Introduction

This document sets out the strategic direction for the communications, engagement and involvement activities of North West Ambulance Service NHS Trust (NWAS) for the period 2024 to 2027 NWAS is geographically the largest ambulance services in the country and as a key service provider, has numerous stakeholders with whom it needs to have effective relationships, in order to deliver the trust’s vision and strategic objectives.

The provision of urgent and emergency care for patients continues to evolve as detailed in the NHS Urgent and Emergency Care Recovery Plan. The current service model advocates helping people access the right care, the first time by embedding 111 as the first port of call and expanding new services in the community – thus reducing the need to go to hospital. Whilst we continue to see the growth of digitally enabled care, we have also increased our workforce. We now have more 111 clinicians and emergency medical technicians increasing our capacity to help those in need. Working collaboratively with our Integrated Care Boards (ICB) and Integrated Care Partnerships (ICP), this means that where, and how patients are assessed and treated for their care is changing, to ensure services and organisations are effective and sustainable for the future and patient experience is improved.

This strategic plan has been reviewed to ensure it remains up to date, reflecting the current environment, and adapts to the varying needs of the organisation. This includes increasing demand on ambulance services and an emphasis on urgent and emergency care recovery, changes to our infrastructure with the introduction of Integrated Contact Centres, a greater focus on digital technologies and a new operational leadership model.

It also reflects improvements in ambulance service culture, Freedom to Speak Up and a focus on both staff and patients from mixed ethnic backgrounds, supporting the trust’s plans to improve inclusivity, diversity and reduce inequalities.

This strategic plan will directly support delivery of the trust’s current strategic priorities to achieve our aims and ultimately, our vision. of delivering the ‘right care, at the right time and in the right place; every time’ for all patients. Supporting communication actions and activity will also be aligned to the trust’s new strategic priorities when these are confirmed in 2025. TA key driver for this strategic plan over the next three years is to close the gap between public perception and expectation of the ambulance service, and what its future offer and operating model looks like.

Our evolving digital strategic plan brings together the implementation of a significant number of digital enabling solutions to bring benefits for staff, patients and partners. Our future delivery of urgent and emergency care is dependent on these solutions.

The trust continues to improve its service model to ensure patients with serious or life-threatening emergency conditions receive timely, high quality care to maximise their chances of survival and recovery. By developing and implementing a robust integrated urgent care model, which provides highly responsive and personalised services for those people with non-life threatening conditions in the community, we will not only improve services for patients but also continue to help to ease the pressure on the emergency health system.

An ongoing focus for the trust is our management of calls that come in to 999 and NHS 111. Giving people advice and arranging treatment for them over the phone (‘Hear and Treat’) or on scene (‘See and Treat’) remains vital to enable us to transform patient care. Whilst we have made considerable progress in the last few years, we will continue to work hard to increase the number of both Hear and Treat and See and Treat patients, when clinically safe to do so.
This will also reduce pressure on other emergency services and the number of patients we ‘See and Convey’ to hospital. An additional benefit is to reduce the number of patients who attend A&Es, which is vital to keep urgent and emergency care services available to those who really need them.

Effective two-way communication with the public and patients, staff and partners will improve the services NWAS provides, strengthen our reputation and achieve mutual understanding of our goals and the needs of our patients and staff. As advocated by the NHS England Patient and Public Participation Policy (November 2015), NWAS embraces a commitment to listening to and involving communities, their representatives and others, in the way we plan and provide our services.

The Communications and Engagement Strategic Plan supports these aims by developing our vision and values into a compelling narrative about the changes that we want to make – with stories and campaigns that can explain to our staff, patients and the public why and how we are changing. We will continue to listen to the needs of our patients and local communities, support managers and clinicians to work together on improving quality and involve our patient and public panel members in the redesign of services that better meet the needs of our communities, his strategic plan’s main aims are to ensure effective and inclusive communication and engagement, ensure the patient voice is at the heart of the
organisation and support the delivery of excellent care for our communities.

Scope

The strategic plan covers the trust’s strategic approach to communication and engagement with all key stakeholders in particular patients and the public, staff, partners, members, volunteers, political influencers and statutory organisations. It is delivered by the Communication and Engagement Team, which is split into two dedicated sub teams providing the full mix of communications and patient engagement and involvement services. The Communications Team provides staff and stakeholder engagement, press office, film; website, campaign and event management, using the full range of digital and traditional media channels. The Patient Engagement Team manage the trust’s Patient and Public Panel, an annual programme of specialist patient and community engagement, community listening events, the Friends and Family Test and the proactive distribution, receipt and analysis of thousands of patient experience surveys in order to better understand the needs of our patients, realise service improvements and enhance patient experience. In addition to this, the trust’s FOI Officer works within the Communications Team to ensure our mandatory duties in responding to these are met.

The strategic plan is monitored by the Strategy Partnerships and Transformation Directorate, Trust Management Committee and Board of Directors and is delivered via annual business plans. Patient and Public Panel and community engagement activities are also reported to the trust’s Board and Diversity and Inclusion Group.

This plan underpins the communication and engagement requirements of the trust’s overall strategy, the integrated business and operational plans as well as individual directorate strategic objectives.

Background and context

In spite of our high number of stakeholders, the size and spread of the area that we serve, and the growing reliance on social media and other digital channels, we continue to work hard to communicate with our communities using a range of face to face, electronic and digital channels… This strategic plan supports the continued exploration of innovative and efficient ways to engage and listen with as wide a group of stakeholders as possible, using their communication channels of choice.

This approach has been enhanced through the trust’s investment in the development and implementation of a Patient and Public Panel. Effective engagement and genuine patient and public involvement in service improvement can be a challenge, so by engaging with panel members based on the level of participation they are able to offer, and in a clear and structured way, it is intended to maximise all levels of involvement. The trust has worked hard to continue to recruit, induct and offer meaningful engagement opportunities with Panel members and we have now reached our target membership of 350 members. In the months to come we will now focus on maintenance of our valued membership, together with a range of investment and development opportunities.

Learning from the Francis report (February 2013) outlined the absolutely essential need for organisations to put patients at the heart of its services and listen to the views of patients and staff in order to deliver the very best standards of care. NHS England’s statutory guidance on ‘Working in partnership with people and communities’ (July 2022) similarly confirmed without insight from people who use, or may use, services, it is impossible to make truly informed decisions about service design, delivery and improvement.

The ways in which services are provided by the ambulance service have and will continue to change, to meet demand and to ensure patients receive the right response for their needs. This is relevant for all service areas the trust provides, emergency, urgent care including NHS 111 and patient transport services, emergency preparedness and resilience. These are supported by a number of corporate service teams including Strategy, Partnerships and Transformation, Human Resources and Organisational Development, Finance, Quality, Innovation and Improvement, Corporate Affairs and our Medical Directorate.

In 2017 the trust adopted the new ambulance response model which focused on getting the right resource for the patient’s needs first time, a significant change in terms of approach, fleet and culture. In the early part of 2019, NHS 111 online went live, and the trust actively supported the national awareness campaign, as well as rolling out a supporting North West campaign which included a mix of digital and face to face engagement work. In December 2020, the trust played a key role in the delivery of the new NHS 111 First model throughout the North West region, working closely with NHS England and Improvement colleagues to develop a consistent regional approach and produce a range of assets, materials and communication toolkits to support this work.

The ever changing landscape of the NHS means that effective communication and engagement is vital to ensure that stakeholders are aware of and understand how the trust works with other partners to provides services. The Health and Care Act of July 2022 saw the establishment of geographically placed integrated care systems, partnerships that bring together providers and commissioners of NHS services with local government and other local partners to create shared plans and forge new relationships to benefit the population.

The NHS Constitution establishes the principles and values of the NHS. It includes staff pledges, which state what the NHS expects from its staff and what staff can expect from the NHS. We view this as part of our commitment to being a good employer, making our staff feeling valued. NWAS will ensure that all engagement activities comply with the underlying principles of the Constitution and that of the NHS People Promise – to work together to improve the experience of working in the NHS for everyone.

The evidence to date also shows the North West suffers from worse health inequalities and worse health outcomes than other regions. Our stakeholder engagement plans must include a focus on public health in order to support a reduction in this effect.

The trust has a duty under the Health and Social Care Act 2006 to involve and consult with patients and the public in the way it develops and designs services. This strategic plan describes our approach to involvement, participation and consultation as well as our duty to warn and inform the public as a category 1 responder within the Civil Contingencies Act 2004.

We are committed to a Duty of Candour and this strategic plan reflects a position of openness and transparency in our communication with the public, when appropriate to do so.

Trust vision, aims and approach to delivery

Our vision is to deliver the right care, at the right time, in the right place; every time.

• 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 aims are the areas we need to focus on to achieve our vision to deliver the right care, at the right time, at the right place; every time by 2025.

1. Provide high-quality inclusive care

We recognise there are health differences between groups in the communities we serve. We will listen to understand and make sire our services are accessible to everyone. We will work to prevent harm while using learning and research to continuously improve patient care and experience.

2. Be a brilliant place to work for all

We will create an environment where our people feel happy and safe, have access to equal opportunities and are supported to be at their best.

3. Work together to shape a better future

We will work together to improve the services we provide. We will work with our partners and the public to find solutions which improve access, outcomes and experience for everyone. We will work together to become more sustainable and have a positive effect on our communities and environment.

Approach to delivery

We achieve our goals through the delivery of a number of enabling strategies, delivery programmes and plans in support of the ‘Right Care’, the ‘Right Time’ and the ‘Right Place’; ‘Every Time’.

Our four supporting strategies outline what we will prioritise over the next three years to achieve our aims and ultimately, our vision.

• People Strategy – aims to develop the culture and leadership environment to facilitate the delivery of the overall organisational goals.
• Quality Strategy – aligns to our aim “provide high quality, inclusive care” and sets out the ambitions, standards and framework which will help us to deliver safe, high quality, person- centred care for patients, every time.
• Service Development Strategy – aligns to our organisational aim to “work together to shape a better future” and provides a framework for developing our operational service lines to make sure we deliver operational performance across all service lines in a sustainable way.
• Sustainability Strategy – explains how we aim to fulfil the needs of current generations without compromising the needs of future generations through environmental sustainability, social value, population health and financial sustainability.

Supporting the trust’s vision and aims through communication and engagement activities

Annual improvement plans support the trust’s vision and aims with dedicated communications plans, events and activities.      

Provide high quality, inclusive care:

• Patient engagement
• Community engagement
• Feedback surveys
• Patient and Public Panel
• Community events
• Analysis and recommendations

Be a brilliant place to work for all:

• Internal communications
• Embedding strategy and values
• Influencing change
• Supporting leaders
• Staff engagement and listening
• Staff recognition
• Videography and photography
• Website and Green Room

Work together to shape a better future:

• Stakeholder engagement
• Public affairs
• Media handling
• Behaviour change campaigns
• Public education
• Freedom of information
• Social media
• Warning and informing

It is important to be clear what the key messages are that we want to communicate to our stakeholders and engage with them to influence our strategic direction.

The following key messages have been produced to support both our vision and priorities. The language and content of the messages will be adapted to reflect the views and needs of stakeholders.

Visions and aims – key messages

Our vision – Key messages

• Demand on ambulance services continues to grow, we need to continue to better integrate our urgent and emergency care systems and work differently with our partners to provide the right care, at the right time and in the right place, every time for our patients.
• There is more to the ambulance service than a trip to hospital – patients may be treated and/or referred via a number of pathways following a 111 or 999 call.
• We aim to be the provider of choice for both patient transport and NHS 111 services.
• We work in partnership with our communities and lead ICB to develop integrated healthcare services and promote health and well-being.

Our aims – Key messages

• We are working closely with our lead ICB and other partner organisations to develop digital solutions to deliver high quality services that will meet the needs of the 21^st century.
• Change is vital to provide sustainable, high quality urgent and emergency care in the future.
• The changes we are making will improve services for patients by ensuring no one is left needlessly waiting and where possible services will be delivered in their local community.
• We have clinicians working across all services to allow for earlier clinical decision making to support both patients and our staff.
• We have strengthened our non-emergency patient transport services, providing additional health information and referral services and strive to become a market leader and provider of choice.
• We have built confidence in our NHS 111 service which offers patients excellent help for their urgent care needs.
• We are actively listening and working with our communities to better understand their needs and develop solutions that are right for them.
• We are supporting people to look after their own health and wellbeing in the community.

Our values

Our values form the foundation of and drive the whole organisation, ensuring we lead by example and create the right culture and conditions for patients to receive safe care every time. Behaviours have been identified with staff to support the delivery of our values and demonstrate our commitment.

Where are we now?

Achievements

The trust has developed a robust communication and engagement function since its inception in 2006 and has demonstrated year on year delivery of the objectives set for communications and community and stakeholder engagement. These are explained in more detail in the Appendix accompanying this strategic plan (below).

Challenges and opportunities

The large footprint covered by NWAS will always present a challenge for effective stakeholder engagement and public involvement. We serve a population of more than seven million people across approximately 5,400 square miles in the communities of Cumbria, Lancashire, Greater Manchester, Merseyside, Cheshire, and Glossop in Derbyshire.

The diversity in our 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. More work is needed to reach these communities, identify their needs and work with them to improve health and care services.

Work will start in the autumn of 2024 on quality improvement programmes to increase the amount of feedback we receive from diverse communities as well as to find ways to increase our understanding of areas of health deprivation and find ways in which to develop targeted solutions.

The high level of demand is an ongoing challenge nationally and there remains a gap between public perception of what is expected and is available from the ambulance service. Communication and engagement activity will continue to focus on reducing this gap in order to ensure patients get the most appropriate response to their needs.

The need for strengthened communications in an ever changing environment is always important and ensuring that this is done in the most cost effective and appropriate way is paramount. By the nature of the trust’s business, it enjoys a high media profile and maintaining public confidence is a high priority.

Often public perception is concentrated on the trust 999 emergency service; however, with the increased abilities of NHS 111 not only to signpost but also to make direct referrals into community based services and the increased profile of the non-emergency service (PTS) to support urgent care in times of exceptional need and the recent retendering of non-emergency services in the region, there is a greater focus on all 3 service lines.

The trust currently operates patient transport services in four of the five counties of the North West and has worked hard with the public and their representatives to ensure the service meets their needs, that they can feedback any issues and to introduce new health initiatives. The trust has been delivering the NHS 111 service contract since October 2013, first as a stability partner and then via subsequent contract awards.

As already referenced, the level of interest in NHS performance and standards of care is high and maintaining public confidence and ensuring transparency will need to be at the root of all communication and engagement activity.

We are the only regional NHS organisation in the North West that operates across five ICSs: Cheshire and Merseyside, Greater Manchester, Lancashire and South Cumbria, North East and North Cumbria, and Derbyshire (which includes Glossop). While there are challenges with working across many ICS areas, we have gained experience as a key partner within the urgent and emergency care (UEC) system. We deliver UEC services across a large area and have valuable data and insight which helps to identify opportunities for improvement, share learning and best practice, and predict future demand.

We will continue to work collaboratively but also to ensure joined up dialogue, sharing of assets and materials and avoid duplication of communication and messages. It is important to get the right message, in the right forum to the right stakeholders.

In terms of staff engagement and internal communications, good progress has been made to increase the level of staff engagement through the delivery of more targeted communications, tailored to the needs of mobile staff with limited access to computers. This has included use of the staff app, producing more short films, use of wallboards in key sites and stations, and information available on staff ipads.

However, more is still needed to have a constant ‘barometer’ of staff morale and views. In 2034/24 the trust committed to the NHS England Sexual Safety Charter and launched a new sexual safety campaign ‘Stop, Speak, Support’ encouraging people to stop inappropriate behaviours, speak out about it and understand where they can go for support

A toolkit has been provided for managers and a programme of sexual safety roadshows are underway. Encouraging staff to speak up, improving sexual safety, reducing misogyny and improving culture are challenges for the months and years ahead.

Increased use of digital technology to support a mobile workforce requires regular investment and effective management but is an enabler for improving staff communications and will be a continuing driver for this strategic plan.

The capacity and capability of the Communications and Engagement Team also requires frequent assessment to ensure we continue to deliver an effective communications and engagement function for the trust whilst acknowledging the need to do things differently in order to work more efficiently. We must constantly evaluate our performance and deliver creative and innovative approaches to ensure our communications remain both fresh and engaging with our diverse stakeholders.

Communications and engagement strategic approach

Communication principles

All corporate communication activities will reflect the trust’s values and the following principles:

• An emphasis on two way communication mechanisms and relationship management
• Information which is clear, accurate, consistent and uses appropriate language
• Dialogue which is respectful and constructive
• Communications and engagement delivered in partnership with ICBs, other health care providers and other stakeholders wherever possible
• Timely communications with our staff in advance of other stakeholders, wherever possible
• Open and honest communication that demonstrates the trust’s accountability to its stakeholders
• Inclusive communication that reflects the needs of patients, the public and our staff
• Adherence to the duties outlined under the Civil Contingencies Act (2004)
• Communication that supports improved health outcomes and reduces inequality
• Communication and engagement activities which demonstrate value for money.

All communications activities and materials will comply with legislation in terms of the Data Protection Act 2018, the EU General Data Protection Regulations 2018 (GDPR), the Freedom of Information Act 2000 and equality and diversity legislation. All promotional work will be carried out in accordance with the Department of Health’s Code of Practice for promotion of NHS Services, published in March 2008.

Stakeholders and audiences

The trust has a diverse range of stakeholders with varying needs and interest in the organisation. Communication must be tailored to suit their differences and requirements – in terms of age, involvement or connection with the service, behaviours, where they live, lifestyle and beliefs etc. – in order for there to be genuine understanding and engagement.

Using stakeholder mapping to identify the level of interest and influence that individuals and organisations have, we can prioritise those we need to engage more closely. The concept allows us to align communications activities, key messages, delivery channels and frequency with the needs of each stakeholder group and ensures our approach is based on insight to be as effective as possible.

• Engage
  • stakeholders who we will actively inform and involve/engaged with on key projects and decisions.
• Influence
  • Key stakeholders with a shared vision who we will work in partnership with to deliver our strategy and achieve our vision.
• Inform
  • Stakeholders who we will communicate with generically to and aim to increase their level of interest.
• Involve
  • Stakeholders who we will make aware of developments and progress, with the opportunity to respond and provide feedback on areas of interest.

When planning communications activities, consideration also needs to be given to the requirements of the relevant service line or project. Where possible therefore, stakeholder mapping is undertaken during the planning phase of any communications campaigns or activities.

Relationships with stakeholders will evolve and change depending on a wide range of factors both local and national. We review our list of stakeholders annually to identify gaps and assess any changes in relationships.

Supporting the wider NHS

We target communications, where appropriate, to priority areas as identified in the NHS Urgent and Emergency Care Service Recovery Plan and annual NHS England communication plans and approaches.

We will also consider the communication needs of hard to reach groups in order to tackle health inequalities in mixed ethnic communities and those who live in deprived areas.

How will we deliver this strategic plan?

Our strategic approach is to consolidate existing communication and engagement practices whilst developing new communication initiatives to support the delivery of the trust’s strategic objectives. This is achieved via the following communication and engagement aims:

• Service users and potential users will have improved understanding, and will be meaningfully engaged and involved in service design, to improve quality and patient experience
• Patients, the public and their representatives will know what to expect from the ambulance service and have high levels of confidence in its service
• All staff can relate to the trust’s vision and values and feel that they are listened to, involved in trust decisions and valued
• All stakeholders and partners fully understand and are engaged with the evolving operational model and digital objectives for NWAS
• NWAS continues to have a trusted brand profile which reflects its vision and values and the main services it represents
• We are an employer of choice for professionals pursuing a rewarding career
• Information is shared by the trust which meets the needs of its stakeholders and promotes openness inclusivity and transparency
• Be the provider of choice for NHS 111 and PTS services
• Public confidence is maintained in the trust’s abilities to publicly warn and inform during major incidents and during periods of increased demand or service escalation

The above aims will be delivered through the annual improvement plans of the Communications and Engagement Team. The plans include detailed actions, timeframes and measures of success.

Strategic plan enablers

The communications and engagement team will use a number of channels and techniques to support delivery of this strategy including:

• social, on line and digital media channels and campaigns
• channel management and correspondence
• horizon scanning and news gathering
• stakeholder profiling and mapping
• consultation exercises
• watching briefs and specific handling strategies
• stakeholder impact assessment techniques
• political monitoring
• regular stakeholder briefings
• staff and patient feedback via traditional and new media
• patient involvement via the patient and public panel
• social marketing and behavioural insight techniques
• community engagement programmes
• creative campaigns and marketing collateral
• written and face to face communications
• patient and public information
• press releases and media statements
• videos, stories and filming
• events and conferences

Risks

A number of risks have been identified in the delivery of this strategy. These include:

• Capacity to deliver effective communications and engagement activities across the large footprint and with a high number of stakeholders.
• Loss of public confidence in ambulance services due to delays and potential harm experienced by patients
• The ability to effectively engage with staff because of the nature of a mobile workforce and some of the technology limitations.
• The changing NHS environment and financial climate requiring increased communication levels to support our urgent, emergency care and digital strategic objectives.

Any specific projects within the delivery plans will link to the trust’s risk register.

All risks are captured on the trust wide corporate risk register which is populated from the risk assessments carried out at all levels and across all directorates within the trust. These are monitored through the relevant directorate and service area risk registers. It is recognised that the type and levels of risk will change over time and will be monitored accordingly.

Implementation – annual improvement plan

The strategic plan and its objectives will be delivered through annual improvement plans which will be published alongside the strategic plan with regular progress reports. Progress will be monitored by the Director of Strategy, Partnerships and Transformation, the Trust Management Committee and Board of Directors.

Resources

The Communications and Engagement Team has a finite non-pay budget to support communication and engagement activities. The team will ensure all activities are within planned budget spending and best use of resources and value for money are provided. Any requirement for additional funding will be subject to the approved business case process.

The strategic plan will support the delivery of the directorate’s required cost improvement plan.

Monitoring and evaluation

The strategic plan will be delivered through annual action improvement plans.

Progress reports on the strategic plan and improvement plans will be presented to the Board of Directors on a quarterly basis Quarterly updates will be provided to the Executive Team via the communications and engagement dashboard.

Specific project updates will also be shared with relevant Committees or Groups as appropriate e.g., the patient and public panel’s activities will be presented to the Equality Diversity and Inclusion Group.

The progress reports will focus on delivering the objectives outlined above.

Communicating the strategic plan

The Strategic plan will be emailed out to Directors/senior managers/heads of service and will be presented to all service line senior management teams.

The Strategic plan will be published on the trust’s website for patients, the public and other external stakeholders to view. It will be made available to staff via the intranet. Both internal and external communication channels will be used to increase awareness of the new plan being published.

Appendix

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