Project A

What is Project A ?

The aims for the ‘Project A’ initiative are based on, and build on, a discussion between Simon Stevens and Helen Bevan, following Simon Steven’s announcement at ALF 2018 that NHS England would fund a full 12 month programme of ambulance improvement.

Led by Helen Bevan and delivered by NHS Horizons and the Association of Ambulance Chief Executives, Project A allows a cross section of frontline staff to share their experiences, gather a reflection of insights into the way urgent care works on a daily basis, and explore ideas from the frontline that lead to improvements across ambulance services.

What are the objectives?

The overarching aims of Project A are to:

  • identify and mobilise frontline ambulance staff (both frontline clinical teams and in control centres) and patients to contribute to improvement
  • have a positive impact on winter 2018/19
  • identify issues the crews want to work on that will have a positive impact
  • develop, test and implement solutions, using and building on existing programmes and creating new ideas, that add up to significant improvements

Background and context

Urgent and Emergency Care (UEC) services are under increasing pressure. Ambulance services play a critical role in UEC and sit at the interface of several key components of the system. As a result, even small improvements in the delivery of ambulance services can make a difference across the whole system.

Significant progress has been made in redesigning and improving ambulance services as a catalyst for transforming UEC. Innovations continue to be tested and implemented by Ambulance trusts. In addition, nationwide improvements have been co-ordinated by the Ambulance Response Programme and, more recently, the Ambulance Improvement Programme, jointly sponsored by NHSE and NHSI and chaired by Dr Jonathan Benger.

It is recognised that much more needs to be done. The AIP programme is expected to run until 2021.  There are already concerns that the service will be under great pressure next winter. There is evidence that frontline practitioners are being pushed very hard to meet the demand for care. Results from the NHS Staff Survey show that people who work in the ambulance service are the group of NHS staff who are least likely to say that they contribute to decision making.

Simon Stevens, the Chief Executive of NHS England, is taking a particular interest in these issues having spent time with ambulance crews in London and the Midlands. He has identified the potential for frontline ambulance staff to play a much bigger role in innovation, service redesign and problem solving.

He asked the NHS Horizons team to work with the Association of Ambulance Chief Officers (AACE) to develop a year-long initiative that supports and builds on the excellent work that is underway in many parts of the system and builds on the ideas and energy of frontline staff.

Where did we start?

Project A starts with the question: How could we speed up and broaden improvement if we worked with frontline teams and patients to identify and implement new ways of working that would add up to large scale change?

Accelerating Change

The first stage of Project A was an “accelerated design event” with a diverse group of stakeholders, held on 28th June 2018 to co-produce the initiative. Accelerated design is an evidence-based approach to change. It is based on the premise that if we create the right purpose, get the right people in the room, with the right data, the right process, the right kind of facilitation and the right environment, we can achieve as much in a one day as might take three or four months using more conventional approaches.

The kick-off event brought together colleagues from every ambulance trust. The majority of people taking part were frontline ambulance staff, though the launch event also included people who represented patients and the public, some ambulance service managers and others who gave some interesting and diverse views on the day.

Over 500 ideas were generated, which were themed into 16 areas.  Attendees chose which one to work deeper into, and then made a corresponding film for each.

You can read the report of the Launch Event here.

The Ideas Channel and Expert Panel

The next stage of the process was to establish an Ideas Channel, an open and transparent platform designed by NHS Horizons & Crowdicity to capture ideas on how to transform ambulance services and foster improvement.

Putting ideas into action

After that, we established an “expert panel” to review the outputs of the Ideas Channel, compare the ideas to existing evidence and identify the actions that should be taken, with one key output being the Directory of Good Ideas.
Read more about that here.

Get Involved!

#ProjectA is an improvement programme led by frontline ambulance staff, and we want to make sure it remains true to this ethos. Please do keep getting involved –  if you’re in the ambulance service keep an eye out for internal communications, and everyone can get involved via Twitter (@HorizonsNHS / #ProjectA).