Finding myself in Manchester twice in two weeks visiting the NHS Confed Expo and the EMS Research Forum, it was the perfect opportunity to catch up with North West Ambulance Service CEO, Daren Mochrie. We talk about plans, demands and partnerships and why being busy isn’t a reason for not doing things.
Daren gets out and about a lot. His Twitter feed shows him going all around his patch in the North West meeting staff in all corners of the ambulance service. He says it’s ‘dead easy’ to say ‘I’m too busy’ but it’s important to him to make that time despite the huge geography challenge along the way. “It’s a team effort to look after people and save lives,” he adds.
His wide experience over the past three decades sees him not only heading up the North West Ambulance Service (NWAS) but also chairing the Association of Ambulance Chief Executives (AACE).
While Daren is clearly committed to engaging with his 8,000 strong workforce through various channels, the bottom line is that the media is still telling the world that the ambulance service is on its knees and ambulances are queuing for hours outside hospitals waiting to hand over patients but can’t because of problems of flow through the healthcare system.
What does this look like for Daren in NWAS? He says that the last six months have been the hardest he’s seen in his 35-year career.
“I try to be positive and lead from the front. I get the challenges; I know what it’s like. It’s a combination of factors that includes coming out of Covid, high levels of respiratory virus infections over the winter, continued problems with flow of patients through hospitals, the usual seasonal pressures and on top of all of this, industrial action.”
This leads us to talk about the Urgent and Emergency Care Plan published earlier this year with its promise to boost frontline capacity with 800 new ambulances, 100 of which will be specialist mental health vehicles and 5,000 more hospital beds. All of which will be paid for by a dedicated £1bn fund.
These are big numbers but what practical difference does this investment make to a trust like NWAS in the short term to relieve the pressures? Daren says that this commitment is welcome but will take time to deliver.
It comes alongside transformational change that NWAS had already put in place despite the immense challenge of responding to a global pandemic. He highlights the robust command and control that NWAS had in place during the pandemic that allowed it to not only manage the pandemic but at the same time, implement major software upgrades to the 111 service, a new triage platform for the 999 service and recruit many new staff.
Not only does NWAS and other ambulance services contend with national level policy change, at a local level it is grappling with the recommendations from the Manchester Arena Inquiry. At the end of 2022, Sir John Saunders published the outcome of his inquiry and this included 13 monitored recommendations for NWAS to implement. Daren says that there is a highly experienced team dealing with this, adding to the learning they already identified long before the inquiry completed its work. With his role in AACE he has been keen to see other ambulance services look at this work and embed the learning too.
Turning to talk about the recent announcement by the Metropolitan Police that it would no longer respond to mental health calls, I ask if this will be the case in the North West as well? Daren says no, not without working together and coming up with a joint way forward, remarking,
“Chief constables have asked NWAS to work with them and others like NHS England to shape the direction of travel in how we all deal with mental health patients which is testament to strong relationships in the North West.”
It’s a useful segue to the conversation I want to have about the Integrated Care System. I shared my concern about the burden that the ICS represents when there are so many of them and so few ambulance services who cover such large expanses of the country. The strategic direction of the ICS is set by the Integrated Care Board and ambulance services are not statutory members so need to ensure they have a voice in this place if they are to be influential.
“ICBs are still finding their feet. It’s much easier dealing with the five ICBs in our area than it was when there were Clinical Commissioning Groups – there were over 40 of them –it is easier than it was in the past.”
Daren can’t possibly be at all the ICB meetings, so he has aligned his strategic leadership team to manage the interface between NWAS and the ICBs and made organisational changes to support the work and have a voice within the ICS. This applies too at the partnership level where Integrated Care Partnerships embrace wider partners from public authorities in the area. In the North West, there is also a strategic partnership board chaired by a lead ICB, which includes NWAS and representatives from other ICBs.
The recent review of the ICS by Patricia Hewitt had a strong emphasis on the prevention work required by partners in the ICSs to help reduce health inequalities. I ask Daren how much time and capacity the ambulance service can contribute to prevention when there is so much demand on its core response business. He returns to the ‘busy’ theme that started our conversation and how that can’t preclude ambulance services from contributing to the wider health agenda – indeed the recent AACE consensus statement on reducing health inequalities sets out that ambition in some detail.
“Ambulance services are busy all the time. We have around 7.5m people in the North West and we see a lot of patients every year, with 1.6 million 999 calls, 3.6m 111 calls, and 2.5m patient transport journeys. We have a role to play in prevention and we are looking at new opportunities to contribute beyond the work we already do, including innovation and integrated digital solutions; the ICS structures will help us do that.”
I conclude after our conversation that I’ve not learned much more about handover delays and solutions for the problem of flow through hospitals. What I do know though is that faced with continual change, Daren’s calmness and positivity and a refusal to hide behind the excuse of being too busy, means that NWAS is in good hands.