1

Endorse the continuation of the existing service model, namely the provision of emergency ambulance services by an external provider.

YES – by WA Health which finalised its 2009-10 to 2012-13 Contract with SJA in 2011. However it did take two years to complete this Contract. The current contract will be extended to 30 June 2014 and a new contract negotiated with a new funding model.

2

Implement, as a matter of urgency, all recommendations (both general and specific) emanating from the Root Cause Analysis process:

i. Review and align call taking process to current best practice in the ambulance industry, taking into account clinical skills of call takers and structured call taking systems

ii. Strengthen the role of the team within the communication centre, building on the role of the Clinical Team Leader and the Manager State Ambulance Operations, thus ensuring these positions are used as a first point of reference for any clinical issues which are unclear or ambiguous

1. Develop and implement a focus on clinical decision making in the call taking phase

iv. Develop and implement a focus on clinical follow up and provision of clinical advice at all times for all calls, as a matter of priority

v. Introduce an audit process for the delineation of call prioritisation as part of a continuous improvement culture.

Substantially – by SJA although it did not agree about what was best practice for call taking

i. Structured call taking, as used in many other Australian and overseas ambulance services but which SJA did not agree was best practice, is implemented [Substantially]

ii. Rather than building on the role of Clinical Team Leader and Manager State Operations, Clinical Support Paramedics (CSPs) have been introduced into the communication centre to provide 24/7 support to call takers, paramedics and volunteers on clinical issues which are unclear or ambiguous [Yes]

1. Structured call taking includes clinical determination of the nature and priority of patient condition, although call takers’ discretion is removed. Any problems arising are to be dealt with after the call [Substantially]

iv. Structured call taking includes structured clinical advice to callers and CSPs are available if more complex cases are identified and have capacity to escalate to rostered medical practitioners [Yes]

v. SJA has implemented largely automated call prioritisation and dispatch, supported by auditing of calls and 24/7 monitoring of ambulance tasking by dispatchers [Yes].

3

Improve the response capacity of the SJA communication centre through:

i. Increased staffing levels of call takers and other key communication centre personnel

ii. A staff performance management and development program with individual plans for all officers

1. A review of training and continuing education, specifically in relation to standards and guidelines for questioning callers, prioritisation, pre-arrival advice, and call card documentation

iv. Examining the feasibility of splitting calls between ‘000’ and other calls

v. Considering the geographical split between metropolitan and country regions

vi. Requesting SJA to remedy the ‘freezing’ of the Computer Aided Dispatch (CAD) network immediately

1. A quality audit of calls against specific standards and guidelines.

Ongoing – by SJA

i. There are increased numbers of call takers and other key communication centre personnel [Ongoing]

ii. Performance management has been implemented and there is a standard development program but these are not individualised for call takers [Substantially]

1. Training and continuing education was reviewed as part of the implementation of structured call taking. No discretion is now exercised by call takers so training and continuing education is more focussed on structured call taking requirements and SJA information technology systems [Yes]

iv. Feasibility of splitting calls was considered but not implemented. SJA no longer considers it relevant because of other changes and targets being exceeded [Yes]

v. There are no specialised country dispatchers, but there are metropolitan and country dispatch desks. [Ongoing]

vi. The indexing problem at the time of the Inquiry has been fixed. ‘Locking’ can still occur, to a lesser degree, but there is a dedicated CAD IT technician to deal with this [Ongoing]

1. Auditing of calls for compliance with structured call taking has been implemented [Yes].

4

Investigate further the feasibility of introducing structured call taking in the communication centre.

Yes – some investigation of the feasibility of structured call taking was undertaken by SJA but no report is available. No agreement was reached between SJA and WA Health about its merits although it was implemented by SJA.

5

Invest in ambulance service infrastructure—both staff and capital—to ensure an appropriately responsive and sustainable service.

Yes – WA Health invested an additional $100 million in SJA staff and capital in the four years following the Inquiry, with another $40 million budgeted for 2013-14, based on SJA’s funding submission. With this investment, SJA has recruited significant numbers of new staff and invested in physical infrastructure and technology. Because SJA is operating more efficiently it is currently meeting some, and almost meeting the rest of its metropolitan ambulance response time targets despite operating at lower than the standby capacity that was the basis for SJA’s funding submission.

6

Ambulance needs in country areas to be the subject of further assessment.

Ongoing – further assessment was done by SJA, but no report is available. With increased WA Health funding, SJA increased paramedic resources, increased its support for volunteers and regionalised corporate support staff. More still needs to be done to strengthen the country service and ensure its sustainability.

7

Expand the existing continuing education program to enable all paramedics, transport officers and volunteers to have their skills updated.

Yes – SJA expanded the continuing education program for paramedics, transport officers and volunteers although the number of paramedics attending compulsory training declined in 2011.

8

SJA develop and implement clinical governance structures and processes that align with the Strategic Plan for Safety and Quality in Healthcare 2008–2013 and the WA Clinical Governance Framework.

Ongoing – SJA has developed these clinical structures and processes and has commenced implementation. More is still to be done for clinical governance in country areas and through the implementation of longterm recommendations identified by an external 2011 clinical governance audit.

9

SJA notify and report sentinel events to WA Health’s Director Office of Safety and Quality in Healthcare.

Ongoing – SJA is notifying and reporting sentinel events, although in some country areas there are no processes to assist in the identification and reporting of possible sentinel events.

10

WA Health pursues, through the Australian Health Workforce Ministerial Council, the national registration of paramedics.

Ongoing – WA Health has done substantial work on pursuing registration although this is ultimately an issue for the Council who will make a determination once they receive and consider a regulatory impact statement, which is currently being developed.

11

Strengthen the capacity of the complaints system including a statement of principles, establishment of a helpline and online complaints registration.

Yes – SJA has done much to strengthen its complaints system. WA Health could do more to make sure its staff is aware of these changes.

12

During the implementation phase, further work to be undertaken in the following areas:

Alternatives to Emergency Department attendance

i. Strengthen the role played by healthdirect in the management of non-urgent Priority 3 calls

Helicopter service

ii. Review the tasking process to ensure that this resource is properly utilised

1. Examine in more detail the proposal of CareFlight to provide a critical care helicopter service to the Southwest Region

Legislation

iv. Pursue the implementation of State legislation to control the operations of the existing ambulance service

Inter-Hospital Patient Transport (IHPT)

v. Examine the separation of IHPT tasking from the emergency tasking process

vi. Examine opportunities to streamline the current IHPT processes

1. Examine the possibility of a computerised IHPT tasking function.

Ongoing – further work was done by SJA and WA Health but with mixed results:

Alternatives to Emergency Department attendance

i. SJA strengthened the role played by healthdirect but 13 per cent of calls are sent back to SJA [Ongoing]

Helicopter service

ii. SJA (with others) reviewed tasking but categorisation of calls and agency responsibility remains problematic [Ongoing]

1. WA Health has identified a process to determine whether any additional helicopter services are needed [Ongoing]

Legislation

iv. WA Health pursued the implementation of State legislation but this was not supported by the Department of Treasury’s Regulation Gatekeeping Unit which prefers the development of contracted standards. Contracted standards are to be developed and implemented for future contracts with ambulance service providers [Ongoing]

Inter-Hospital Patient Transport (IHPT)

v. -vii. Work was done in this area by WA Health but no outcome was achieved [All ongoing].

13

Establish an implementation team, led by an independent chairperson, to oversee the implementation of all recommendations and report to the Minister for Health in 6 and 12 months.

Substantially – Government appointed the Inquiry Chairperson as implementation chairperson to oversee the implementation of all Inquiry recommendations and we have the 12 month report to the Minister (‘the implementation report’).