About us
North West Ambulance Service NHS Trust (NWAS) serves more than 7.5 million people across approximately 5,400 square miles – the communities of Cumbria, Lancashire, Greater Manchester, Merseyside, Cheshire and a small part of Derbyshire (Glossop).
The trust’s vision is to deliver the right care, at the right time, in the right place; every time for patients accessing its urgent and emergency care service (999), non-emergency patient transport service (PTS) and NHS 111 service.
To achieve this ambitious vision, the trust has to balance getting the basics right while continuously striving for excellence. Its approach to this is outlined in its 2022 – 2025 strategy, developed with input from its people.
The trust’s workforce of 7,300 staff undertakes over 300 different roles and is supported by over 1,000 volunteers as members of its patient and public panel, volunteer car driver network and community first responder network.
The trust is part of a complex health and care system, working collaboratively with 4 integrated care systems, 42 NHS provider trusts, 22 Healthwatch organisations, 2 air ambulance charities, more than 160 primary care networks and 5 police and 5 fire services across the region.
In July 2022, Integrated Care Systems (ICS) replaced the Clinical Commissioning Groups (CCGs). Previous to July 2022 they had 31 CCGs covering the North West. They now work to five ICS areas in the North West.
- Lancashire and South Cumbria
- Cheshire and Merseyside
- Greater Manchester
- North East and North Cumbria (For North Cumbria)
- Derbyshire (for Glossop)
Nationally there are 42 ICS, and their aims are:
- Improving population health and healthcare
- Tackling unequal outcomes and access
- Enhancing productivity and value for money
- Helping the NHS to support broader social and economic development
Along with North East, Yorkshire and East Midlands ambulance services, NWAS forms part of the Northern Ambulance Alliance, which has an ambition to do things better in partnership to deliver patient-centred, efficient and forward-looking services.
The diversity in the region makes the North West a unique place to live, but also presents some challenges. In the North West, 32% of people live in the highest levels of deprivation and have significantly worse health outcomes, healthcare experiences and life expectancy than the general population. People living in the north west’s communities are sicker than before the Covid-19 pandemic. There are more people living with poorly managed long-term conditions and, as people get older, it is expected there will be more people living with illnesses.
The overall health of the region’s population has a huge effect on demand for NWAS’ services. Therefore, the trust aims to address health inequalities help tackle the causes of illness by looking at the wider factors that affect health; helping people to stay healthy and reducing the need for them to have care from the NHS.
Key challenges
NWAS faces several ongoing and emergent challenges which include:
- Sustainable delivery of performance – we are not sustainably achieving our performance standards as this is dependent on having the right levels of resource to meet increasing demand, and a workforce who are appropriately skilled to meet patients needs. Our performance is also impacted by pressures in the wider urgent and emergency care system, with national focus on recovery across several performance indicators including category 2 performance and hospital handover.
- Financial efficiency and productivity – due to significant national and system-level deficits, NWAS has a responsibility to demonstrate that we are delivering value for money and being efficient with the resources available to us. There is also a specific requirement for NWAS to reduce spending each year through cost-improvement schemes.
- Workforce and culture – ambulance services are tackling huge cultural challenges within the workforce, most notably issues around sexual safety and misogyny have been identified as part of sector-wide independent reviews. NWAS continuously strives to improve ‘Freedom to Speak Up’ reporting and staff confidence that concerns raised will be addressed.
- Health inequalities – the challenging socio-economic context is continuing to affect the health of the population, particularly those from minority groups who face inequality in access, experience and outcomes. NWAS demonstrate how we are taking action to reduce health inequalities in partnership with other health and social care organisations.
- Partnership working – our footprint is large and diverse and NWAS operates across five ICB footprints which poses challenges when trying to balance local priorities with delivery of a consistent regional service.
Our strategy
NWAS’ published a new strategy in 2022, outlining its vision is to deliver the right care, at the right time, in the right place; every time.
What does this mean?
Right care – proving outstanding care that is safe, effective and focused on the needs of the patient.
Right time – achieving all operational performance standards for the paramedic emergency service, NHS 111 and patient transport service.
Right place – providing care in the most appropriate setting for each patient’s needs, taking fewer people to emergency departments by providing safe care closer to home or referring people to other health and care pathways.
Every time – providing services which are consistent, reliable and sustainable.
To achieve this vision, the trust focuses on three aims, which are to:
Provide high-quality, inclusive care
The trust recognises there are health differences between groups in the communities it serves. It will listen to understand and make sure its services are accessible to everyone. It will work to prevent harm while using learning and research to continuously improve patient care and experience.
Be a brilliant place to work for all
The trust will create an environment where its people feel happy and safe, have access to equal opportunities and are supported to be at their best.
Work together to shape a better future
The trust will work together to improve the services it provides. It will work with its partners and the public to find solutions which improve access, outcomes and experience for everyone. It will work together to become more sustainable and have a positive effect on its communities and environment.
Our vision
to deliver the right
care, at the right time,
in the right place;
Right care
We will provide outstanding care that is safe, effective and focused on the needs of the patient.
Right time
We will achieve all operational performance
standards for our paramedic emergency service, NHS 111 and patient transport service.
Right place
We will provide care in the most appropriate setting for each patient’s needs, taking fewer people to emergency departments by providing safe care closer to home or referring people to other health and care pathways.
Every time
We will provide services which are consistent, reliable and sustainable.
Our values
The trust’s values form the foundation of the whole organisation, setting out the behaviours expected from its staff for patients to receive the right care every time. Putting its values into practice supports the trust to provide compassionate care and improve outcomes and experiences for its people, patients and communities.
Urgent and Emergency Care
The trust’s emergency service responds to over 1.1 million emergency incidents each year; with a highly skilled workforce providing the best possible pre-hospital care to patients in remote-rural and urban environments.
Emergency responses are measured through the national Ambulance Response Programme (ARP), which allows for early recognition of life-threatening conditions and ensures patients are responded to in a timeframe suitable for their clinical need.
Demand for the emergency service increases each year and the number of immediately life-threatening cases has increased by 60% from the previous year.
For patients whose conditions are not serious or life-threatening, the trust seeks to minimise hospital attendances by developing alternative pathways of care.
NWAS collaborates with healthcare partners to develop a range of solutions and optimise opportunities to treat more patients by telephone, at scene and in community settings to help to reduce unnecessary conveyance to hospital – a better outcome for patients and the whole of the NHS system.
The trust has a central role to play in the development of urgent and emergency care as it is uniquely placed as a region-wide service, giving it an opportunity to influence and improve urgent and emergency care delivery across the whole area.
A renowned clinical leadership and supervision structure, enabling career, skills and educational progression for clinicians up to the level of chief consultant paramedic, underpin the urgent and emergency care service.
Resilience
The Resilience team is responsible for the development of effective and valid emergency and contingency plans, which allow the trust to mitigate and respond to risks and hazards alongside multi-agency partners, such as the fire and rescue service.
Such plans include mass gathering events at fixed sporting or entertainment venues and those that occur in town centres or other open venues.
The Resilience team works alongside wider NHS partners in particular, supporting and driving the NHS Emergency Preparedness, Resilience and Response (EPRR) Programme. It achieves this through close working with health partners in the Local Health Resilience Partnership (LHRP) structures.
Two of the country’s Hazardous Area Response Teams (HART) form part of the trust’s Resilience department. HART is made up of specially trained paramedics who attend incidents that have the potential to be more dangerous, those which require a more specialised set of skills, or incidents that are declared a major incident such as those involving chemicals, explosions, unsafe structures, heights, water, accessibility issues and so on.
Emergency Operations Centres
NWAS handles approximately 1.8 million 999 calls every year from the public and healthcare professionals in its Emergency Operations Centres (EOCs) located in Preston, Manchester and Liverpool.
Emergency medical advisors (EMAs) are the first people from the service that patients come into contact with. They use a clinical assessment tool called NHS Pathways to ask questions about the patient’s condition and provide helpful instructions such as how to do CPR to assist a patient in cardiac arrest.
Based on the nature of the illness or injury, patients are prioritised into one of four categories to determine the type of response and the speed at which it will be provided.
Based within the EOC, the trust’s Clinical Hub is staffed by a range of clinicians such as paramedics, nurses, pharmacists, mental health practitioners and so on, who support staff on the road with clinical advice and decision making, and triage patients who call 999 or 111 to determine the best course of action. arrange this.
EOCs also handle requests from healthcare professionals whose patients urgently need taking into hospital, or transferring from one hospital to another.
NHS 111
The trust delivers the NHS 111 service across the region for people who need medical help or advice, handling more than 2.7 million calls in 2021/22. NWAS is the largest provider of 111 in the country.
People who call 111 speak to a specially trained health advisor who asks a series of questions about the patient’s health concern or condition to determine what clinical help they need and where to get it. When appropriate, these calls can be referred to a nurse or paramedic for assessment.
111 can help patients access the most appropriate care; which could come from out of hours’ doctors, pharmacies, community nurses, emergency dentists, walk-in centres, minor injuries units and emergency departments.
The NHS Service Finder used by 111 provides quick access to the Directory of Service (Dos) for healthcare professionals to enable them to signpost patients to the most appropriate service.
Calls from patients who have originally contacted 111, that require an emergency response, go automatically into the ambulance dispatch system for a response.
111.nhs.uk is available for patients online – the service is provided nationally but patients using the online service who live in the North West, that need a clinical assessment over the phone, are referred to the NWAS 111 team for a response.
Patient Transport Service (PTS)
NWAS is the largest provider of non-emergency patient transport across the country, undertaking 1.5 million journeys annually. PTS crews assist eligible patients in getting to and from their healthcare appointments.
The trust currently provides patient transport services in the counties of Cumbria, Lancashire, Greater Manchester and Merseyside – another provider operates within the Cheshire area.
PTS is a contracted service awarded following a competitive tendering process.
The criteria for entitlement to transport is set nationally and depends on specific requirements, medical conditions and mobility, therefore patients must meet the eligibility criteria as defined by local commissioners before using the service.
PTS crews play a vital role in health promotion and prevention by sharing health information and advice to patients and raising concerns to other support services if necessary.
Support Services
Operational service delivery is supported by a number of corporate support service functions.
Patient and Public Engagement
Through active listening, recording feedback and acting on patients’ insights, the trust implements change to reflect patients’ needs. It does this through a range of methods including postal surveys, community engagement events, focus groups, comments cards and the national Friends and Family Test.
To improve patient and public engagement, the trust set about establishing a Patient and Public Panel in 2019. The panel now has more than 200 members and gives a voice to the public, enabling them to influence service design, and has flexible levels of involvement requirements:
- Consult – responding to surveys, giving feedback on strategies, initiatives and publications and providing thoughts on events and campaigns on an occasional basis, often virtually.
- Co-produce – contributing to meetings or discussion groups by providing opinions, experience and expectations to help inform improvements and review how services are planned and provided on a task and finish basis.
- Influence – Taking an ongoing, active role in high-level meetings and committees to enhance decision making and discussions.