Emergency services review

Overview

Netcare 911 is a leading private provider of emergency medical services (EMS) in Africa, and offers a critical solution to patients in crisis situations.

Products and services also include specialised travel advice, trauma support, Health-on-Line and managed emergency services care for medical scheme and corporate clients on a risk contract basis. Our emergency management surpasses basic international standards, and our network of 121 emergency vehicles and 61 rapid response vehicles, crewed by advanced life support paramedics, is well-equipped to handle any medical emergency.

We provide the following emergency services, which continue to strive for the highest quality standards:

• Our 24-hour Emergency Operations Centre, operating from Midrand, Johannesburg, is the hub of our network and is staffed with clinically trained emergency call agents and resource coordinators able to manage pre-hospital emergencies and inter-facility transfers.
• Our Aeromedical division consists of fixed-wing and helicopter air ambulances, managing and providing aeromedical evacuations for a large number of insured and private clients locally and internationally. We are pleased that this division has been accredited by the European Air Ambulance Institute (EURAMI) for the second year running. This represents a guarantee of service excellence for patients utilising our aeromedical services.
• Netcare 911 International Assistance provides a 24-hour contact centre for insured South Africans across the world.
• Our Industrial Operations and International Business division have built a core competency in providing mining, industrial and commercial clients with turn-key emergency medical solutions for all on-site and remote medical requirements within SA and Africa.

Netcare 911 operates the largest private EMS training centre in Africa. The School of Emergency and Critical Care is led by a dynamic team of experienced instructors and academics in the EMS field and is accredited by the Health Professions Council of SA.

Enhanced delivery across all divisions

Netcare 911’s revenue decline can be attributed to the decrease in lives covered under risk contracts. Total lives under management at 30 September 2011 were 6.9 million (2010: 7.6 million).

We have seen growth in our industrial sites, with our international project sites expanding by five. We believe all these markets provide growth opportunities for the future.

The market for EMS providers continues to be attractive to small, regional operators, the majority of whom are located in remote areas in SA. In response to this environment, the Netcare 911 productivity model has enabled operations to clearly define, measure, analyse, improve and control the appropriate deployment of resources relative to predicted demand – to have the right resource at the right place at the right time. The operations’ performance objectives of dependability, flexibility, quality, cost and speed are measured and managed.

Expanding our network through partnership and growth

A formal partnership between Netcare 911 and De Beers was announced in Johannesburg in June 2011. An AW139 Helicopter belonging to the then De Beers Chairman, Mr Nicky Oppenheimer, was made available to augment the service of Netcare 911 helicopter emergency medical service (HEMS) – the only 24-hour service of its kind in Africa – to evacuate patients in bad weather and service long distance flights that are out of range of the Netcare 911 HEMS fleet.

The demand for, and market-share growth experienced by the South African Industrial Operations division continues to show positive trends year-on-year. A further nine industrial sites were installed during the 2011 financial year.

Netcare 911 International continued to grow its interests in Mozambique by adding remote site operations for three clients on five new sites. The business shows good growth potential as coal mining operations at Vale’s Moatise coal mine begin in 2012 and as Rio Tinto commences coal mining operations after buying out Riversdale. The Mozambican business has also been awarded contracts to provide medical services to the new oil and gas industry entrants in the north of the country.

Best practice in emergency care

The international air ambulance service completed 242 missions covering 840 700 kilometres. The service has maintained a high profile, participating in the successful transfer of a 500 gram neonate from Accra, Ghana, to Johannesburg. The service ended the year on an equally high note as business concluded an 18-month review of the delivery model and took the decision to expand the fleet by one aircraft. This will facilitate greater efficiencies in the domestic market and bring the high standard of international air transport to SA.

The Netcare Major Incident Response Team (NMIRT) was established to deal with the growing demand for emergency responses to disaster and major incidents throughout SA and Africa. During the year the NMIRT team facilitated the largest private airlift of critically ill patients recorded, bringing 14 ICU patients to Netcare’s South African hospitals in a 48-hour period. The team creates a single point of contact for organisations facing serious events and provides facilitation of multiple casualties at many different hospitals simultaneously as a result of a single event.

‘Chain of Care’ quality assurance

Best and safest patient care remains our focus. The clinical team contributes to the final outcome experienced by our patients, not only in the pre-hospital and inter-hospital setting, but as part of the ‘Chain of Care’ provided by a comprehensive healthcare system. The quality assurance strategy was designed to identify potential areas of improvement in all divisions and levels of care within Netcare 911. The Medical division within Netcare 911 plays a key role in facilitating teaching and training.

An ongoing strategic ambulance review included a benchmark against European standards of safety specification for ambulance crew and patients in relation to size and construct of the vehicle. Our vehicles only transport one Priority 1 patient at a time, which allows for greater focus on the patient and a better clinician-to-patient ratio. Infection control issues have also been addressed, including a shift from porous material to the use of powder-coated, single-unit moulded steel in vehicle conversion.

For further information on standards and monitoring, refer to the SA Clinical governance report on page 66.

Growing with our people

A national shortage of skilled paramedics and doctors with training and experience in emergency medicine remains a challenge, with the pool of paramedics and doctors constantly decreasing. As a result, the demand for our experienced and specialised staff remains high. We continue to offer competitive remuneration and people management policies in our efforts to maintain our position as an employer of choice. Critical to the supply of quality clinical staff, our school trained almost 5 000 students during 2011 of which 90% came from within the industry. A total of 506 paramedics completed their studies in 2011.

Making social responsibility part of our business

Netcare 911 responds to all life threatening emergencies. This means that we provide services to indigent patients who are not in a position to pay for the services. Following emergency care and resuscitation, these patients are transferred to public facilities. Netcare 911 assisted more than 6 400 indigent patients during the year at a cost of R11 million.

We have continued to provide medical event standby services at high-profile signature events, in line with our objective of showcasing Netcare 911 as the “best and safest product”. Netcare 911 has contracts with organising committees for events including the Old Mutual Two Oceans Marathon, the Comrades Marathon, the Momentum 94.7 Cycle Challenge and more recently the Soweto Marathon.

For further details on our social commitments, refer to the Corporate social investment report on page 77.

Addressing environmental challenges

To optimise environmental management and associated costs, Netcare 911 is a member of the Sustainability Committee. The carbon footprint of the air ambulance service has received attention and efforts have focused on appropriate utilisation of aircraft. Jet aircraft, for example, are no longer used in the domestic environment and have been replaced by more fuel-efficient turbo-prop aircraft.

Looking ahead

• Pursue new and exciting growth opportunities within and beyond SA.
• Continue our business optimisation programme under the Good-2-Great theme.
• Ensure clinical protocols remain on par with, or exceed, international standards.
• Continue our commitment to training with a focus on best patient care.