ANNUAL REPORT 2016-17

NHS

AM

BULANCE SER

VICE

Contents

1.0 General Overview 3

2.0 Capabilities 4

3.0 Training and Education 5

4.0 Compliance 6

5.0 JESIP 7

6.0 Communications and Stakeholder Engagement 8

Annex A 9

Overview of NARU Compliance andQuality Assurance 9

Summary Compliance and Quality AssuranceSuccesses for 2016/17 10

Whole System Review 10

Standard Operating Procedures 11

Policy Development 11

www.naru.org.uk

2

Contents

NHS

AM

BULANCE SER

VICE

NARU operates under the remit of NHS England who approveNARU’s Annual Business Plan, Workplan and Risk Registerand all three of these documents were approved by the NHSEngland Steering Board at the start of the year. In 2016/17NARU received funding of £5.35M for this work and a further£5.6M but this latter sum was immediately passed-through toAmbulance Service providers to support specific areas of work.NARU finished the year within its budget with increasedefficiencies and service improvements which were used to fundnew initiatives and extra in-year commitments for NHS England.

NARU worked with Ambulance Service Trusts in Englandas well as the Devolved Assemblies and Crown Dependenciesto help them meet their required standards and improve heir responses.

In preparation for the Care Quality Commission (CQC)inspection of WMAS, the Trust conducted an internal reviewof NARU and considered it exemplary.

The NHS England Steering Board has recently approved theNARU End-of-Year Workplan which successfully completed allthe work that NARU was tasked to undertake either at the startof or during the course of the year. This report will now reportupon specifc areas of work successfully undertaken by NARUand its staff in the various disciplines.

The National Ambulance Resilience Unit (NARU) - ANNUAL REPORT 2016-2017

1.0

General

Overview

3

1.0 General Overview

Mission

NATIONAL AMBULANCERESILIENCE UNIT

Our MissionPreparingfor theFuture,ProtectingLives Today

This Annual Report has been prepared for stakeholders by Keith Prior, Director, National AmbulanceResilience Unit (NARU). The report provides a narrative and commentary for the period March 2016 toMarch 2017 with progress in main areas highlighted.

Keith PriorNARU Director

2.0

Capabilities

www.naru.org.uk

4

2.0 CapabilitiesKey markers in the Capabilies area are;

PROCLUS dashboard functionality has been enhanced

(National telephone directory, dashboard reporting,

dairy and movement sheet).

Contracts were awarded, after competitive tender,

for the HART Replacement vehicle to WAS UK Ltd and

Wilker and that for the HART Incident Ground

Technology Contact to Excelerate Technologies Ltd.

The research for Phases 1 & 2 for the development of

the NARU Special Operations Recruitment and Selection

Manual has been completed.

Project SULIS reviewed the current clinical

decontamination procedure and identified and evaluated

an optimised, evidence-based revised procedure.

A FAQ sheet has been produced for Initial Operational

Response (IOR) and Nerve Agent Countermeasures.

The NARU Central Stores based at Winterbourne

Gunner in Salisbury have achieved CQC compliance.

NHS

AM

BULANCE SER

VICE

In addition the Faculty has:

Enhanced the practical exercise facilities enabling

more staff to train for the same cost, demonstrating

value for money.

Supported the safe system of work project with development

of training information sheets and competencies.

Introduced competency assessed command education

for Ambulance Tactical and Operational commanders,

well attended and a significant enhancement of capability.

Supported multi agency strategic command courses and

CBRNC command courses.

Supported MTFA National multi agency programme

throughout the year.

Assisted in the planning and supported national exercises

throughout the year.

Conducted Exercise AMBER 3 the largest Ambulance

Service exercise in the UK.

The National Ambulance Resilience Unit (NARU) - ANNUAL REPORT 2016-2017

3.0

Training

and Education

5

3.0 Training and EducationThe Training and Education Faculty has successfully delivered the planned programme of courses forthe year to support HART operations with over 1,000 delegates attending courses and workshops.USAR courses were increased to meet demand as well as MTFA responder courses as an outcome of theNARU MTFA survey.

23RD MARCH 2017, UK

4.0

Compliance

www.naru.org.uk

6

4.0 ComplianceCompliance is one area which has changed and advanced the most in the last year. It is important thatthe reader understands what ‘compliance’ means to the Ambulance Service in this context and the workbeing undertaken by NARU in this area. To that end Annex A (Page 9) gives a detailed resume of NARU’scompliance work.

NHS

AM

BULANCE SER

VICE

The National Ambulance Resilience Unit (NARU) - ANNUAL REPORT 2016-2017

5.0

JESIP

7

In order to support this have:

Reviewed the Joint Doctrine and

published edition 2.

Designed and delivered updated

commander courses to further support

the joint training of commanders.

Designed and delivered an all staff

training package which can be

delivered via e-learning or in a classroom setting.

Updated the mobile App which is now available across

all main mobile platforms.

Delivered two update days for delivery leads and trainers

with over 100 people attending.

Continued to support the national CT exercise programme

with scenario build, objectives and umpires.

Identified a replacement for the JOL system with an aim

to making the capture of lessons and searching for inputs

much simpler and robust.

Begun the assurance programme visiting every Ambulance,

Fire and Police service in the country to assess the levels

to which JESIP is embedded into business as usual. This

programme will run through to August 2017.

5.0 JESIP (THE JOINT EMERGENCY SERVICES INTEROPERABILITY PROGRAMME)The JESIP team have continued to promote interoperability across the emergency services and widerresponder agencies.

JESIP’s stated aim is:

To ensure the blue lightservices are trained andexercised to worktogether as effectively aspossible at all levels ofcommand in responseto major or complexincidents (including fastmoving terroristscenarios) so that asmany lives as possiblecan be saved.

“

”

6.0

Communications and

Stakeholder Engagement

www.naru.org.uk

8

In particular, NARU has focused on:

Developing relationships across all ambulance services,

NHS England, commissioners, the wider NHS health

economy and across Government Departments and

communicating clearly with the other emergency services

about the remit and range of the NARU work programme.

Ensuring the NARU website continues to be a leading,

industry-standard shop window explaining how NARU

works and provides users with the opportunity to

communicate with us and receive immediate responses

to their various queries. The site, combined with our daily

social media and general communications activity

(such as our regular online NARU newsletter) also gives

patients and the public information about how NARU

is contributing to national resilience on a daily basis.

Attending AMBITION (the annual event for professionals

working in the emergency preparedness, resilience and

response field, linked to the Counter Terror Expo in

London) which was a valuable way to meet suppliers,

counterparts from other emergency services and related

government agencies, and representatives from other

countries, who are always keen to learn more about

NARU and in particular, our world class training facility.

The publishing work has continued throughout the year,

providing various important items of national ambulance

service guidance and training materials for use by all

NHS ambulance services.

NARU released two important awareness films in 2016.

The first was aimed at Ambulance Service Board

Members to raise awareness of the corporate liabilities

arising from the specialist capabilities. The second was

aimed at NHS Commissioners to raise their awareness

of the role that interoperable capabilities play in UK

emergency preparedness.

6.0 Communications and Stakeholder EngagementDuring the past year, NARU has continued to work hard to ensure key stakeholders understand moreabout the work we do and why we do it.

NHS

AM

BULANCE SER

VICE

The National Ambulance Resilience Unit (NARU) - ANNUAL REPORT 2016-2017

A

Annex A

9

NARU is responsible for coordinating and maintaining a set

of nationally interoperable capabilities. They include:

Hazardous Area Response Teams (HART),

Marauding Terrorist Firearms Attack (MTFA),

Chemical, Biological, Radiological and Nuclear (CBRN),

Mass Casualties.

Each of these capabilities extend NHS care into the high-risk

area of complex emergencies to save life and improve clinical

outcomes.

During 2016/17 these capabilities were responded to over

12,689 incidents and the capabilities were utilised at over

6,913 incidents to provide patient care in high-risk areas.

In extending its reach, the NHS has also extended its legal duty

of care, both to employees and to those critically in need of its

services. It has increased its exposure to risk at these incidents

exponentially. The capabilities that facilitate this care must,

therefore, be subject to clear standards and a nationally

consistent safe system of work. NARU facilitates this through

its ‘Compliance and Quality Assurance’ activities.

NARU’s Compliance activities involve setting and monitoring

national standards. Its Quality Assurance activities involve

reviewing and improving those standards. Both of these are

done with the aim of keeping Ambulance Service specialist

responders safe whilst taking calculated risks to improve

the clinical outcomes of patients caught within dangerous

environments. NARU works closely with a range of

stakeholders to develop these standards, including Regulators,

NHS Commissioners and various responding agencies. NARU

also works closely with NHS England and the Department of

Health to develop policy which is consistent with the balance

of risk described above.

As always, it is essential that the Ambulance Service

undertakes this work in a manner that achieves the greatest

efficiency from the public funds allocated. Over the last 12

months this is exactly was has been achieved - more for less.

Annex A to NARU Annual Report 2016/17Overview of NARU Compliance and Quality Assurance

RESPONDED TO OVER

INCIDENTS

12,689CAPABILITIES UTILISED AT OVER

INCIDENTS

6,913

A

Annex A

www.naru.org.uk

10

NARU has conducted a

comprehensive review of

the national safe systems of

work for each interoperable

capability. In conjunction

with the Health and Safety

Executive and other

stakeholders we have

developed a new

Compliance and Quality

Assurance Framework

which was published in 2016,

see opposite.

Compliance and Quality Assurance FrameworkThe Safe System of Work for Nationally Interoperable Capabilities

Summary Compliance and Quality Assurance Successes for 2016-17

WHOLE SYSTEM REVIEW

QUALITY ASSURANCE

Ongoing Maintenance

Safety Notification System

Change Management Process

SOP Amendment Process

Learning Lessons Process

Service Specifications

Capability Matrices

CONTROLS

RISK ASSESSMENT

National Standard Operating Procedures

Monitoring

Support to National Policy Development

National Assurance Courses

Physical & Psychological Evaluation Process

National Operations GroupNational Trainers ForumNational Equipment GroupClinical Reference Group (NARU)

Reviewing & Improving Standards

COMPLIANCE

NHS Contract Standards

Setting & Monitoring Standards

Annual Whole System Review

Service SpecificationsCapability MatricesStandard Operating ProceduresResilience & Capability SurveyReview of legal and regulatory provisionsProcedures

Rescue PlansOperational Risk AssessmentsEquipment Data SheetsTraining Information Sheets

Audit / Reviews / InspectionsAssurance Support to NHS EnglandCommissioning SupportSupport to RegulatorsResource Level MonitoringRoot Cause Analysis Investigations

ACTIVITIESEQUIPMENT COMPETENCE

NHS

AM

BULANCE SER

VICE

The National Ambulance Resilience Unit (NARU) - ANNUAL REPORT 2016-2017

A

Annex A

11

STANDARD OPERATING PROCEDURES

To ensure effective national interoperability, NARU

develops Standard Operating Procedures (SOPs) for each

of the interoperable capabilities.

In 2016/17 NARU has undertaken a root and branch review

of the HART and MTFA SOPs. They have been subject to

extensive research and consultation. They have also been

re-formatted into the revised safe system of work framework.

A bespoke online interface has been designed to facilitate

rapid access to operational activities and controls. This

innovative system is unique in the emergency services.

STANDARD OPERATING PROCEDURES

During 2016/17 NARU has worked closely with NHS England

and the Department of Health to develop policy in several

important areas. NARU developed a new operating model for

the Mass Casualty Capability which has received Ministerial

approval and a range of enhancement options for the MTFA

capability have been put forward. NARU has also produced a

new contract service specification for Ambulance Command

and Control which will enhance and standardise the quality

of Ambulance Commanders throughout England.

The National Ambulance Resilience Unit (NARU)ANNUAL REPORT 2016-17

For further information please contact:

National Ambulance Resilience Unit (NARU)

Website: www.naru.org.uk

© National Ambulance Resilience Unit (NARU). Produced by NARU Communications and Stakeholder Engagement, May 2017.

NHS

AM

BULANCE SER

VICE