The first Hazardous Area Response Team (HART) unit to be set up with the assistance of external change support
Great Western Ambulance Service (GWAS) NHS Trust provides emergency and urgent care as well as patient transport services across Wiltshire, Gloucestershire and the former Avon. While GWAS is the smallest ambulance trust in the UK, it covers a significant geographical area, some 3,000 square miles with a population of almost 2.4 million people.
The trust employs more than 1,700 staff across 33 operational sites and its headquarters, including 30 ambulance stations and three emergency operations centres.
Context
The Hazardous Area Response Teams (HART) initiative was born from a need for ambulance service paramedics to triage and treat patients within hazardous and contaminated areas. This is expected to save lives and improve outcomes for patients through earlier intervention.
The creation of GWAS’s HART unit took place under challenging circumstances. The schedule was advanced 6 months by the DH with a timeframe to delivery of just one year. At the time, capacity and experience around project and programme delivery within the Trust was low. This was a considerable undertaking and included the first capital build project since the original merger that formed the Trust.
Introduction
The programme to set up the new HART unit had to be cost neutral to the Trust. It could not be a drain on skills, resources or budget. A key condition was preventing any negative impact on the Trust’s key performance targets. The Trust had one other stipulation: this unit had to be well integrated into the Trust. It was not to have an elitist culture and must respect the role played by the rest of the Trust in the care pathway, particularly as transfer would be handled by other units.
Given the constraints, and the historical capacity external support for the programme was recommended and the Trust engaged Practicus – making this the first HART unit to be set up with the assistance of external change support. "This was a considerable undertaking and included the first capital build project since the original merger that formed the Trust."
Budget
- Implementation £1m
- Refurbishment £2.7m
- Annual budget £2.8m
Deliverables
- Evidence-based business case to secure funding
- Memorandum of understanding
- Capture best practice and lessons learned from other HART units
- Recruitment, Training & HR elements
- Procurement
- Indentifying a fit for purpose estate to create the unit
- Delivering temporary accommodation
- Capital build and Refurbishment of new secure site
- Operational Readiness
- Transition to BAU
Stakeholder Management
Despite the direction from the board prohibiting impact on the wider Trust, this programme could not take place in splendid isolation. In fact, stakeholder management across multiple functions and operational teams would prove key to success and maintaining performance targets.
"It is testament to the consistent quality of the new facility that it was not only fit-for-purpose from day one but that staff have been unable to work out which aspects of the building are refurbished and which are new build"An excellent example was building the team of 43 paramedics, all of whom had to be recruited, trained and retained in a very short period. With a shortage of paramedics nationally, the best prospect for gaining these skills in the tight timescales would be looking internally. This required strong collaboration with both operations and HR to recruit paramedics from the main teams while back filling their roles with an external recruitment campaign to maintain numbers. Understandably, operations had a fear of losing too much capability too quickly to meet A&E targets and a careful plan was jointly constructed that would prevent dips in performance.
Procuring for a new unit
Procurement of the equipment for the new unit involved not only special purpose vehicles but all new safety critical systems as well as the specialist equipment and apparel to be used by the paramedics themselves. It involved more than 100 different types of item, all of which needed to be fit-for-purpose, high quality and procured on a limited budget. Moreover, procurement of the refurbishment works needed to take place through the Procure21 framework, requiring specialist experience.
Managing 3rd partiesThe capital build project necessitated a close working relationship with a construction and engineering firm to deliver a high quality, secure building within 14 weeks of the agreement of the contract. It required an assertive but collaborative management approach – providing enough flexibility to enable the 3rd party to meet the challenging timeframes and adjustments to the plans but with robustness to ensure the Trust’s expectations were met.
For example, in order to meet the Trust’s requirements for the unit to be culturally well-integrated into the wider organisation, it was decided to provide additional space and facilities for other teams to be co-located. However, without knowing exactly which business units would collocate at the beginning of the process, considerable flexibility was required by the third party to meet emerging needs.
staff have been unable to work out which aspects of the building are refurbished and which are new build. It is testament to the consistent quality of the new facility that it was not only fit-for-purpose from day one but that staff have been unable to work out which aspects of the building are refurbished and which are new build."The implementation of the HART unit is considered an example of best practice by the DH and resulted in a GWAS CEO award for the key Practicus change practitioner involved."
Outcome
The Trust now has its HART unit which is responding to circa 90 callouts a month based out of a fit for purpose site. The unit is integrated with the rest of the Trust to create a supportive environment. In fact, rather than being a drain on the trust’s resources, it is providing additional state-of-the-art facilities that can be used by other teams. This additional space has facilitated the start of the implementation of an ambitious estates strategy for the Trust responding to the development needs of the organisation and its ambition to improve patient care.
The implementation of the HART unit is considered an example of best practice by the DH and resulted in a GWAS CEO award for the key Practicus change practitioner involved.
Other benefits:
- Delivered in time and under budget
- Increased the Trust’s confidence in project-based working
- Cost neutral to the Trust
