disability
Maths and English qualification provision
We have referred 92 members of staff to get their Maths and English qualifications. This is to enable them to progress either towards a development pathway.
We have supported 243 Emergency Medical Technicians to access the Associate Ambulance Practitioner level 4 qualification. This is to enable them to progress towards the Paramedic Degree Apprenticeship opportunity.
Total = 243
Gender Split:
- 37% female
- 63% male
Ethnicity:
- 5.3% minority ethnic
- 94.7% white British
Disability:
- 11% declared disability
Progress and highlights from 2021 to 2022
Training educators
We continue to support Educators to achieve their:
- Level 4 Certificate in Education & Training
- Level 3 Certificate in Vocational Assessment
and through continuing professional development events and updates. Also, Driving Instructors undertake a Level 4 Driving Instructor training course.
We supported a change to the Emergency Operations Centre (EOC) triage system. We retrained all Emergency Medical Advisor (EMA) staff in the new system. We are supporting their ongoing learning as we implement the new triage system.
The EOC Education Team supported an increase the number of call handling staff. The EOC delivered 26 Emergency Medical Advisor (EMA) courses. This supported the ongoing efforts of the pandemics. This also aided pressures over the winter period.
We introduced modular approaches to the Emergency Medical Technician 1 apprenticeship programme. The programme retained its 14 week guided learning time but placed learners into practice sooner. Progressive support for learning built upon their experiences in the role.
the 2021 Apprenticeship Regional Awards awarded us ‘Macro Employer of the Year’.
Our clinicians partnered with around 150 military personnel on the road in January 2022. This allowed us to efficiently use our resources and support the NHS system. The Education Teams spent two weeks delivering a three day course to enable us to deploy them across all areas of the Trust.
We funded 569 post-registration modules in 2021/22. We continue to explore the use of technology-enabled learning through:
- the use of technology
- online learning
- remote delivery of sessions.
Learning and Occupational Development (L&OD)
Learning & Development has returned close to pre-pandemic levels. Over the past 2-3 years, we minimised face to face learning and development opportunities. This was to support social distancing and infection prevention control protocols.
- leadership
- morale
- mental health
we have developed learning opportunities for NWAS leaders.
We are developing our leadership coaching. This is to equip them with skills to have difficult conversations and lead with a different style.
We are relaunching the Chartered Management Institute Level 5 Award in Management Coaching and Mentoring. After learners complete the programme they will become our organisational coaches.
We are reviewing our Leadership Circles offer to meet staff need and delivering themes 1, 3, 4 and 9 on:
- looking after self
- setting the emotional tone
- being inclusive in the way you lead
- looking out for your team.
We have launching our Civility Saves Lives workshop which draws on the principles of:
- Dignity at Work
- Duty of Candour
- Freedom to Speak Up
- Just Culture
- Treat Me Right
- Equality, Diversity and Inclusion
- NWAS Values
- Be Think Do
to shine a light on the importance of civility. This is to increase our ability to provide the right care, at the right time, in the right place; every time.
We launched the revamped Making a Difference programme modules 1, 2 and 5. Module 1, ‘leadership of self’, focuses on:
- leadership and management differences
- understanding the ask of valued-based leadership
- developing the skills to self-regulate for emotional intelligence demanded of effective leadership.
Module 2 helps staff to understand:
- how teams are formed, operate and function
- apply situational leadership approaches to build highly motivated and engaged teams
- understand inequalities and the impact on teams.
Module 5 focuses on our Be Think Do leadership philosophy. This module looks at developing our level of cultural competence. This involves recognising difference and understanding the value to staff and patient experience.
Widening participation
Continued support for staff progressing to Paramedic degree. This has provided an internal progression route for our Emergency Medical Technician (EMT) workforce.
Barriers, challenges, and difficulties
Training educators
Its continues to be a challenge to source venues. The Trust on-site premises are not always available. We have agreed short-term temporary venues in three areas of the region. This is to support the consistency of delivery for core induction courses.
Challenges continue regarding cover and support for learners in practice education. This is due to the amount of learners that we now have. We are looking to increase the size of our teams to support this
We have placed more emphasis on the importance of mandatory training completion. This has led to a rise in course population, though this could still improve further. Mandatory training is also delivered via online learning. The engagement of the staff to complete requires improvement.
Learning and occupational development (L&OD)
We evaluate all learning and development via a Microsoft Outlook voting buttons evaluation. We provide this to learners after the course to inform improved practice.
Widening participation
- We have had challenges with capacity of placements due to other pre-registered student allocations for our cadets.
- Level 4 work-based assessor qualification has had to be put on hold during the pandemic. This has also been impacted by the training environment pressures being high. This will hopefully resume asap in the new year.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Training educators
We will deliver an Emergency Medical Technician (EMT1) apprenticeship programme for new staff. This is currently under review against a new qualification specification. We hope to introduce this with a new course in 2023. We have reviewed the current programme and reduced the assessment burden for learners and educators.
We will be recovering mandatory training. We will be conducting a review of this year’s classroom programme to support this
Staff inducted to the education teams will need a higher level of CPD and qualifications. This is to support them in their new role to deliver high quality training.
There has been development of an applicant dashboard within our electronic staff record (ESR) system. This to support candidates prior to starting with the Trust and improve the information, advice and guidance they receive as part of the onboarding process.
Learning and occupational development (L&OD)
We have developed more learning and development opportunities since Covid. However, Covid can still be felt and has an impact throughout the service. We are now making sure that development opportunities are available outside these periods. We will continue to promote these with maximised uptake.
Widening participation
We will continue to support North West Ambulance Service (NWAS) staff to obtain Maths and English qualifications.
We will continue to support NWAS staff within internal development opportunities.
When at work, staff are free from abuse, harassment, bullying and violence from any source
What this means to The North West Ambulance Service (NWAS) in practice
Corporate HR
The Trust has placed considerable emphasis on tackling abuse, bullying, harassment and violence from any source.
One of the improvement goals in our People Plan is around ‘reducing staff experience of bullying and harassment, through development of a culture which consistently reflects our values and through effective management and support.’
From the NHS Staff Survey results we saw a downward trend in relation to the number of staff experiencing abuse, bullying, harassment and violence.
at work from the public, managers and colleagues. This may be as a result of a focus in 2021/22 around support for staff and managers with bullying and harassment issues. The Treat Me Right Campaign was launched in May 2021 and focused on the practice of workplace civility and respect. It underpins our progress towards a compassionate and inclusive culture.
A toolkit supported the campaign helping all staff feel empowered to seek early resolution and to encourage open communication. The Trust promotes the Dignity at Work and Freedom to Speak Up policies and processes. This is to reinforce our commitment to develop a positive working environment.
Communications
We strive to create a place of work that is safe and a workplace culture where there is no place for abuse, bullying, harassment and violence from any source our Board and Executive Directors support this position. They advocate for a civil and respectful workforce. They encourage staff to speak out if they encounter negative interactions with:
- patients
- the public
- other staff.
Our values underpin our desire to live and breathe inclusivity and our committees, policies, staff networks, channels of engagement and campaigns support positive behaviours as well as make sure staff have access to support mechanisms if things go wrong.
Freedom to Speak up
Our staff work hard to deliver the very best care for the people who use our services. We’re proud of our staff and we make sure we’re a great place to work and that staff are free from harm and abuse of any kind. Any forms of abuse, bullying, harassment and discrimination are never okay. The Freedom to Speak up Guardians support workers to speak up when they feel that they are unable to do so by other routes. They also make sure we continue to promote a speaking up culture as normal business. Freedom to Speak up Guardians make sure that people who speak upare thanked and that the issues they raise are responded to and make sure that the person speaking up receives support and feedback on the actions taken.
Freedom to Speak up Guardians have carried out work to adopt measures which empower staff. This allows them to speak up in confidence about issues that concern them. This is taking into account equality, diversity and inclusion.
The Freedom to Speak up Guardians continue to be supported by the executive and non executive lead for freedom to speak up. Freedom to Speak up Guardians will safeguard the interests of the individual. They make sure that there are no repercussions for them due to speaking up, immediately or in the long term. They also make sure that they have access to support as required.
The Freedom to Speak up (FTSU) guardians continue to help develop a culture where speaking up is valued throughout the trust. They work with local managers and leaders to promote a healthy culture of psychological safety. This is supported by having access to the Chief Executive, Executive Lead and Non-Executive Director for FTSU. The Guardian maintains a position of impartiality and independence at all times.
We remind staff that no-one should tolerate abuse, harassment, bullying and violence from any source. We remind them that the Trust will support all staff that highlight the issue. There are policies and procedures in place to ensure that any such behaviour is dealt with.
Emergency Operations Centre (EOC)
The Emergency Operations Centre (EOC) has placed considerable emphasis on tacklingbullying, harassment and violence from any source.
There has been significant improvement in refreshing policies and procedures to outline support available to staff and promote best practice protocol. We have had a recent re-launch of the Freedom to Speak up campaign. We hosted drop in sessions and are dealing with queries as a result of this.
Within The Emergency Operations Centre (EOC) we have seen a significant uplift in internal incident reporting. These reports include those surrounding violence or abuse towards staff members. We provide regular feedback and host an open discussion around these issues within our EOC Learning Forum. We track trends and concerns via this route. This is an issue for the whole of the NHS and work is being done on a national level to address the issue. We also wanted to try and tackle the problem locally.
Progress and highlights from 2021 to 2022
Corporate HR
We launched the Treat Me Right Campaign in May 2021 and this focused on workplace civility and respect. The campaign aims to reduce staff experience of bullying and harassment. We are doing this through development of a culture which consistently reflects our values. We are also doing this through effective management and support. It is underpinned by a toolkit which helps support all staff and managers to feel empowered to seek early resolution. This is also to encourage open communication which in turn will strengthen the existing Dignity at Work Policy.
The toolkit provides guidance and support and sets out the informal resolution routes available to staff.
We delivered Dignity at Work and Managing Grievance workshops. These workshops are designed to equip people leaders/managers with the necessary:
- tools
- understanding
- practical applications of the Dignity at Work and Grievance procedures
in order to investigate any complaint quickly. This is drawing appropriate conclusions/actions and managing any impact on the workplace and employee relationships following the outcome.
Communications
We took part in another series of the BBC ‘Ambulance’ programme which aired in Autumn 2021 and showcased the daily experiences of staff. This has created goodwill towards our staff and proved beneficial to expose how staff are sometimes treated when doing their jobs.
Having greater public awareness of the ambulance service has increased social media responses. This has also allowed us to engage with the public directly.
We monitored of the staff Facebook page to make sure comments comply with the trust social media policy. We reported incidents of bullying and harassment to relevant managers.
We were involved in the #WorkWithoutFear campaign. This was led by the Association of Ambulance Chief Executives and supported by NHS England. The aim of the campaign was to promote respect for ambulance staff across the country. Case studies involved real life accounts of abuse which we shared via online news and social media.
- violence
- assault
- aggression based incidents.
The NHS Long Term Plan is committed to investing £8 million over five years for a body worn video camera pilot in the ambulance sector. The pilot commenced in March 2021 and 230 cameras were deployed to 27 stations across the trust. This pilot is to be expanded in 22-23.
We highlight convictions and assaults against staff on our social media sites. This is to highlight our zero-tolerance approach to the public. We have developed a ‘Treat me Right’ toolkit to help reduce staff experience of bullying and harassment.
- development of a culture which reflects our values
- effective management and support
Staff can raise concerns about employment rights or personal treatment under the trust’s Individual and Collective Grievance Policy and Procedure. We encourage staff to seek support via the Freedom to Speak up route.
We worked with Trade Union representatives in helping to address bullying and harassment. We encourage members to approach representatives where they do not feel able to approach HR or their line manager.
We Improved our internal policy on violent and aggressive incidents. We also provided managers with guidance for supporting staff who have been assaulted.
We created a step-by-step guide for managers to investigate cases of assault so ensure equity of support.
Communication representatives sit on the trust’s Diversity and Inclusion Sub Committee.
We worked with the National Ambulance Health and Wellbeing Programme to share best practice and issues from other trusts.
Members of the Communications Team attend staff support forums such as the:
- Disability
- LGBTQ
- Race Equality
- Equality, Diversity and Inclusion networks
to offer support and advice on both internal and external engagement.
We promote national awareness days, weeks, months promoting protected characteristics in our social media. This is together with communications plans to further inclusivity, for example Black History Month, LGBT Pride. We provide regular communications support for the cultural audit and its outcomes.
Freedom to Speak up
Freedom to Speak up has moved from the corporate affairs executive to the medical directorate. We increased the number of guardians to support our people.
The lead Freedom to Speak up Guardian provides reports to the Trust Board. This identifies:
- key themes raised by staff
- key concerns and potential action
- learning needs.
Freedom to Speak up Guardians (FTSUG) encourage staff from minority groups to speak out and are not disadvantaged for doing so.
FTSUG works in partnership with other parts of the organisation.
- complaints and incidents
- HR and organisational development
- staff side reps
- the Workforce Race Equality Standard team
- diversity and inclusion groups
This enables triangulation of concerns and for guardians to be able to visit sites to hear from workers where concerns are raised.
- raises the awareness of the Trust’s Values and Behaviours which specify the conduct expected from staff
- encourages staff to Datix incidents of harassment, bullying, abuse and violence. Staff also have the option to follow up incidents by reporting them to the police
- has a Raising Concerns Policy (in line with integrated national policy)
- policy has had an EIA completed
- feed data into the Trusts Non-Clinical learning forum
- forms part of the annual mandatory training programme
A refreshed Freedom to Speak up (FTSU) page on the NWAS Greenroom FTSU raises staff awareness of the Violence and aggression marker procedure. The procedure outlines the steps and actions for reporting an act of violence and aggression and includes supporting guidance for all involved.
Emergency Operations Centre (EOC)
We have seen a significant increase in incident reporting over this period. Reported incidents have almost doubled.
We celebrate EOC’s success. We have worked with communications colleagues to celebrate international control room week. We also highlight the hard work undertaken by our staff.
We have introduced new roles within the EOC. We created roles developing leadership within the frontline, such as call- handler team leader roles. These roles are focused on supporting staff.
We have launched a SharePoint platform, which allows us to communicate with our staff. We have worked with the trust psychologist to develop drop-in sessions for contact centre staff.
We have developed a EOC People plan, including initiatives developed across all EOC service lines.
Barriers, challenges, and difficulties
Corporate HR
Operational pressures can impact on the time that colleagues have available to access resources and training.
Communications
It will always be difficult to eliminate abuse, but we have a range of support mechanisms in place for staff who experience it. It is vital to have a proactive approach to promoting zero tolerance to abuse by the public which the public know about. Staff should also feel that they will be supported to report abuse.
Freedom to Speak up
As new guardians we are continuing to understand the barriers of speaking up. From anecdotal evidence time is a key player in preventing people speaking up alongside the impression that things don’t change when you do.
Emergency Operations Centre (EOC)
It would be impossible to eliminate abuse. We have a range of support mechanisms in place for staff who experience it. It is vital to have a proactive approach to promoting zero tolerance to abuse by the public which the public know about. Staff should also feel that they will be supported to report abuse. We have encountered challenges in achieving prosecutions about verbal abuse directed over telephone. We remain committed to working with our Police colleagues and other service lines to manage these incidents in a robust fashion.
Work being carried out to meet this overarching objective April 2022 to March 2023
Corporate HR
Staff Survey results showed that staff with protected characteristics had more negative experiences in relation to:
- abuse
- harassment
- bullying
- violence
compared to the rest of the workforce. We will undertake engagement with the Race Equality, Disability and LGBT+ staff networks to understand this data and identify potential solutions.
We will further embed the Treat Me Right campaign and resources in to ‘everyday practice’ within the organisation.
We will deliver the Beyond Bias workshop which focuses on understanding bias, prejudice and discrimination and how this impacts the workplace.
We are developing cultural competence for inclusive practice.
We are embracing and leveraging diversity for better patient care and improved staff experience. We aim to be able to adopt inclusive ways of working using our systems and processes.
Communications
A Violence Prevention and Reduction Group (VPRG) has been set up with representatives from across the trust. This is to enable the trust to work through the VPR standards as set out in the NHS Long Term Plan and the NHS People Promise. We will be able to measure performance against our own Violence Prevention and Reduction Strategy. This will be a key step towards a commitment to staff health and wellbeing through the adoption of public health methods.
We recognise the negative impact that poor staff health and wellbeing can have on patient care. We have focused on embedding Cultural Competence in our back-to-basics training courses.
- issues relating to culture
- how this may influence care
- its impact on how care is given
to reduce disparities in healthcare outcomes. We are teaching our staff to recognise biases, stereotypical beliefs, ignorance and prejudices to treat their peers better.
In line with the trust’s Communications and Engagement Strategy the Communications and Engagement Team will continue to support inclusivity and a safe and respectful culture. We do this via all the trust’s internal and external communication channels.
Creative campaigns, film and other assets will help staff networks, service lines and committees.
Social media will be used to highlight negative experiences and their impact on our staff.
Areas of focus for 2022/2023 include ongoing internal support for the Manchester Arena Inquiry and receipt of the final report.
Freedom to Speak up (FTSU)
FTSU continues to promote the role of the Guardian and the FTSU function through:
- communications relating to Freedom to Speak up (FTSU) including payslips, staff Facebook groups, a Twitter handle and bulletins
- attendance at a variety of forums including LGBT, Workforce Race Equality Standard (WRES) Disability and V&A Operational Group.
The FTSU Guardian will continue to triangulate data through working with other departments to ensure a understanding of our speaking up culture. The freedom to speak up guardian will continue to present reports to the Trust Board.
- continue monthly meetings with CEO, Director of people, Medical Director.
- continue meetings with Non-Exec Director.
- engage with the North West Guardian networks alongside the national ambulance network
The national ‘Speaking Up’ month in October will involve face to face engagement with staff as well as online events.
We will create a new freedom to speak up brand in line with The North West Ambulance Service (NWAS) branding.
Will will increase in the number of ways staff can speak up utilising both traditional formats and new digital formats.
We will provide greater support of managers and leaders to embed a ‘speaking up’ culture.
Emergency Operations Centre (EOC)
We commit to listening to feedback and providing a safe space to report concerns. We are beginning a series of staff drop in forums with senior managers. This is to make sure that any concerns can be voiced directly to senior leadership team.
We are developing and hosting away days for our leadership and management team. These are focusing on the principles of leadership, including a zero tolerance to abuse, harassment, bullying and violence.
We continue to promote HR masterclasses about Violence and Abuse and incorporate these into away days.
We are progressing with building on the previous work around celebrating success. We have established a robust process for nominating and rewarding staff. We continue to make sure we give feedback for the reporting of any incidents, to create a safe environment to raise concerns.
Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives
What this means to NWAS in practice:
HR
We seek to achieve a healthy balance between work, family and personal commitments. We are doing this by providing flexibility through the short or long term and on a temporary or permanent basis through a number of different policies and procedures such as:
- flexible working procedure
- carer’s/dependant leave
- foster carer leave
- study leave
- parental leave
- medical appointment leave
- religious leave
- urgent/emergency leave
- parental leave
- disability leave
We allow flexibility in the form of adjusted duties and reduced hours. This could be to reintegrate people back into the workplace following long term absence or more permanent adjustments/flexibility when recommended by occupational health.
It is also important to recognise that flexibility also features in a number of other policies such as:
- sickness policy
- maternity policy
- menopause policy
The policies are available through the Trust’s intranet. All people managers along with HR are proficient at dealing with these requests. We also make sure decisions also leave suitable cover to maintain operational standards and effective patient care.
Progress and highlights from 2021 to 2022
HR
The use of a hybrid approach for eligible staff to work on an agile basis mixing working from home with some office-based working has now become embedded following Covid. This has brought advantages such as:
- flexibility around working hours
- reduced costs
- better use of time and convenience.
This is now officially captured in the recently signed off Agile working policy.
The return of staff who have had long Covid as well as other previously long term sick staff has seen an increased use of flexibility on phased return hours/duties. In a number of cases this has resulted in temporary redeployment.
We developed a menopause policy in partnership with staff. This is not only to recognise the impact this has on both male and female colleagues but also to provide a more structured discussion. There have been considerations of flexible adjustments including work patterns.
The flexible working policy continues to be used to good effect. This is following promotion of the new flexible working guidance allowing applications from day one. The number of applications has more that tripled since the previous year. However, 2020-21 was heavily impacted by Covid and there was already a lot of temporary agile/flexible/homeworking. Now it’s more than double the amount we recorded for 2019-2020.
Applications for flexible working
Year | Applications |
---|---|
2019-2020 | 153 |
2020-2021 | 98 |
2021-2022 | 324 |
This doesn’t include any local informal flexibility that was put in place.
We have different working patterns across our call centres. We recognise the need for flexibility in both team and individual rotas. Emergency Operations Centre (EOC) currently has 97 different working patterns. 111 currently has 274 patterns (81 standard patterns).
We also recruit on both full and part time contracts to provide flexibility.
In the annual staff survey the Trust has had results in line with the industry average for flexible working opportunities.
Barriers, challenges, and difficulties
HR
- we have had conflict between operational needs and employees’ preferred working patterns
- we have had issues with consistency of application and request consideration/acceptance across service lines and sectors
- day 1 flexible working requests now make recruitment to meet demand more challenging. We recruit for hours we need which the prospective candidate agrees to. Sometimes the employee can’t do the hours, leading to a flexible working request
Work being carried out to meet this overarching objective from April 2022 to March 2023
HR
We are doing a rota review in 111. Flexibility is the greatest barrier to recruitment and retention in this area.
We are doing training with managers on how to manage special leave requests.
We are reviewing the flexible working policy. This is particularly in areas such as Fleet that have lower volumes of application.
We are considering flexible training periods in the call centres to support recruitment. Someone may be joining part-time but the training period is currently Monday-Friday 9-5pm. This is unachievable for some people with other commitments, for example childcare.
We continued analysis of staff survey results around:
- staff feeling they have opportunities for flexible working patterns
- the organisations commitment to help balance work and home life
- staff feeling that they can approach their manager to talk about flexible working.
Staff report positive experiences of their membership of the workforce
What this means to NWAS in practice
Corporate HR
The Trust continues to engage with staff and seek feedback on their experience through:
- the annual National Staff Survey
- National Quarterly Pulse Survey
and additional staff experience surveys led by individual directorates or the communications and engagement.
Local managers use the findings of the Staff Surveys to understand local successes and development areas, and produce Local People Plans.
We can benchmark data from national surveys against other service lines. We also look at it at in context of historical comparisons.
The Trust continues to promote the staff app which has seen significant response in terms of downloads. Additionally, staff networks have continued to develop further over the last year. By March 2022, there were four staff networks established:
- Armed Forces
- Disability
- LGBT+
- Race Equality
Positive Action
- minority ethnic
- LGBT+
- disabled
- armed forces staff
through increased engagement, supportive networks and greater development opportunities.
- LGBT+ Network
- Race Equality Network
- Disability Network
- Armed Forces Network
- provide a safe space for employees, ensure that minority groups have a voice
- enable peer support
- raise awareness of issues affecting their members
- promote opportunities for influencing change within the organisation
Networks also have visible advocacy at board level by an Executive Sponsor. This links in with Goal 4 – Inclusive Leadership of the EDS2 framework. We also supported the Religion and Belief Forum.
The Equality Diversity and Inclusion (EDI) Networks Council Group supports these networks. This group has an overview of our response to equality, diversity and inclusion issues. This group develops and manages equality, diversity and inclusion plans. This is so we can evidence our progress. This provides assurance to the Trust and wider stakeholders. The People Directorate Senior Management Group authorises The EDI Networks Council Group. This is also linking in with Goal 4 – Inclusive Leadership.
The staff network chairs/co-chairs received training received training on:
- influencing stakeholders across the trust and engaging with peers and colleagues
- working with the executive sponsors and building and harnessing a two-way collaboration
- creating the networks’ brand and reputation.
Initial discussions took place with regards developing a Women in Leadership group.
Progress and highlights from 2021 to 2022
Corporate HR
The Trust has continued to support the development of the Staff Networks. Last year both the Disability and Armed Forces Forums transitioned to Network status.
We provided support for developing a Women’s Network. The network has agreed and managed their work plans and met regularly with their Executive Champions. This supports inclusive leadership within EDS2 framework.
We have asked the network to share their views on work including the refresh of the Trust strategy and equality impact assessments. We developed a council of staff networks which meets on quarterly basis. This is an opportunity for Networks to share best practice and learn from each other.
The staff app has continued to used by staff across the Trust. It is a helpful resource for staff to access information including:
- content on the Green Room
- rostering
- emails
- work perks.
We introduced the Work and Wellbeing Passport to help staff access support within the workplace. This can be used by anyone who feels they may need some additional support at work.
36% of our workforce participated in the 2021 annual NHS Staff Survey. This was a lower figure than 2020. Our results across the survey largely remained static with some positives emerging too. The results showed that we were above average in relation to most of the People Promise themes, including ‘We are safe and healthy’.
Year | Overall response rate |
---|---|
2021 | 36% (2308) |
2020 | 41% (2622) |
2019 | 45% (2774) |
2018 | 46% (2789) |
We have continued to be deliver Local People Plans in each of the service lines and sectors. The introduction of identified Health & Wellbeing Leads in each area has supported this.
The plans reflect the needs of the workforce in different parts of the service. The challenges faced by staff may vary depending on their roles/areas. We share updates on the progress of the plans with:
- the Health and Wellbeing Leads meetings
- the Health, Wellbeing and Culture Assurance Group.
We continue to do new starter / exit interviews for new starters and those leaving the organisation. This gives them the opportunity to formally feedback their experiences.
Positive Action
We have developed employee forums/networks. These provide a safe space for employees to have open conversations and enhance inclusivity.
LGBT+ Network
LGBT+ Network focuses on improving staff and patient experience and provides a voice on behalf of all LGBT+ staff.
Highlights include celebrations of LGBT+ History Month and Pride. We promoted these on our social media.
Race Equality Network
The Race Equality network are a voice on behalf of staff from different racial backgrounds. This network improves the experience of staff and patients in relation to racial equality.
Highlights include raising awareness during Race Equality Week, Black History Month, and International Day for the Elimination of Racial Discrimination.
Disability Network
The Disability Network promotes equality across the trust. The network opens conversations about the barriers experienced by people with disabilities. This gives staff a voice to improve understanding of disabilities.
Progress has included the launch of the formal Network with dedicated Co-Chairs and committee members in December 2021.
A highlight was raising awareness of Disability Awareness Month and International Day of Disabilities.
Armed Forces Network
The Armed Forces Network promotes a better understanding of the Armed Forces Community. This is to create a more supportive and inclusive working environment.
- social media campaign during Armed Forces Week – recognising and raising awareness of The North West Ambulance Service’s (NWAS’) Reserve and Cadet Forces.
- supporting Remembrance services nationally and locally.
- launch of the formal Network with dedicated Co-Chairs and committee members
- participating in a steering group to discuss changes to the Armed Forces, Reserve and Cadet Forces Policy.
Religion and Belief Forum
This network had a session promoting Sikhism, which was well attended. Feedback from members and executive sponsors of the networks/forums has been positive.
Barriers, challenges and difficulties
Corporate HR
- increase staff participation in the annual and quarterly staff surveys Electronic Staff Record (ESR) declaration rates
- need for a consistent approach to engagement and wellbeing across areas of the Trust
- greater awareness of the Work & Wellbeing Passport
- new starter and exit interview responses remain low and require further engagement form managers to encourage completion
Positive Action
- delay to delivery of the Executive Sponsor training – this has been delayed to 2021/2022.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Corporate HR
Promoting key messages reinforcing the improvements made as a result of feedback emerging from the Staff Survey (‘you said, we did’ style approach).
Review content on the Support Hub to ensure it provides relevant, up to date information to staff. The Support Hub ensures that staff have access to all resources to support their wellbeing accessible in a ‘one- stop-shop’ approach.
The Mental Health Continuum Delivery Group will focus on delivering on our national commitments. This is in relation to improving mental health and preventing suicides within our workforce. This group has been established and is already beginning to work through the requirements of the national commitments.
A review and refresh of the Work & Wellbeing Passport is planned to ensure that it is a resource which is fit for purpose. This is also to promote it for increased use across the Trust.
- transition of the Religion and Belief Forum to the Religion, Belief and Culture Forum
- development of a formal Women’s Network with invites to join committee, launch and development of terms of reference
- training planned for executive sponsors with the aim to further strengthen their respective approaches. This is with regards the development of the staff networks and to increase their capability to drive the networks forward (this was initially planned to take place during 2021/2022, however was postponed)
- development of Green Room network pages
- development of focused network pages on external website.
- development of branding toolkits for each network – working in collaboration with the Communications team; and development of branded promotional awareness resources to promote the networks
- training for all network staff to project manage/manage network budgets working collaboratively with the Finance Team
- delivery of road shows across NWAS hubs to promote the Race Equality Network with the aim to engage with staff members across the trust and to raise the profile of the network
- round-table events by the Disability Network to discuss issues affecting people with disabilities; delivery of Access to Work sessions; and supporting promotion of the Work and Wellbeing Passport to all managers and employees
- continued work by the Armed Forces Work to review the current special leave entitlement for the Reserve and Cadet Forces.
- all staff networks co-ordinating events to raise awareness of their groups
Goal 4: Inclusive leadership
Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations
What this means to NWAS in practice
Corporate governance
The Board continued their commitment in leading, promoting and demonstrating their commitment to delivering the Equality, Diversity and Inclusion (EDI) agenda across the Trust. There are clear links between staff experience and patient experience. It is vital for the Board to show visible leadership on matters of diversity.
The membership of the Board are keen to further develop their understanding of the barriers facing different groups of patients we serve and among our staff. One way this is achieved is through hearing staff and patient voices at Board meetings.
Progress and highlights from 2021 to 2022
Corporate governance
- Despite the continued challenges with Covid-19, the Board continued to support a large number of events and attended programmes to promote and raise awareness of relating to Equality Diversity and Inclusion.
- Directors continued in their Executive Champion roles aligned with networks or particular equality strands. Champions are accountable for supporting network objectives, acting as allies and advocates and for bringing the perspective of their equality strands to Experience Led Care debate and decision-making.
- The governance structure includes the Diversity and Inclusion Sub Committee which has strengthened focus and assurance related to Equality Diversity and Inclusion being reported to the Resources Committee and Quality and Performance Committee.
- The Board of Directors receive regular updates relating workforce equality, include race, gender and disability. The e-learning assessment relating to Equality, Diversity and Human Rights is also undertaken by Board members.
- Diversity and inclusion was embedded into all Board Directors objectives during 2021/22, particularly around developing role as Board champions and continues into 2022/23 including senior leaders. Executive Directors attended Pride and The North West Ambulance Service (NWAS) won the North West Pride Award 2022 for the best event.
Individually and collectively, Board members attended and participated in a range of internal and external conferences and meetings related to Equality Diversity and Inclusion (EDI).
These events included board development sessions:
- 28 April 2021: Introducing Anti Racism Facilitated by J Herring, Strategic Lead for Organisational Development and System Leadership (Greater Manchester, Health and Social Care)
- 23 February 2022: Mobilising Anti Racism
The Chairman supported the Equality, Diversity and Inclusion (EDI) agenda by attending:
- NHS North West Black and Asian Minority Ethnic (BAME) Assembly on 30 September 2021
- Association of Ambulance Chief Executives (AACE) Women in Leadership Seminar on 7 March 2022
- Royal Foundation Emergency Services Mental Health Symposium on 25 November 2021
- Association of Ambulance Chief Executives (AACE) Ambulance Sector Role in Health Improvement and Reducing Health Inequalities 1 February 2022. This event was chaired by Director of Health Inequalities for NHS England and Improvement, and sponsored by the Trust’s Medical Director.
During 2021/2022, the Director of People recruited a number of posts to strengthen and support equality, diversity and inclusion (EDI) across the Trust:
- Head of Inclusion and Engagement
- EDI Advisor – Corporate Services
- Positive Action Officer – Corporate Services
- Employee Engagement Manager, Wellbeing Guardian
- Consultant Psychologist
The Director of People has undertaken the following activities in support of the Equality, Diversity and Inclusion (EDI) agenda over the last 12 months:
Race Equality
- attended monthly forum events alongside other directors (CEO, Chair, Medical Director, Deputy CEO)
- specific engagement events with interested staff to develop them from a forum into a network (Sept-Dec)
- Race Equality Launch Event
- also attended a range of ad hoc development events through the national Executive development offer focused on race
- took part in national focus group work through NHS England/Ireland on how to best support and develop networks Participant on Greater Manchester (GM) Leadership for Inclusion programme – bringing senior leaders together across GM to focus on leadership of the race equality agenda. Involved in drafting a GM wide statement of commitment which it is hoped will be adopted by the mayor and GM public sector bodies.
LGBT+
- Executive Champion and attends quarterly network meetings
- attended two virtual social events
- regular contact with LGBT chair to resolve issues and support e.g. inclusion of trans issues and HIV in mandatory training to raise awareness and educate staff on these issues
- published her own LGBT hero piece as part of LGBT History month
Other engagements
- Patient and Public Panel event on health and wellbeing with focus on our response to mental health
- video recorded in support of Army Reservist D day Social media activity in support of equality related events
- attended quarterly Wellbeing & Culture Assurance Group
- bi-Monthly National Ambulance HR Directors Group meetings
- liaison with ENEI (Employers Network for Equality & Inclusion)
- monthly North West Human Resources Department Network meetings
- bi-monthly NHS Staff Council Plenary meetings (Equality, Diversity and Inclusion (EDI) Updates included
- monthly and quarterly National Ambulance Strategic Partnership Forum (NASPF) meetings
- monthly People Digital Advisory and System Leadership working meeting
- attended various Health and Wellbeing meetings
The Director of Corporate Affairs is Executive Champion of the Armed Forces Network and attended the following events during 2021/22:
- NHS Providers Governance and Quality Conference on Cognitive Bias and How Leaders Can Minimise it on 19 May 2021
- NHS Confederation of NHS Non-Execs Driving Diverse Leadership on 15 June 2021
- Racism at North West Ambulance Service (NWAS) Roundtable on 21 October 2021
- Women in Leadership at NWAS Roundtable on 8 March 2022
- Diversity and Inclusion Sub-Committee on 4 May 2021
- North West Ambulance Service (NWAS) Equality Diversity and Inclusion (EDI) Networks Council on 14 February 2022
The Director of Strategy, Partnerships and Integration and Director of Operations are joint Executive Champions for the Race Equality Network and met with the Chairs on a regular basis. They also attended the network meetings. The Director of Strategy, Partnerships and Integration is a member of the North West Black and Asian Minority Ethnic (BAME) Assembly which meets on a quarterly basis. He also attended the following meetings during the period:
- Chair of Diversity and Inclusion Sub Committee and Mersey Internal Audit Agency (MIAA) collaboration masterclass ‘Leading Diversity – Having Brave Conversations’ on 27 January 2022
- National Black and Asian Minority Ethnic (BAME) Forum ‘race for care’ virtual conference on 7 October 2021
- Hosted the Racism Roundtable on 21 October 2021
- Disability Network Launch on 14 December 2021
- Association of Ambulance Chief Executives (AACE) Women in Leadership Seminar on 7 March 2022
- Women in Leadership Roundtable on 8 March 2022
The Director of Strategy, Partnerships and Integration supported the Chair of the Race Equality Network for Black History Month in October 2021 sharing his thoughts on the importance for action to be undertaken to understand and address inequalities that exist today.
The Director of Operations implemented a standing agenda item on his Senior Management Team meetings and invited a different guest each month from the networks/inclusion team to discuss latest work/projects. This allowed the Director of Operations to brief the Senior Operations teams in relation to the latest Equality, Diversity and Inclusion (EDI) work and progress. This was also to identify areas of improvement.
The Director of Quality, Innovation and Improvement is the Executive Champion of the Gender Equality Matters Network (GEMS). The network was created by the women of The North West Ambulance Service (NWAS) and is a network for all women. She also led the Women’s in Leadership programme, together with the Medical Director which resulted in the Women’s Network launch in 2022/23. In addition, she published a blog – ‘Does equality matter’ in the NWAS Weekly Bulletin on 8th March 2022.
The Medical Director is in a Champion of the Women in Leadership programme and has attended a number of sessions during 2021/22. He has also attended the following external meetings:
- Association of Ambulance Chief Executives (AACE) and College of Paramedics: Employee Wellbeing and Suicide Prevention Workshop on 12 November 2021
- AACE Rountable: Ambulance Sector Role in Health Improvement and Reducing Health Inequalities on 1 February 2022
The Director of Finance is the Executive Champion for the Disability Network and attended its launch on 14th December 2021, in addition to the network meetings. She also attended the following external events:
- National Women of Leadership for NHS Finance on 2 November 2021
- Mersey Internal Audit Agency (MIAA) collaboration masterclass ‘Leading Diversity – Having Brave Conversations’ on 27 January 2022
- Association of Ambulance Chief Executives (AACE) Roundtable: Ambulance Sector Role in Health Improvement and Reducing Health Inequalities on 1 February 2022
The Chief Executive has continued to support the internal networks and met with the Chairs of the Disability Forum Network, Race Equality Network, LGBT+ Network. He also supported the launch of the Disability Network. He also attended a number of external meetings to support the EDI agenda as follows:
- discussion regarding the Anti Racism Agenda with the North West Regional Director of the Royal Nursing College on 27 July 2021
- Liverpool Race Equality Taskforce Meeting on 19 August 2021
- NHS Providers Annual Conference and attended the keynote speech relating to Exploring Allyship and Antiracism, focusing on what can be built into our working lives on 16 November 2021
- series of Race Ahead conversations and panel discussions arranged by NHS England People Directorate focusing on; Zero tolerance; Leadership that makes a difference; Improving Health and Wellbeing for all staff; Strategic approaches to achieving racial equality
The Chief Executive as Chair of Association of Ambulance Chief Executives (AACE) and member of The Royal Foundation’s Emergency Responder Leaders Board, supported and attended The Royal Foundation’s Emergency Services Mental Health Symposium, co-hosted by the Association of Ambulance Chief Executives and the other emergency services, where The Duke of Cambridge announced a new package of mental health support for emergency service workers.
The Association of Ambulance Chief Executives (AACE) hosted a webinar on 8th March 2022 covering a range of topics relating to women in leadership. The Director of Quality, Innovation and Improvement discussed how ambulance services can improve and what needs to happen for us to eradicate sexism within the service. Maxine is a real champion for women in leadership.
Following the statistic released from the Office of National Statistics indication that male paramedics are 75% more likely to take their own life than any other health care professional, the Chief Executive as Chair of Association of Ambulance Chief Executives (AACE) partnered with the Chief Allied Health Professions Officer for England to commission a programme of work and established an ambulance sector suicide prevention and wellbeing advisory group.
As a result three publications were launched:
- Working Together to Prevent Suicide in the Ambulance Service – A National Consensus Statement for England
- Prevention of Suicide in the Ambulance Service – What we Know
- Working Together to Prevent Suicide in the Ambulance Service – Next Steps
Further support is being developed to help address the tragic link between suicide and working in the ambulance service.
Barriers, challenges and difficulties
Corporate Governance
The Board of Directors support the Equality, Diversity and Inclusion (EDI) agenda and priorities. The challenges vary from changes in Board membership to the large number of projects, networks and initiatives being undertaken by the Trust. On occasion it may be difficult to gain Board presence at all the events.
Despite this, the commitment from the Board is illustrated through the number of engagements undertaken throughout 2021/22.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Corporate Governance
The Board clearly supports all work undertaken to progress the equality, diversity and inclusion agenda. The aim is keep the conversation fresh at Board level with continuous education relating to these topics into 2022/23.
The Board through the Committee assurance structure will continue to receive assurance and annual reports, with further opportunity to become further involved to support developments. Network Chairs/Deputy Chairs will become formal members of the Diversity and Inclusion Sub Committee for 2022/23.
The Chairman is the Non-Executive champion for equality, diversity and inclusion and will continue to drive this agenda forward.
Objectives relating to equality and diversity were set for 2021/22 and have been implemented into the objectives of senior managers to provide visible leadership around the diversity and inclusion agenda. This continues at Board level who are leading from the front in order to promote equality and equity across the organisation.
Papers that come from the Board and other major committees identify equality related impacts including risks, and say how these risks are to be managed
What this means to NWAS in practice
Corporate Governance
Any recognised Equality related impacts are a key focus of the reporting processes to the Board of Directors, Committees and Sub-Committees. The Corporate Governance Team support this work through the use of report templates and report the completion of Equality Impact Assessments for Policies, procedures and strategies to the Executive Leadership Committee.
Risks are discussed: both the broader aspects of approaches and the impact on individual groups.
Progress and highlights from 2021 and 2022
Corporate Governance
Review of documentation including reference to Equality Impact Assessment documents. All covering reports submitted to Board, Committees and Executive Management Committee have any equality related impacts identified on the front sheet so that it is immediately visible.
The report templates for all meetings within the Trust, including Board of Directors, Committees and Sub Committee include a section on the front cover to indicate whether there are any equality related impacts. Within the main body of the report, there is a section to include any Legal, Risk or Governance Implications.
During 2021/22, the report templates were updated to include a further section within the main body of the report for authors to include further information relating to equality impacts.
The Board receives information about the staff survey and information about the responses of different staff groups.
The Board and Committees have sight of action plans for projects and for work supporting particular groups, such as:
- the Workforce Race Equality Standard (WRES)
- Workplace Diversity Equality Standard (WDES)
- gender pay gap and their action plans.
The Board review and approve the Annual Equality report.
Barriers, challenges, and difficulties
Corporate Governance
Equality related impacts are not always recognised by authors of reports and policies however is an improving position and will continue to be strengthened.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Corporate Governance
Report templates are reviewed on an annual basis to ensure they remain fit for purpose and capture the required information, particularly in relation to equality and risks.
The Corporate Governance Team will continue to support the reporting completion of Environmental Impact Assessments (EIAs) to the Executive Leadership Committee for all policies, procedures and strategies.
Middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination
What this means to NWAS in practice
Learning and Occupational Development (L&OD)
At The North West Ambulance Service (NWAS), cultural competence work is focused on achieving the ability to leverage diversity for improved staff experience and patient care. Our work is dedicated to progressing managers and leaders of services and people to work in culturally competent ways. This works towards actively reducing any disparity in staff and patient experience and outcome for underrepresented groups. The key messages made to staff to help develop cultural competency is to:
- use evidence and data when making decisions
- have a healthy scepticism for own decision making
- be aware of our own over confidence in decision making (may make it difficult to correct prejudice and bias)
- make contact with people not like you
Progress and highlights from 2021 to 2022
Learning and Occupational Development (L&OD)
To date, we have:
- embedded ‘cultural competence’ learning into our leadership flagship programme called ‘Making a Difference’
- embedded cultural competence into each of our training packages
- embedded cultural competence into each of the HR Masterclass training packages
- invested in a national NHS Reciprocal Mentoring programme to drive cultural competence in service design, development and delivery
- supported the maturity of staff networks to respond more effectively as conduits for growing cultural competency across The North West Ambulance Service’s NWAS’s decision making infrastructure
- made our first steps to embedding cultural competence into our mandatory training packages.
Barriers, challenges, and difficulties
Learning and Occupational Development (L&OD)
There have been challenges with embedding the above interventions with pace due to the demand on North West Ambulance Service (NWAS) services. The staff focus on health and wellbeing interventions refocused leadership development on maintaining personal and professional resilience over inclusive leadership development. However, cultural competence embedding was obtained. The challenge now is ensuring those delivering this aspect of their training programme are comfortable and competent with the material.
Work being carried out to meet this overarching objective from April 2022 to March 2023
Learning and Occupational Development (L&OD)
The work for this theme is described above and will continue over this year.