Behind the managers behind those front-line paramedics sits a business intelligence (BI) team of some 20 people. However, Simon Mortimore, assistant director for business information at the South Central Ambulance Service (SCAS) NHS Foundation Trust, is no stranger to the inside of an ambulance. He can sometimes be found carrying things for his paramedic colleagues.
This is perhaps why he reaches for a driving analogy when talking about the first wave of the Covid-19 pandemic: “It was like driving in fog at high speed.”
The service’s data function has had to move at great speed during the crisis, which has proved the value of its use of Qlik business intelligence software, says Mortimore’s colleague Vivienne Parsons, specialist business analyst at the SCAS NHS Foundation Trust. Speed, but also being able to join up different data stores, such as those from Ordnance Survey – location data is crucial to an ambulance operation.
Parsons adds: “We’re very lucky to have Ordnance Survey on our doorstep [in Southampton]. We’ve built a very good relationship with them over the last few years. I think that was probably the start of our journey with looking at other datasets, just realising how important they were.
“Because we would struggle if we did everything on our own data, because we’re not sited. And the engine behind Qlik very quickly allows you to join datasets, such as government datasets.
“We pull so much from the government because there’s this lag between confirmed cases and acuity going up. So, if we can keep monitoring the government data, we generally see a two to three-week gap between it hitting the healthcare economy.
“If you don’t study that government data, you lose that early warning indicator of what might be heading your way. In terms of joining up datasets, that’s really important to us. I think we’ve opened our eyes a lot to these external things.”
Mortimore adds: “Our chief exec summed it [the second wave] up well when he said, ‘One of the bad things is, we know what’s coming. One of the good things is, we know what’s coming’.”
Fog has lifted
That figurative fog that Mortimore speaks of has lifted as the crisis has gone through the second wave, which is far from over. The BI team has patterns of data to reflect on – and some of the findings have been surprising.
The area that SCAS covers stretches from Milton Keynes through Oxford to the south coast. And an ambulance service – there are 10 in England – covers much more ground than an individual hospital. SCAS’s geographical span includes urban and rural areas, pockets of wealth, and areas of poverty and deprivation.
And geography matters. There were fewer Covid cases than expected in Portsmouth, for instance. The city’s demographic profile should have generated the same number of Covid cases in the first wave as Slough, but it did not – because Portsmouth is effectively an island. People going through it are often heading for the Isle of Wight or the Channel Islands.
Parsons says the BI team could also trace the first wave spreading along the road network, again by harnessing location data.
The data also told the team that demand for the ambulance service was 3% down during the first wave, confirming that people where not calling 111 or 999 when they should have been – presumably out of a misguided concern not to trouble the NHS.
Mortimore says: “One of the key challenges we had in the first week was we didn’t know what the impact of Covid on other demands was going to be. Within a week, we could see normal demand being suppressed.
“Because we had the ability to get that data online really quickly, we could see that stuff was being suppressed, like trips and falls, and strokes. We ended up in a position where the bar was roughly the same.
“Strokes was the classic one. We were really worried that strokes were dropping – people must still have been having strokes. And so we were able to get some communication out quickly to encourage people to call us.”
Parsons also points out that the BI team learned it could not automatically read from the first wave the nature of the second, in terms of its demand on the service. “Within the second wave, the majority of people who have been contracting Covid have been in a much younger demographic,” she says. “And the younger demographic tends to have fewer co-morbidities, fewer underlying medical conditions, and don’t need so much of the healthcare system.”
As well as producing information to help managers deliver the ambulance service, the BI team also reports out to external partners – local authorities, the fire service and the police. Mortimore says they were once able to tell Milton Keynes police that they had more road traffic accidents at certain times than they thought because injured motorists and passengers were being transported to the John Radcliffe Hospital in Oxford. Some 60 to 70 people across eight agencies receive SCAS data by way of Qlik.
Internally, they have 550 Qlik licences, with the data consumed from chief executive level down to team leaders.
Mortimore and Parsons confirm they have looked at alternative suppliers, such as Tableau and Power BI, but they are happy with Qlik, which they have used since 2010. Parsons says they don’t really see the same depth of peer user community with the other suppliers, or the same range of connectors to data stores.
“But the technology is the least important thing about all of this,” says Mortimore. “What I like about Qlik is that I never notice it. It never causes me a problem.”
Turning to processes, Mortimore adds: “A management process is a process. If you’re a manager, your job is about policy strategy, demand management, quality management, resource management. We’re quite heavily focusing now on back-office functions, HR, finance, estates, ICT, to bring them up to speed.
“Our HR director would like a cycle [like the ambulance crews]. But instead of it saying ‘assigned to mobile on scene, cleared up for handover to hospital’, you have: ‘advertise, interview, offer made, in post’. And then the monitoring of that using business intelligence software.”
Everything the paramedics do is automated, says Mortimore, as is evident from watching Inside the Ambulance – they don’t use radios, the routes are programmed in, the medical aid they give at the scene and en route to the hospital is captured.
“We’re a logistics firm with a very special cargo”, says Parsons. She and Mortimore have some final advice: just don’t call the paramedics “ambulance drivers”.