An agile and flexible vehicle fleet is essential for South East Coast Ambulance Service NHS Foundation Trust (SECAmb) to meet changing demands. As a bluelight fleet, it has to transform from purely transporting patients to hospital into a mobile health care provider that delivers specialist care and treatment directly to patients.
SECAmb operates a fleet of around 700 frontline vehicles that includes almost 300 double-crewed ambulances, 200 response cars, 27 4x4s, more than 160 patient transport service vehicles and more than 30 specialist vehicles, including hazardous area response team and chemical biological radiological nuclear vehicles. It also has around 200 pool cars and ‘grey fleet’ vehicles.
In 2014/15 the vehicles travelled 17 million miles attending almost 900,000 emergency calls. They also took 1.2m patients to hospital which included almost 500,000 non-emergency journeys.
Demand on the service is increasing by around 5% a year – equivalent to about 45,000 emergency calls – so even a small initiative can have a profound effect on fleet efficiency.
To meet this challenge head-on, SECAmb delivered a string of developments to achieve fleet operating cost savings, while also meeting challenging 999 response times and battling traffic congestion and traffic calming measures.
These initiatives saw SECAmb named public sector and bluelight fleet of the year in the 2015 Commercial Fleet Awards.
“It was a great accolade for the Trust and real recognition of the hard work completed every day by our technical teams,” says Justin Wand, head of fleet and logistics.
“Their focus on improving quality, innovation and support for the frontline is unrivalled and, in cost-conscious times, proves great things can be achieved. I am immensely proud of the team, whose work contributes directly to patient care.”
Winning the award has increased SECAmb’s profile across the UK and globally, leading to interest in initiatives and innovations from emergency service fleets across Europe, Australia, Canada and the USA.
“The accolade has validated all the hard work we have done and continue to do, and shows SECAmb to be one of the best emergency service fleets in the world,” says Wand.
Demand management is critical, requiring both lean system design and innovative working methods. “We achieve this through the use of high-performance systems,” says Wand.
“We forecast the supply rate required to meet the ever-changing pattern of demand, ensuring we are able to produce a fully-maintained, stocked, sanitised and audited vehicle across 330 shifts per day, 24 hours per day, seven days per week.”
The single biggest initiative, which is ongoing, is the introduction of ‘make ready’ vehicle preparation centres. A £50 million investment, the centres are effectively self-funding through a combination of efficiency savings and the sale of outdated, badly-located ambulance stations.
Prior to the beginning and at the end of every shift, specialist teams of staff clean vehicles, restock them to a standardised specification with medical equipment checked and serviced. Additionally, on-site vehicle maintenance experts undertake planned preventative maintenance to reduce the risk of vehicle breakdowns and thus keep downtime to the absolute minimum. Many of those tasks were previously carried out by clinically-trained employees, who can now spend more time treating patients and saving lives.
SEACAmb currently has five make ready centres –with at least a further five scheduled to open by 2020 – strategically spread across its 3,600 square-mile territory, across east Sussex, west Sussex, Kent, Surrey, and north-east Hampshire.
The Trust’s target for vehicle failures has shifted dramatically, following the introduction of make ready centres. Overall, the ‘airline-style’ maintenance system has resulted in increased availability and utilisation of the ambulance fleet and a 75% reduction in ‘critical’ vehicle failures.
“The fewer failures, the more time an ambulance crew is available to respond to patients,” says Wand.
“By providing this gold-standard vehicle maintenance preparation system, it means our highly-skilled frontline staff can focus on the job of responding to patients in well-maintained vehicles rather than spending time before, during and after their shift cleaning and stocking vehicles.”
Ambulance staff begin and end their shifts at the make ready centres before being sent to ambulance community response posts (ACRPs) from which they respond to 999 emergencies.
A further initiative in 2014 saw the start of the implementation of a three-phase driver safety system that initially embraced installation of a vehicle speed controller before moving on to include internal and external CCTV to vehicles and telematics to monitor driver behaviour.
SECAmb spends approximately £6.6m a year on fuel responding to emergency calls, so has introduced a dynamic speed control system on ambulances.
The result has been a 13% reduction in fuel consumption, equating to a cash saving of more than £800,000 a year, which is being re-invested into frontline services, alongside a simultaneous reduction in emissions.
The system restricts vehicle speed to 62mph, but disengages in ‘bluelight’ mode, while also controlling torque and engine revs. Additionally, as the vehicle’s acceleration profile is controlled, wear and tear is improved, as is ride comfort.
The technology has been fitted to all accident and emergency vehicles and is to be introduced into patient transport services vehicles and other support vehicles on the fleet.
Further initiatives focusing on driving have seen the introduction of driver risk index assessments as part of a suite of online profiling tools developed to measure and address at-work driver risk.
The index enables drivers’ personality traits and behaviours to be assessed, with a range of interventions delivered to those deemed ‘at risk’.
The increased focus on safe driving has included the recruitment of a driving standards manager who, with the fleet team, developed a campaign that has seen the Trust’s accident rate reduce from one per 25,000 miles to one per 34,000 miles. The severity of accidents has also reduced.
The updated driver training programme, which includes the training of new recruits, has also seen the introduction of a 10-stong fleet of dedicated driver training vehicles. The five vans and five cars have been specially converted.
They feature driver safety technology, such as CCTV and telemetry, enabling trainers to reconstruct critical incidents and feed live data directly into the Trust’s fleet management system providing alerts to support staff and paramedics.
The installation of CCTV across the operational fleet provides a 360° view of the vehicle with the video used to improve driving and as evidence if challenging false claims. Added to this has been the implementation of telematics, delivering additional information on the performance of vehicles and the way they are being driven.
Data from vehicles is used not only to monitor driver behaviour, but also to influence deployment practice by the Trust’s command and control centres to improve procedures and reduce excessive mileage incurred through poor tasking and work-load management.
All frontline staff have passed advanced driving courses as part of their job requirement and receive real-time feedback on their driving via a smartphone app. Vehicles are involved in around 500 road traffic collisions annually.
Wand argues that driving vehicles correctly “is part and parcel of patient care”.
“Patients need to have a stable journey and how a vehicle is driven when they are on board is part of delivering a good service,” he says. “Our safety programme will take shape over the next three to five years, and we expect to see incremental improvements in incident frequency.”
The all-Mercedes-Benz chassis-based fleet sees vehicles purchased or leased and replaced after five or seven years of operation, depending on their role. Typically, bluelight vehicles are purchased and patient transport service vehicles are leased.
Gone are the days of a one-size-fits-all ambulance, with patients demanding improved care closer to their homes. That sets a design challenge that has seen SECAmb’s emergency vehicle fleet redesigned to meet a changing operational model and support the delivery of advances in clinical skills.
Developments include, for example, the launch of a critical care ambulance, essentially an intensive mobile care unit, a paramedic practitioner vehicle that enables patients to be treated on board in the community, and specialist neo-natal and bariatric ambulances.
February’s annual Ambulance Leadership Forum saw SECAmb unveil the world’s first ‘connected ambulance’. Built on a Mercedes-Benz chassis and developed in conjunction with specialist emergency service provider Ferno UK, the vehicle features wi-fi for vehicle to hospital communication, high-grade CCTV to provide the foundations for clinical support, marine grade solar panels and no tail-lift.
Additionally, its state-of-the-art stretcher minimises manual handling and its tracked modular layout delivers complete flexibility and configurability options for the trust, ensuring the optimum layout for the clinician. That means that during its life it could be used as a critical care ambulance, a ‘normal’ ambulance or as a passenger transport vehicle.
Wand says: “Taking a flexible approach and enabling good vehicle rotation through reconfiguration during an ambulance’s life could ultimately mean we are able to reduce the overall size of the fleet and drive further efficiencies.”
He adds: “No more do ambulance services just fulfil a transport role taking people to hospital. We are mobile healthcare providers bringing the skills and the diagnostics to the patient’s side.
“We need an agile, flexible fleet able to respond to this change and that is what we are on course to deliver.”
The standardisation of the fleet around Mercedes-Benz vehicles – at one time there were 23 variations of ambulance at the Trust – has enabled operating efficiencies to be improved with a focus on wholelife costs and added value.
“We have been able to improve standards of maintenance and highlight trends far more accurately,” says Wand.
“That has led to a reduction in the amount of diagnostic tools and parts stock held.”
In turn, that has enabled investment in better quality training for mechanical staff across a more defined vehicle fleet.
The overall result, says Wand, was “improved efficiencies in operational support, increased vehicle utilisation and improved fleet availability enabling SECAmb to respond to patients quicker. Also, our technicians have become experts on every vehicle”.
Investment in the team, including mechanical skills and driver training initiatives, contributed to SECAmb last year becoming the third ambulance trust in the country to achieve the Freight Transport Association’s Van Excellence accreditation.
The FTA had been invited by the Trust to undertake a gap analysis for the fleet department. However, during the auditor’s visit, SECAmb was told it not only met all necessary standards but in some cases exceeded requirements.
SECAmb was the first ambulance service to trial the Volvo V60 plug-in hybrid car used as a single responder vehicle, and this year will take delivery of 15 Mitsubishi Outlander plug-in hybrids adapted for bluelight use.
SECAmb’s environmental focus has also seen a network of electric vehicle charging points introduced at its make ready centres.
“Sustainable and reliable vehicles are key for the fleet and we have chosen the Outlander for a number of reasons, not least its 4x4 capability, load capacity and the availability of a petrol engine to support electric use,” says Wand.
“We must be alive to technology developments and if as a fleet you want to improve you must be bold.”
That sums up the challenges facing Wand as he seeks to continue developing a fleet that supports staff clinical skills and patient needs.
Embracing new technology in all its forms and incorporating it into the fleet in a meaningful way is among the major challenges, as is coping with traffic congestion, road layout changes, increasing patient demand and a requirement to reach a patient inside seven minutes and 59 seconds.
Wand’s message to colleagues is: “Have good solid foundations in place to cover the basics, but be bold, innovative, learn from your mistakes and never stop communicating.”
Organisation: South East Coast Ambulance Service NHS Foundation Trust.
Fleet size: 700 (300 ambulances, 200 response cars, 27 4x4s, 160 patient transport service vehicles, 30 specialist) vehicles
Replacement cycle: Five to seven years
Patient needs brings humanity to fleet operation
Justin Wand has had a 22-year career with South East Coast Ambulance Service NHS Foundation Trust and believes he brings a unique insight and humanity to the role of head of fleet and logistics.
A paramedic who maintains his clinical training and with a strong background in risk and safety management, Wand has worked in operational support for the past decade. Most recently he spent more than four years as head of fleet operations before promotion to his current post.
He heads a team of more than 100 people with responsibility for vehicle design, procurement, preparation and disposal, as well as equipping and maintaining vehicles across the Trust.
“I am not a fleet manager by design, but my team is composed of experts with decades of experience,” says Ward. “They are the technical inspiration and their support is invaluable. They keep me on the right side of what’s needed and in return I am able to promote the needs of the clinician and patient.”
The ability to bring clinical expertise and being able to place the patient at the heart of the fleet operation when designing and maintaining vehicles was, says Wand, crucial. “It brings a level of humanity to a fleet operation that we may not achieve if all that is being looked at is the bottom line,” he says. “We are building and running vehicles for clinical operations and not for convenience.”