South East Coast Ambulance Service NHS Foundation Trust covers a geographical area of 3,600 square miles which includes densely populated urban areas, sparsely populated rural areas and some of the busiest stretches of motorway in the country. The busy Fleet Department, headed up by Justin Wand, has broken away from tradition to provide, not only an efficient, high-quality service centred around the patient but one that enables fleet support staff to be valued as professionals and play their part in the whole care process too. Here, Justin talks to Sue Hurst...
What prompted the need for a complete overhaul of the fleet department back in 2012?
With a five per cent increase in ambulance demand across the area year on year (45,000 additional calls p.a.) it was becoming increasingly clear that to improve efficiency and quality of service whilst delivering costs savings we had to do something different. We needed to transform to meet the requirements of the modern ambulance service whilst developing a culture to match.
Modernising the fleet and medical equipment through innovation and continual improvement was also part of the approach. However, making sure the technical teams gained insight and understanding as to their role in support of patient care helped improve things dramatically – this is the entire ethos behind the modernisation programme.
Improving productivity and enhancing service delivery has been possible through reducing waste, improving quality and making sure the support teams understand they are an important part of the care process.
How has this modernisation programme developed over the years in terms of making the fleet department more commercially viable?
We have developed a ‘Make Ready’ system so that clinicians don’t have to waste patient-care time cleaning and prepping vehicles. Twice daily vehicle checks are also included in this system.
This has meant that we have had to change some of the infrastructure to support workstream and we now have purpose-built depots and have disposed of a number of old ambulance stations not suited to service delivery.
Make Ready is crew-friendly system, designed to maximise patient safety and reduce risk of infection. In real terms, by implementing Make Ready across the entire region we have saved £50m that is reinvested back into the infrastructure and improved patient care.
Additionally, we have invested a lot of time improving quality and standards of the fleet. Standardising the fleet on two main platforms (Mercedes-Benz for our ambulances and Skoda for our rapid response vehicles) has enabled vehicle technicians to focus whilst developing expertise on those specific chassis.
The medical equipment has also gone through the same refinement process. Each vehicle has a standard load list and the layout is the same across the fleet enabling the clinical staff the opportunity to focus on what is important – responding to the patient!
Finally, a robust driver safety programme has been developed that includes new technology linking a telematics system and CCTV. These are synced to give an overall perspective of the challenges faced by our staff when delivering care.
In addition a Dynamic Speed Controller has also been fitted to vehicles that restricts speed during normal driving. As soon as blue lights are activated the vehicle is derestricted. This technology has contributed to a 13.2% saving on fuel which equates to approx. £800,000/year.
The team has looked at the problem holistically and aims to reward drivers with ‘Clever Miles’ rewards as the system beds in. The quality of driving plays a critical part in the experience of the patient – Comfort, Satisfaction, Outcome. Good, safe driving also has knock-on benefits from a fleet management perspective too – less RTCs, lower insurance premiums and less wear and tear results lower maintenance costs.
We have also seen a drop in critical vehicle failures of about 75%, meaning more vehicles are available more often.
What issues and challenges is the department currently facing?
The pace of change is key for us. There has been a significant change in demand on the service and technology also, it is having an impact on what we do behind the scenes, affecting our business decisions and how we manage our ever changing pattern of demand.
The fleet and technological infrastructure also needs constant review and investment to ensure we are as smart as we can be and the vehicles are all operationally effective.
How important is it to gain accreditations and awards and what does it mean to the Trust?
Gaining accreditations and receiving awards has proven to be crucial. They have helped
validate the quality of services offered and allowed us to raise the profile of the Trust in a positive way.
For example, SECAmb received the Freight Transport Association’s Van Excellence accreditation earlier in 2015. SECAmb is one of only three ambulance trusts to have gained the accreditation and our team is very proud of this.
The Van Excellence audit looked at our fleet management, maintenance and repair standards, vehicle roadworthiness, workforce licence checking, vehicles specifications, driver training, safety initiatives, and recruitment and how the vehicles were operated on a day-to-day basis. The accreditation provides assurance to patients and commissioners of the quality and standard delivered by the Trust.
Last year we won Public Sector & Blue Light Fleet of the Year at the Commercial Fleet Awards. Judges praised our development of the national ambulance driver risk indexing tool as well as our driver performance management. We were also proud to
receive highly commended in the GreenFleet awards.
Most recently, the Trust has been shortlisted for six 2016 Fleet News Awards: Fleet of the Year – 251 - 1000 vehicles, Most Improved Fleet of the Year, Safe Fleet of the Year, Green Fleet of the Year, Cost Saving Initiative of the Year and Fleet Manager of the Year…so wish us luck when the winners are announced on 10 March!
Would you ever consider purchasing Electric or Hybrid Vehicles on the
In the next couple of months we will be taking delivery of 15 Mitsubishi Outlander PHEVs in recognition of the Trust’s environmental agenda. It’s important that we embrace this kind of technology rather than looking to run all diesel vehicles where particulates are proven to have an impact on health.
After a successful bid for funds by Julia Brown, the Trust’s sustainability manager, the Outlander PHEVs are being part funded by the Office for Low Emission Vehicles (OLEV) and will be the first fleet of hybrid vehicles entering into front line services. Tied to high speed chargers these state-of-the-art Hybrids will be deployed in the towns and cities of Kent, Surrey and Sussex.
How do you make decisions about which vehicles and equipment you source for your fleets in terms of choosing manufacturers/converters?
The main tactic around how we choose a chassis for our ambulances is based around operational requirements – that’s capability and not the badge. A great illustration of this is our rapid response cars, our Skodas are all AWD vehicles to maximise their flexibility in adverse weather and on rough terrain. They are good for operational staff who are used to driving a car as a response vehicle and are big enough to cope with various equipment whilst not impacting too much on the environment.
The frontline ambulances are Mercedes-Benz chassis with high quality box conversions – it’s not the cheapest option, but in terms of longevity and whole life costs it makes sense. We look to run the cars for five years and the ambulances for seven years. An emergency ambulance will cover about half a million miles in its operational life.
Is the fleet serviced and maintained in-house or do you use an external provider?
We have a network of in-house servicing and maintenance facilities with an incredibly skilled and experienced team of technicians. I feel if we outsourced this side of fleet management we could lose control of the asset and, ultimately, increase downtime.
Additionally, through the sterling work of one of my fleet operations managers, Mike Bowron, we have been able to embark on an apprenticeship scheme and are learning about what it takes to support and develop local talent. One apprentice, Jorden Snell, has already gone through the process and we are working with local colleges to train, recruit and retain more mechanics for the future.
What other kinds of ideas will help the ambulance fleet of the future?
In my view driver risk and behaviour is a crucial element of the patient experience and fundamental to operating a safe and effective fleet.
Driver analytics, collected and reported through Ferno’s ACETECH advanced vehicle intelligence system provides a really good steer on how certain drivers perform, highlighting what type of intervention they might need and, more unusually, I believe we can use this data to understand how driver behavior effects the patient. For example, ‘G’ forces may affect somebody suffering a heart attack or stroke – I am keen to explore this kind of non-traditional idea and this definitely seems to have gained some recognition internally in other authorities and emergency medical services.
Again, with the patient in mind, we have also been working FERNO to make major breakthroughs with an Integrated Patient Transport & Loading System. This is a project which directly challenges the traditions of ambulance design. The system enables a modular approach for equipment and will improve ergonomics for paramedics resulting in a direct contribution to improved patient care.
Do you think there is a place for shared services within the public sector?
The idea of shared services within emergency services is a hot topic at the moment and whilst there are many pros and cons we have to be really clear how this collaboration may affect our core role and operational specialties.
Over the last decade Ambulance services nationally have amalgamated across regions reducing from 35 services to 10 Trusts, the economies of scale that this releases are significant and it has provided enough critical mass to transform services discussed in this document. Further opportunities for joint responding, shared HR, Finance, IT, collaborative purchasing and procurement or other back-office services are areas that could work. In my view it’s too lean a proposition otherwise.
What is the most rewarding element of your role?
I enjoy growing and developing the team that has changed dramatically in recent years. Staff now feel part and parcel of the whole care process and it’s rewarding to know that the team is valued for their professionalism.