Tethering fleet & optimising Make Ready in an ambulance service

In September 2023, TN developed a diagnostic to review the efficiency of fleet management for an ambulance service. The diagnostic highlighted several challenges, including, a high number of vehicle moves, low vehicle availability and high numbers of crews without a vehicle at the start of shift. The diagnostic identified two key drivers of these challenges:

• The centralised model for allocating and moving vehicles between ambulance stations
• Misalignment between the scheduling of frontline staff and Make Ready’s vehicle prepping patterns

Subsequently, the ambulance Trust commissioned TN to redesign the fleet management model including: 

• Managing ambulance fleet: Moving from a central ‘flexi-fleet’ to a local ‘tethered fleet’ model, minimising waste in unnecessary vehicle moves, reducing the number of crews without a vehicle at start-of-shift, and devolving ownership over vehicles to local Group Stations (see Figure 1)
• Make Ready windows: Moving away from ad hoc last-minute planning to creating designated ‘windows’ for cleaning and prepping vehicles, which align with frontline staff rotas, to improve vehicle availability

Figure 1: Tethered fleet model

Designing the new model

During this stage, TN:

• Facilitated workshops to design the tethered fleet model, with relevant stakeholders
• Performed quantitative analysis to identify fleet requirements of each Group Station
• Assigned a fixed fleet and devolved responsibility to local Group Stations
• Conducted comprehensive demand analysis to inform a rota transformation in Make Ready

Two new SOPs were introduced to devolve ownership over the production of staffed, kitted, roadworthy vehicles to local teams:

• Bi-weekly ‘forward planning’ meetings to improve communication and ownership within local teams
• Protected time slots for Make Ready to ensure that crews have fully prepped and cleaned vehicles at the start of each shift

Rolling out the new model

Following the design workshops, two pilot sites were selected to trial the new operating model. TN supported the pilot of the ‘prototype’ tethered fleet model, including selecting, analysing and monitoring KPIs. After the pilot Groups demonstrated their success at increasing their vehicle availability under the new model, the Trust rapidly rolled out the model in other Group Stations.

There was improvement in each of the KPIs being measured in the programme:

Average daily
vehicle moves

31

vehicle moves per day

On average, the ambulance Trust are moving 31 fewer vehicles per day. This reduces fuel costs and time lost whilst vehicles are relocated

Crews without
a vehicle

1.4%

out-of-service hours

Greater proportion of crews have a vehicle at the start of shift, overall increasing the operational hours where crews can respond to calls

Vehicle availability
(Make Ready)

0.5%

vehicles prepped by Make Ready

Greater proportion of vehicles are prepped by Make Ready, increasing the overall number of vehicles available for use

Vehicle availability
(Fleet)

2.5%

vehicle off-road rate

Fewer vehicles went off-road for repairs after tethering fleet, reducing repair costs and increasing the number of vehicles available to use