South Central Ambulance Service - Annual Report 2014/15

ANNUAL REPORT & ACCOUNTS 2014/15

SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST ANNUAL REPORT & ACCOUNTS 2014/15 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006.

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

CONTENTS 1

2

Strategic Report

A word from our Chief Executive and Chairman

èè Page 8

èè Page 2

3

What we do èè Page 18

5

4

Annual Quality Report 2014/15

Director’s Report èè Page 156

èè Page 42

6

7

Accounting Officer’s Statement of Responsibilities

Operational and Financial Review èè Page 204

èè Page 200

1

A word from the Chairman and Chief Executive

2 2

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

1 A WORD FROM THE CHAIRMAN AND CHIEF EXECUTIVE

3 3

A word from the Chairman and Chief Executive

The last 12 months have seen unprecedented levels of demand on ambulance services and accident and emergency departments across the country and here within the South Central region we have experienced that too.

As well as continuing to deliver excellent levels of clinical care for all our patients and meeting two of our nationally set performance targets, whilst narrowly missing out on a third, we did all this at a time when financial pressures on doing ‘more for less’ continue to increase across the NHS.

Most satisfyingly, from the Board’s point of view, this wasn’t just something that was noted by the inspectors. Most patients whose views were captured as part of the inspection process echoed these sentiments and we were delighted to see the inspectors recognise how the Trust at all levels is passionate about improving patient care and experience. There was clear evidence throughout the organisation showing how patient feedback was routinely used to inform and improve the services the Trust offers.

The final published report identified a small number of areas for improvement and many of the action plans have already been implemented in order to address these.

The Trust’s vision and strategy which you can read more about in this year’s Annual Report were found by the inspectors to be clear and the CQC report identified many areas of outstanding practice that had significantly enhanced the standard and quality of clinical care given to patients.

These included the introduction of blood transfusions, ultrasound and blood gas analysis on the air ambulance, the 24-hour Labour Line in the emergency control room in Otterbourne, Safe Space and Ice Bus in city centres at weekends to reduce the volume of people attending Emergency Departments (ED) as a result of injuries or alcohol-related incidents, and having a mental health and learning disability clinician within the Trust. We were extremely proud that these, and many other innovations and areas of excellent working practice the inspectors observed, show that staff at all levels are living the Trust’s values of ‘caring, professionalism, teamwork and innovation’ in everything they do day in, day out.

Maintaining our stakeholder relationships during this time has been extremely important to us. Many examples of close partnership working have been evident in our efforts to ensure we are integrated in to the NHS locally and continue to be regarded as a vital and visible provider in the healthcare system, both locally and further afield. The Trust has also grown considerably in the number and complexity of patients treated this year, with significant expansions of our NHS 111 and Patient Transport Service (PTS). This has only been possible thanks to the hard work and professionalism of everyone in the organisation, irrespective of what team or department they work in. On behalf of the Board and, I am sure, the four million people we serve, we would like to express our sincere gratitude to every single member of staff and volunteer without whose support we would not have been able to successfully meet the challenges of the past year.

Never was this dedication more strongly demonstrated this year than in our formal pilot inspection from the Care Quality Commission (CQC) that took place in September 2014. The CQC inspectors confirmed SCAS’s staff as delivering outstanding care and compassion for our patients. Our staff were repeatedly seen treating patients with extreme sensitivity, dignity and respect.

4

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

As a result of the considerable expansion of the Trust’s services in 2014/15, over 750 new staff have joined SCAS this year across a variety of our services.

The majority of these new faces have appeared in our enlarged PTS and NHS 111 services, but we have also undertaken significant recruitment drives to attract more paramedics to the Trust in order to meet the further challenges of increasing demand at a time of a national shortage of paramedics.

Unlike some of the other NHS 111 contracts being delivered in other areas of the country, ours is fully integrated with the Trust’s emergency 999 service in our two dedicated Clinical Co-ordination Centres (CCC).

This ensures the most appropriate response to any incident where a caller has dialled 111 but using the NHS Pathways questioning tool, the call handler has identified that the situation is potentially critical or life-threatening. Despite media reports this winter suggesting that the significant increase in ED attendances was down to NHS 111 call handlers advising too many people to go to ED, the evidence of our own data tells us quite a different story. Only around 6.5 per cent of calls to SCAS’ NHS 111 service this year resulted in the caller being advised to attend an emergency treatment centre within the hour. Furthermore, our transfer of calls to our 999 centre is lower than the national average, as is the non-conveyance of patients to EDs if an emergency vehicle has been sent.

As well as increasing the numbers of our own staff we support through paramedic degree programmes (both traditional and fast track routes) and undertaking recruitment activity in the UK, we also took the considered decision to explore further afield and after extensive research began a campaign with a leading, international recruitment company in Poland to attract qualified paramedics, with English language qualifications, to consider working for SCAS. We currently have four Polish paramedics (and one Australian) attending a familiarisation course at our Nursling Station and in June 2015 a further 11 paramedics from Poland are due to arrive. With university paramedic training taking up to three years and an estimated national shortfall of paramedics at the time of writing of up to 3,000, we will need to continue to invest and explore these diverse recruitment strategies in the immediate years ahead to maintain our clinical quality at a time of rising demand for our services.

The Business Development Directorate not only successfully retained several contracts on improved commercial terms for the Trust, but in 2014/15 SCAS was proud to win new contracts for expanding our existing Patient Transport Service (PTS) across Hampshire. The service carried out over half a million patient journeys this year and despite the increase in volume, satisfaction amongst patients with the service remains high. This is testament to the commitment and hard work of all the team, including a dedicated and invaluable pool of volunteer drivers. And right at the end of this year, we were delighted to once again retain the contract for the Milton Keynes PTS service for at least a further three years, in the face of some very strong private sector competition. The fact we did so is a real credit to our staff and their ongoing commitment to the service.

The past year has also seen a significant expansion of our NHS 111 service. We took on our first NHS 111 contract in September 2012 and at the time employed 46 people to deliver that service. Today, our NHS 111 service now runs across six contracts, employing around 480 people and this year we took over 1.2 million nonemergency calls.

5

A word from the Chairman and Chief Executive

6

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Looking back at our introduction to the first Annual Report we delivered in April 2012 we wrote: “New challenges do however lie ahead.

The current economic climate has and will continue to present considerable financial and business challenges with a potential reduction in funding in real terms for the foreseeable future. Our future financial plans will ensure that our existing high standards of care to patients are maintained.”

Despite many changes over the last three years, the level of challenge described then is similar to what lies ahead of us again: increasing demand for our services against a backdrop of financial constraints. And we are convinced that how we successfully responded then will be exactly the same as how we will successfully respond in the future due to a vital constant in a seemingly ever changing healthcare landscape: our people.

Never have we been more convinced that our staff, volunteers and members have the compassion, dedication and commitment to ensure that SCAS continues to thrive and deliver the high quality clinical care and patient experience that would be expected from one of the country’s leading healthcare providers.

Will Hancock Chief Executive Date: 27 May 2015

Trevor Jones Chairman Date: 27 May 2015

7

Strategic Report

8 8

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

2 STRATEGIC REPORT

9 9

Strategic Report

ABOUT US We will achieve our vision by:

Over the last five years, South Central Ambulance Service NHS Foundation Trust (SCAS) has transformed itself from being a traditional ambulance provider to a dynamic and innovative organisation that delivers a holistic healthcare service to the population of over 4 million people whom we serve.

èè helping people access appropriate care by assessing individual needs and directing people to the most relevant service èè dispatching emergency clinicians to treat people with life-threatening injuries or conditions and providing specialist care whilst transporting those people to the most appropriate healthcare facility èè enabling people to stay safe and well in their own communities by providing mobile healthcare closer to home èè supporting whole system healthcare by working with partner organisations to assess needs and plan care for local communities and individual needs.

Our role has gone far beyond simply transporting people to the nearest hospital. Today, we provide a single point of access for people, predominantly, in Berkshire, Buckinghamshire, Hampshire and Oxfordshire who are ill, injured or concerned about their health. As well as clinical assessment, sign-posting and advice services, SCAS also works closely with clinical networks and trauma teams to provide the best possible care for those with critical or life-threatening conditions.

We deliver our services from: èè our headquarters in Bicester, Oxfordshire, and a regional office in Otterbourne, Hampshire. Each of these sites also houses a Clinical Coordination Centre where 999 and NHS 111 calls are received, clinical advice provided and emergency vehicles dispatched if needed. èè 78 sites including resource centres, standby points, PTS bases and air ambulance bases èè 279 frontline vehicles èè 2 air ambulances

SCAS became an NHS Foundation Trust on 1 March 2012 and now has a foundation trust membership of more than 13,000 people.

Despite a number of densely populated urban cities such as Southampton, Portsmouth, Reading, Oxford and Milton Keynes within the four counties we serve, our operational area is classified as predominantly rural. High levels of demand for our services continues to put significant pressure on us and requires us to continually review and improve the services we offer.

We rely on the support of:

Our vision >

èè 3,000+ members of staff èè 1,024 Community First Responders (CFRs) and Co-responders èè 83 volunteer car drivers èè 26 governors èè 13,500 Foundation Trust members.

TOWARDS EXCELLENCE - SAVING LIVES AND ENABLING YOU TO GET THE CARE YOU NEED

10

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

SCAS COVER 3,500 MILES. THAT’S THE SAME SIZE AS CYPRUS

11

Strategic Report

NATIONAL PERFORMANCE TARGETS TARGET

NATIONAL TARGET

ACTUAL 2014/15

ACTUAL 2013/14

RED 1

75%

75.0%

79.2%

RED 2

75%

74.5%

75.7%

RED 8

75%

N/A*

76.0%

RED 19

95%

95.5%

95.4%

*Red 8 target was not reported nationally 2014/15

National targets are set by the Department of Health and they apply to every ambulance service in England.

These standards are amongst the most challenging standards set for ambulance services in the world.

All other red calls are measured against a 19 minute response.

In spite of being faced with continually increasing demand we have achieved two of our three key national response time targets for Red 1 and Red 19, narrowly missing our Red 2 target by 0.5%. This has been achieved whilst in year activity has increased by 5.3% over the number of incidents responded to in 2013/14.

The targets ensure the Trust is measured against the percentage of calls responded to in 8 or 19 minutes depending on the priority of call with Category A calls measured as the highest priority. This data is extracted from the Trust’s Computer Aided Dispatch (CAD) systems.

Category A calls are subdivided into Red 1 calls covering response to patients with critical conditions which are measured against an 8 minute response time, and Red 2 calls where the condition is less critical but still measured against an 8 minute response.

12

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

HOSPITAL HANDOVER DELAYS BY MONTH

48,000 46,000 44,000 42,000 40,000 38,000

2014/15 ACTUAL

2014/15 PLAN

520,000 500,000 480,000 460,000 440,000

420,000 2013/14

999 calls

13

2014/15

ar M

b Fe

n

2013/14 ACTUAL

ACTIVITY (999 INCIDENTS)

2012/13

Ja

c De

No v

ct O

p Se

g Au

Ju l

Ju n

M ay

Ap r

36,000

Strategic Report

REGULATORY RATINGS As part of its regulatory regime, Monitor assigns risk ratings to each NHS Foundation Trust as an indicator of the Trust’s compliance with the conditions of its licence. South Central Ambulance Service NHS Foundation Trust (SCAS) was authorised as an NHS Foundation Trust on 1 March 2012 and has been assessed under this framework since that date.

The Trust achieved a 4 rating for Continuity of Service which identified that Monitor had no evident concerns.

The Trust achieved a green rating for governance.

Monitor amended the risk ratings on 1 October 2013 replacing the financial risk rating with a new continuity of service rating. This comprises a liquidity rating and a capital servicing rating. SCAS achieved the following risk ratings for 2014/15 and 2013/14 based on assessment of its submissions.

2014/15 Continuity of Service Rating Governance Rating

2013/14

ANNUAL PLAN

Q1

Q2

Q3

Q4

4

4

4

4

4

Green

Green

Green

Green

Green

ANNUAL PLAN

Q1

Q2

Q3

Q4

4

3

3

Amber/ Green

Green

Green

4

4

Green

Green

Under the compliance framework Financial Risk Rating Governance Risk Rating

Under the risk assessment framework Continuity of Service Rating Governance Rating

14

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

RISKS The Trust has developed a risk management culture to empower all staff to make sound judgments.

This forms part of the Trust’s Risk Management Strategy. We are committed to continuous improvement of those processes.

Each risk is entered in a risk register which is reviewed on a periodic basis by the Audit Committee and Quality and Safety Committee. These form the basis of the Trust Board’s Assurance Framework which is reviewed periodically by the Board as well as the Audit and Quality and Safety Committees.

THE TRUST’S MAIN POTENTIAL STRATEGIC RISKS HAVE BEEN IDENTIFIED AS FOLLOWS: èè Operational response targets are not consistently met èè Hospital handover delays resulting in delays in reaching patients èè Poor operational performance in the NHS 111 call handling service èè Failure to build adequate stakeholder relationships resulting in poor organisational reputation èè Inability to recruit and retain staff in high enough number to deliver operational performance.

There are several risks of an external nature that may impact on the Trust, including an ageing population, changes to NHS competition rules and the challenge of meeting performance targets in a predominantly rural area.

15

Strategic Report

DEVELOPMENTS The Five Year Forward View published

by NHS England in October 2014, clearly set out the need for the NHS as a whole to evolve and adapt to meet the new challenges. All healthcare providers are faced with a growing, ageing population and an increase in more complex health needs amongst large sections of the population.

èè Developing partnerships with GPs and community teams to enable more people to be assessed in a timely fashion in their own homes èè Implementing a single technical platform across commercial services èè Successfully mobilised the first phase of the new Hampshire Patient Transport Service (PTS) contract that went live on 1 October 2014 èè Improving information and data management across the Trust with a range of technical innovations allowing us to be more efficient and effective in analysing, interpreting and improving our systems of care

The Trust has, over the last five years, already developed into much more than a traditional ambulance service by ensuring we offer the right care, first time to each patient.

Our strategic plan for the Trust, both in the national context outlined by NHS England and in relation to our own analysis of, and response to, local needs, is highly ambitious and over the last 12 months we have again made significant progress against some of the key goals of our transformation programme.

Our focus in 2015/16 will remain on our strategic priorities to improve patient care and support local systems in managing the rise in demand, within the context of tightening finances and increased competition.

In line with our commissioners’ thinking, there are four broad areas of focus for our plans in 2015/16, which are outlined below.

Whilst a great deal of work has been delivered, our key successes can be summarised as:

To enable people to identify and access the care that they need first time, we will:

èè Beginning to move our Patient Transport Service, Logistics, NHS 111 and 999 services onto a virtual telephony platform. This will also enable us to pilot home-working as a way of securing access to wider range of clinicians èè Implementing a common assessment tool (NHS Pathways) for 999 and 111 èè Increasing the proportion of calls resolved by telephone advice or referral to minimise demand on frontline resources èè Improving our mobile healthcare capability by rolling out electronic patient records to 50% of SCAS with the remainder to be introduced during 2015

èè Combine the leadership of 999, NHS 111 and other services within our clinical co-ordination centres èè Ensure our current and future estate has the capacity to meet the demand for our service èè Redesign our NHS 111 service to ensure full compliance with the new specification, including investing in infrastructure to more closely integrate NHS 111 with other care systems

16

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

To support efficient and effective patient flow around systems of care, we will:

èè Provide clinicians with access to the care plan component of Summary Care Records èè Exploring the use of new technologies and developments to deliver more proactive, accessible and holistic care

èè Enhance the analytical capability and capacity of the Trust èè Improve the quality of the data we hold èè Improve and expand access to QlikView, our reporting tool èè Introduce a planning simulation tool.

To enable more people to stay safely in their own home or community setting, we will: èè Improve our pathways, processes, practices and clinical leadership that will ensure more people can be supported at home èè Provide access to the Directory of Services and Summary Care Records for mobile teams èè Work with local partners to implement service models identified in the Five Year Forward View èè Assess the feasibility of introducing mobile screening and diagnostic services To ensure people travel safely between home and care settings, we will: èè Mobilise the second phase of the new Hampshire PTS contract èè Continue to bid for new business opportunities as they arise èè Introduce dynamic scheduling to make more efficient use of our resources, reduce distances travelled and fuel costs, and most importantly, improve the patient experience

Will Hancock Chief Executive Date: 27 May 2015

17

What we do

18

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

3 WHAT WE DO

19

What we do

SAVING LIVES AND ENABLING YOU TO GET THE CARE YOU NEED

20

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

999

As well as responding to emergency 999 and urgent GP calls that you would expect from a traditional ambulance service, the expansion of our non-emergency NHS111 service means that SCAS now provides a much more integrated clinical assessment, sign-posting and advice service too.

Our clinical co-ordination centres are based in Bicester and Otterbourne and receive well over 1,000 emergency calls every day, which are handled by over 500 call centre staff who work 24/7.

Our two clinical co-ordination centres based in Bicester, Oxfordshire, and Otterbourne, Hampshire, have allowed us to co-locate our NHS111 and emergency operations centres where our ethos is two numbers, one service. We can now provide simplified access to healthcare across the four counties we serve, whether someone has telephoned 999 in a crisis situation, contacted NHS111 with an urgent query, requires advice and support or needs to access a GP in or out-of-hours service.

To meet this demand we have more than 1,400 paramedics, technicians and emergency care assistants on the road delivering excellent front line care. We have a fleet of 279 specially-equipped emergency vehicles from over 30 sites across the region.

Our paramedic practitioners work in the community with additional skills such as being able to supply medication for a range of minor illnesses, provide advanced care for long term conditions, and manage a range of minor injuries at home.

During the past 12 months our focus has been on developing from an emergency point of contact to become more of a single point of contact for patients needing access into local healthcare services. As we build this capability, the Trust will also become a provider of more mobile healthcare services, providing advice and support over the phone and in-person that allows more people to be supported in their own homes and local communities.

To support delivery of our key performance targets (Red 1, Red 2 and Red 19) we have established a network of stand-by points, where vehicles wait until dispatched, to ensure the fastest response times for patients. We deploy rapid response vehicles (RRVs) and ambulances, each with highly-skilled staff trained in the use of the latest medical equipment. We also respond to urgent calls from GPs and other health care professionals.

One of our key challenges this year has been keeping up with demand, particularly in emergency 999 calls where we have seen a 5.3% year-on-year increase compared to 2013/14.

As an ambulance service, we regularly work in close partnership with other blue light and emergency services in response to a wide range of incidents.

This comes at a time of a national shortage of paramedics. As well as supporting staff from within the Trust to train to become qualified paramedics, we have also been working with Oxford Brookes and other local universities to ensure that we are building the required capacity within the higher education sector to increase the volume of graduate paramedics entering the job market in future years.

As well as working together routinely, we also train together regularly in order that we can be more prepared for emergency situations. Such cooperation and interoperability ensures the public receives a joined up, coordinated and comprehensive service in crisis situations.

21

What we do

TRAUMA RESPONSE

In addition, we are able to rely on a number of in-house, partner and voluntary resources in dealing with emergencies which not only helps us save time and lives, but also helps free our core resources to respond to emergencies elsewhere.

Patients with major trauma are no longer taken to their nearest hospital for treatment: patients are transported to Major Trauma Centres where expert trauma teams treat them for their injuries. Transporting major trauma cases further across the Trust places additional pressure on our crews, but they have been extensively trained to deliver life-saving interventions en route to hospital.

Such resources include:

HART (HAZARDOUS AREA RESPONSE TEAM) HART is a team of paramedics specifically trained and equipped to deliver first class care to patients who are injured or ill in hazardous environments. Previously the ambulance service was unable to work in these areas as it would have been unsafe for ambulance staff to do so. By ensuring ongoing specialist training with partner agencies such as the Police, Fire Service and Maritime & Coastguard Agency, and by having the correct specialist equipment and procedures, we are able to provide the public with greater reassurance that we can respond to challenging, complex incidents where they need help.

SCAS has a team of highly experienced BASICS (British Association for Immediate Care) doctors who respond to emergencies to support crews. We also have an Enhanced Care Response Unit (ECRU) covering the Thames Valley, and two air ambulances to take the care, once only available in hospital, to the patient’s side. The air ambulances are staffed by experienced doctors and paramedics who have additional skills to deal with trauma.

There is evidence that trauma networks are having a dramatic impact on death rates – with a 30% reduction in trauma deaths since 2011.

Incidents where HART has been deployed to in the last 12 months include major incidents, chemical incidents, collapsed buildings and flooding as well as inland river incidents, patients injured while at height and complex road traffic accidents.

HART also supports Trust operational staff daily by sharing the team’s knowledge, experience and unique use of equipment in other incidents that thankfully are not deemed hazardous in nature but can still be challenging for the Trust.

AIR AMBULANCES Where speed is vital because of the severity or nature of a patient’s injuries, or if the emergency cannot be reached easily by road, we rely on our air ambulance partners, Thames Valley and Chiltern Air Ambulance (TVCAA), and Hampshire and Isle of Wight Air Ambulance (HIOWAA), to deliver paramedics and doctors to the patient as quickly as possible. The team takes dedicated physician care to the patient to ensure the most critically injured patients receive the care and treatment they need.

By providing excellent clinical care in these hazardous areas, we can ensure that our patients receive the best appropriate clinical treatment and management at the earliest opportunity.

22

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Extended flying hours from 06:00 to 21:00 have increased from the summer months to all year round and a Pre Hospital Qualified Doctor is available at all times during the day. We will be working closely with both charities over the next six months as we plan to extend the flying hours into night time operations from November 2015. We are also now deploying a HEMS (Helicopter Emergency Medical Service) paramedic and a doctor in the ECRU at peak demand periods across Thames Valley.

The SCAS AED App identifies the closest defibrillator to a patient and we encourage everyone to download this app onto their smartphone.

We are working to develop a new training and education package for all our responders which will provide them with an accredited training certificate which we hope will be adopted by all ambulance trusts across England.

Please contact SCAS if you are interested in getting involved either as a responder or a fundraiser and we will let you know how.

COMMUNITY FIRST AND CO-RESPONDERS

NHS111

SCAS has a large, well-trained group of Community and Co-Responders made up of members of the public, fire service, police community support officers, coastguards and military responders who volunteer and undertake training to be able to support people in their community with the support of SCAS.

NHS 111 is a ‘one stop number’ for the public to access information and local services to support their health needs. Like the 999 emergency service provided by SCAS, NHS 111 is free to the caller and accessible 24/7, 365 days a year.

The Trust’s NHS 111 service has grown over the past twelve months and we now deliver this service against six contracts covering Oxfordshire, Berkshire, Buckinghamshire, Bedfordshire, Luton and Hampshire. This year, our NHS 111 service took over 1.2 million calls and staff numbers have increased from 46, who were employed from September 2012 when the Trust delivered one NHS 111 contract, to around 480 by the end of this year.

We now have 783 members of the public trained as Community First Responders covering the SCAS area. We are continuing to work with the Fire and Rescue Services in Buckinghamshire, Oxfordshire and Berkshire to expand the Co-Responder schemes in these counties.

We have increased the number of military Co-Responders with new schemes now live operating across all four counties.

These groups also spend significant time, voluntarily, to raise funds to provide vehicles and equipment in their local community. We will continue to work with local groups and communities to place defibrillators in as many areas as we can across the SCAS region. As part of this roll out we will continue to train community groups in the use of the defibrillator and basic life support to ensure we maximise the availability of someone to treat a patient who suffers a cardiac arrest.

23

What we do

Health information service

The NHS 111 service is provided using NHS Pathways trained call handlers and professional clinicians (nurses/ paramedics). The Trust is justifiably proud of meeting the NHS 111 service contract key performance indicators (KPIs) on most occasions: 95% of calls are answered within 60 seconds; call abandonment rate is well below the 5% target; and transfer to 999 has been reduced over the past 12 months compared to the figure for 2013/14, and remains consistently lower than the national average for all NHS 111 services.

èè A number of staff are being trained to deliver a new health information service based on the previous NHS Direct CHIMES model.

This ensures that trained health information advisers can take any calls regarding health information or medication enquiries (which are not symptomatic) following initial triage that were previously passed to a clinician. The service went live at the end of February and is expected to release approximately 500 calls per month from clinicians thereby increasing clinician capacity within the NHS 111 service.

Regular surveys undertaken over the past year confirm that patients are generally satisfied with the NHS111 service that SCAS provides.

Review of 999 Green Call Over the last 12 months we have undertaken a number of innovative developments and pilot projects to further develop and enhance our high quality nonemergency service and improve the patient experience. A summary of some of these developments is given below:

èè At times of peak demand, particularly bank holidays and weekends, we have placed additional clinical support staff to review 999 calls and support call handlers. Results have shown that this has been able to reduce the overall transfer rate to 999 over the winter period despite this coinciding with a rise in call volumes and higher acuity of patients.

Home working for clinicians èè 13 staff have been selected across both the Bicester and Otterbourne clinical co-ordination centres and home risk assessments undertaken to allow staff to log on at home in the event of absence or a surge in volume of calls, in order to increase clinician capacity when needed.

SCAS has been given approval from NHS Pathways to pilot this project which will go live in May 2015.

We are currently taking part in two national NHS 111 phase 2 pilots with direct reporting to NHS England and will undergo evaluation through the University of Newcastle.

The first pilot relates to identifying and managing the impact of frequent callers to NHS 111, Out of Hours and 999 services across Thames Valley and working to manage these patients more effectively.

For the second pilot, we are also trialling a new pathway whereby we transfer relevant calls directly to a pharmacist for minor ailments, repeat prescriptions and medication enquiries.

24

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

NHS DIRECT We were delighted to be offered the opportunity, by the NHS Trust Development Authority, to become the formal legal successor body for NHS Direct (NHSD) when it dissolved on 1 April 2014.

We saw this as an ideal opportunity to build further on the SCAS brand, and being asked to take on this role was testament to the reputation SCAS has both regionally and nationally for being a reliable and high performing organisation.

Prior to the dissolution of NHSD, we had already been appointed to take on the NHS111 service that NHSD had been providing in Buckinghamshire, as well as also taking over responsibility for delivery of the National Pandemic Flu Service.

The opportunity to become the formal NHSD successor body developed from these existing commitments, and was an acknowledgement of the complementary aspects of the SCAS and NHSD businesses.

On becoming the formal successor body to NHSD, SCAS established a Legacy Management Programme Office to oversee the effective close down of NHSD and the transfer of residual activities to SCAS. This work programme was completed successfully, and SCAS continues to provide both NHS 111 in Buckinghamshire and the National Pandemic Flu Service.

25

What we do

COMMERCIAL SERVICES NON-EMERGENCY PATIENT TRANSPORT SERVICE (PTS)

An additional range of services, including Patient Transport Services, Logistics & Courier Services and First Aid and Clinical Training, is provided by the Trust and managed within the Business Development Directorate. These markets are open to any company or organisation, both public and private sector, and are highly competitive.

Our non-emergency Patient Transport Service (PTS) transports patients who are eligible for transport from home to a medical treatment site and back. Journeys typically involve transporting patients to outpatient clinics for pre-planned appointments, hospital admissions and discharges, as well as transfers between hospitals, and are not confined to our four counties. The volume of journeys undertaken by the PTS makes SCAS both the main provider of emergency and nonemergency patient transport in the South Central region.

Work has been on-going throughout 2014/15 to improve the financial viability of a number of commercial contracts.

Historically a proportion of commercial contracts have been rolled over for many years and the outcomes did not always accommodate increased activity, higher demand or inflationary cost pressures.

With renewed focus on operational and financial performance, including user expectations, our contractual position was strengthened and several contracts were retained on improved terms.

The service is split to support contracts across four business areas, these being Hampshire, Buckinghamshire, Oxfordshire and Berkshire and the service is provided across these areas by over 400 team members comprising managers, ambulance care assistants and contact centre functions which are split between Bicester and Otterbourne. In 2014/15 we undertook over 500,000 PTS journeys; the increase in demand is due to the on-going changes in urgent care services across our region and a higher volume of short notice requests to improve discharges and patient flow within the regional healthcare system. We are particularly indebted to our volunteer car drivers who give their time freely and, over the last year, undertook 15% of all patient journeys.

The Commercial Management Team has focused on exceeding customer expectations and this has contributed to the very high level of customer retention and new business development in 2014/15. The team has developed excellent working relationships with customers and especially local commissioners who recognise the high quality service SCAS provides.

26

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

è One of our new Patient Transport Service vehicles at Queen Alexandra Hospital, Portsmouth

27

What we do

In 2014/15 SCAS was proud to win new contracts for PTS services across Hampshire and Milton Keynes. Mobilisation project teams were initiated to oversee the contract implementation processes with Hampshire going live October 2014 and Milton Keynes going live April 2015.

With a highly competitive marketplace characterised by frequent retendering, the Trust is focused on improving efficiencies to continue to deliver a costeffective option for commissioners (such as reviewing and rigorously enforcing eligibility criteria), whilst maintaining a customer and patient focused service and expanding our successful PTS beyond our current regional borders. In 2014/15 SCAS PTS went through considerable change including new IT systems to enable additional functions such as text messaging to patients, introduced a virtual contact centre for call handling efficiencies, procured PDA devices for all vehicles across SCAS PTS and due to new contracts procured 70 new vehicles.

Satisfaction amongst patients with the service provided by SCAS remains high.

The Trust has both a paper survey form available on vehicles and also a permanent online survey that allows any patient transported by the PTS to quickly and easily provide feedback on their experience. All respondents rated their experience of the quality of service, staff appearance, staff conduct and patient care as satisfactory or very satisfactory. We use this feedback to shape our service to meet patient needs and an example of this is alterations we commissioned to tail lift systems to alleviate excess noise which was identified through patient feedback.

LOGISTICS & COURIER SERVICES Non-patient transport is provided by the Trust’s Logistics & Courier Service across Berkshire and Oxfordshire and the service provision includes moving parcels, mail, passengers and medical specimens safely and securely thanks to a pool of experienced drivers and using a variety of fleet options.

In September 2014 SCAS PTS was included in the Trust’s pilot CQC inspection and as a result of this inspection a specific PTS action plan was initiated alongside the overall Trust action plan.

The plan details all actions required to address the CQC ‘must’ and ‘shoulds’ from the CQC report and an example of this is a revised statutory and mandatory training course which all PTS staff members will attend. PTS has in addition introduced new roles within the service to support CQC recommendations including a PTS Clinical Governance Lead and Patient Experience Manager.

During 2014/15, logistics transported; Specimens 338,928 Goods 12,852,265 Passengers 53,201 Total 13,244,394 (2013/14 12,890,212) We deliver mainly for the NHS between hospitals and GP surgeries. Overall logistical activity continues to rise to meet the ever-increasing demand and passengers increased due to the introduction of new shuttle bus services for staff to and from Wexham Park Hospital.

28

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Specimens

338,928

Passengers

53,201

13.2m 2013/14: 12.8m

Goods

12,852,265

29

What we do

FIRST AID AND CLINICAL TRAINING (FACT)

FACT is ideally placed to provide first aid and clinical training to the general public along with bespoke workplace first aid training to companies and organisations in order to help ensure all workplaces meet the minimum legal standards in providing first aid to staff. All trainers provided

by SCAS are healthcare professional clinicians experienced in operational and practical situations, as well as being skilled instructors.

In 2014/15 the Trust committed to raising the awareness of South Central Ambulance Service NHS Foundation Trust as a competitive and high quality training provider through communicating and marketing this provision effectively to target customer groups.

FACT has also introduced a revised PTS initial training course programme including formal national accreditation for both the first aid and driving elements of the course.  

Commercial Training was rebranded as First Aid and Clinical Training (FACT) and a communications and marketing plan raised awareness of the provision, including the competitive quality, cost and additional unique benefits SCAS brings as a training provider and also introduced a brand new website for FACT with the development of online course booking and payment systems. The Trust, in addition, is a member of the National Ambulance Services First Aid Training Group; the aim of the group is to enable ambulance services to jointly tender for national contracts and split the contract delivery across the ambulance services’ geographical areas.

30

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

SOCIAL AND COMMUNITY ISSUES

The Trust can provide training and advice for anybody interested in installing a PAD as this important adjunct compliments the already valuable service our volunteer Community First Responders provide.  

As well as playing a vital part in providing healthcare and other services for the communities we serve, the Trust is committed to investing in our local areas to help build a better society.

We have continued to invest in the local communities by recruiting, training and developing a diverse team of community based volunteers who work side by side with our frontline staff to deliver care in medical emergencies. SCAS has over 400 schemes and the Trust is able to call upon 957 active Community First Responders who generally respond within a three mile radius of their location. At the time of writing (19 March 2015) the team has been assigned to 51,756 incidents.

We have continued to install automated public access defibrillators (PADs) throughout the Trust and had 99 live by the end of 2013/14. With the continued efforts of working with our local communities we are delighted to have been able to increase this total to 401 by the end of our financial year 2014/15.

Our groups of volunteers continue to assist us in raising awareness amongst our local communities about the lifesaving benefits such installations can bring as well as how beneficial CPR (cardio pulmonary resuscitation) can be. Some of our communities are involved in the national Heart Start programme which encourages residents to learn basic life support.

Statistics show that in cases of sudden cardiac arrest outside hospital, only 1 in 10 people survive. However when bystanders provide CPR and use such defibrillators before emergency services arrive, as many as 4 in 10 victims survive.

31

What we do

VALUING STAFF OUR WORKFORCE

STAFF DEVELOPMENT

Our workforce remains our priority and we continue to invest in the workforce at all levels. Our key focus during 2014/15 has remained recruitment and retention, increasing our understanding of what motivates our staff at work and factors which may influence their decision to leave. A major factor increasing the rates of attrition has been the increased opportunities to deploy paramedics within the health economy, no longer seeing their skills confined to roles within the ambulance services. We continue to invest in growing our paramedic workforce and are working in partnership with Health Education Thames Valley and our local universities to offer greater numbers of places on paramedic science degree programmes, both to our staff and students.

A major part of our recruitment and retention action plan is the development of our staff. We continue to invest in training staff to become paramedics and, during 2014/15, introduced a new student paramedic programme in conjunction with Oxford Brookes University, offering greater access to places on these programmes.

This was in addition to staff being sponsored at Portsmouth University. Our plans for 2015/16 are to further increase these opportunities.

Our second major opportunity during 2014/15 has been the development of a new specialist paramedic programme, with the first 20 staff selected to begin their training in April 2015 and a second cohort to begin in September.

We continue to support a wide range of staff to further their education, with support for studies from GCSE and A levels, to BSc and postgraduate qualifications. Our apprenticeship schemes continue to support staff to study for qualifications in a range of subjects including customer services, business administration and leadership. We have increased the range of Continuing Professional Development available to staff through eLearning. This includes modules available on the National Learning Management System and from the British Medical Journal (BMJ). Additionally, modules have been developed by the education team in response to requests from the clinical directorate and from staff.

Statutory and mandatory modules are also available, supplementing the face to face teaching provided by the education team.

In addition to our front line 999 workforce, we have continued to recruit within our EOC and 111 control rooms to meet growing demand, and across our commercial Patient Transport Service (PTS).

Our commercial workforce has grown during 2015/16 following the TUPE of staff as a result of the successful bid and implementation of the Hampshire PTS contract.

Recruitment and retention will remain a key priority during 2015/16. In addition to increased opportunity for staff to train as paramedics, our recruitment plan includes offering flexible contracts and support to qualified paramedics who may not be currently in work but considering a return to the profession, improving our links with schools and colleges, attracting more applicants from underrepresented communities, and increasing overseas recruitment from EU countries.

32

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

STAFF SURVEY

A face to face training programme is delivered for all patient facing staff including, Manual Handling, Resuscitation, Safeguarding and Dementia. In addition to driver training as part of induction for all road staff, the driving training team also delivered Advanced Driving Courses, Rapid Response Vehicle courses and refresher programmes for staff returning to work or post incident.

Feedback from our staff is very important, and we encourage all staff to share their opinions through our staff surveys. During 2014/15 all staff were invited to share their views through the Family and Friends test in addition to the annual staff survey.

For the second year, staff were invited to complete the survey online, with paper copies of the survey available to staff on maternity leave and in PTS, where staff were less inclined to complete the online version. Response rates were similar to the previous year at 59%, with some departments achieving over 90% returns.

Our response rate was again the highest of all English ambulance trusts, the average being 34% (for ambulance trusts) and 42% across all NHS trusts. This is a significant improvement on the response rate achieved by the Trust in previous surveys.

The Trust works closely with the Thames Valley and Wessex Leadership Academy who have continued to support leadership development within SCAS. Staff have gained places on national and local leadership development programmes in addition to programmes being delivered purely for SCAS staff.

We participate in the TVWLA Leadership Faculty which includes NHS organisations across Wessex and Thames Valley, with staff benefiting from the Coaching Register and SCAS trained OD facilitators having access to a range of leadership development diagnostics and tools, including Leadership Framework 360 and Myers Briggs.

33

What we do

RESPONSE RATE TRUST

NATIONAL AVERAGE

2011/12

41%

54%

2012/13

32%

50%

2013/14

60%

49%

2014/15

59%

42%

The 2014 survey consists of 92 questions, with the results reported against 29 key findings. 86 questions were used in both the 2014 and 2013 surveys, reported against 27 key themes.

TRUST SCORE

NATIONAL AVERAGE

% of staff agreeing they would feel secure raising concerns about unsafe clinical practices *

72

60

% of staff feeling pressure in the last three months to attend work when feeling unwell #

31

38

Fairness and effectiveness of incident reporting procedures *

3.29

3.18

Support from immediate managers *

3.59

3.25

40

31

TOP 5 RANKING SCORES - STAFF SURVEY 2014

% of staff agreeing that feedback from patient / service users is used to make informed decisions in their directorate / department * * the higher the score the better

# the lower the score the better

34

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

BOTTOM 5 RANKING SCORES STAFF SURVEY 2014

TRUST SCORE

NATIONAL AVERAGE

3.22

3.29

% of staff receiving job related training, learning or development in the last 12 months *

69

74

% of staff believing the trust provides equal opportunities for career progression or promotion *

66

69

% of staff believing their role makes a difference to patients *

86

86

% of staff working extra hours

85

85

Effective team working *

* the higher the score the better

# the lower the score the better

ACTIONS TAKEN FOLLOWING THE 2013 RESULTS

Selection and promotion data continues to be monitored and reported to the Board against the protected characteristics and while none has been identified, focus will remain on this as the trust adopts the Race Equality Standard in 2015. Opportunities for development have been increased with Student Paramedic and Specialist Paramedic roles introduced during 2014/15.

In 2013, the findings reported as needing most attention were: èè Percentage of staff believing the trust provides equal opportunity for career progression or promotion èè Percentage of staff suffering workrelated stress in last 12 months èè Percentage of staff appraised in last 12 months èè Staff motivation

Focus will remain on staff appraisals in 2015. Additional training was provided to managers in summer 2014 to enable a more meaningful discussion. Due to pressures of REAP, not all staff have had a full appraisal during 2014, but managers have been encouraged to undertake ongoing performance reviews and provide feedback as part of the shifts worked together.

Actions were taken following the release of the results of the 2013 survey to try to reduce stress at work. Human resources managers and occupational health introduced a pilot in NHS 111 ‘Be Happy, Be Healthy, Be Here’, to identify and support staff with symptoms of stress and help them return to work more quickly.

The success of the pilot has led to its roll out into other areas. Trauma Risk Management (TRiM) has continued to be supported as a route for staff to obtain care, with further numbers of staff trained as practitioners.

Since the publication of results in 2012, each department has received their own detailed staff survey report. Each manager agrees a set of pledges with their staff based on their local findings.

Pledges focused on their local areas for improvement, which included appraisals, training and development, improving local communications and support from immediate managers.

35

What we do

ACTION PLANS FOR 2014 SURVEY

Informal routes for staff engagement exist in a variety of ways. These include access to the Chief Executive and members of the Board through CEO meetings and leadership walkarounds, feedback to the Chief Executive through a dedicated confidential email address and staff and station meetings.

Actions to address the key findings of concern, and the areas where the Trust was lower than average across all ambulance trusts, include a continuing focus on appraisals and development.

Appraisal processes and training to deliver appraisal will be reviewed during 2015/16, consistent with development of a values based behaviour framework.

Operational managers are being supported to undertake interim reviews, in addition to full appraisals.

SUPPORTING STAFF HEALTH AND WELLBEING We continue to provide support to our staff through our Occupational Health service provider Team Prevent. The Team Prevent ‘Wellbeing’ website is a wellsupported resource that is used by our managers and staff. The site aims to help anyone:

The training plan for 2015/16 includes leadership development to support team leaders in addition to the training required by all staff to support them in their clinical roles.

èè understand more about the role of Occupational Health through the information provided in the Manager and Employee Zones èè find out how to get the best from the Occupational Health service èè complete an individual confidential health risk assessment and download a personalised health report èè discover what steps individuals can take to improve their health and wellbeing

Local action plans and pledges are also being developed and will be monitored by the Executive Team. A series of communications will provide further feedback to staff on progress against key findings and pledges, both at a Trust and a local level. The Trust will continue to communicate and engage with staff, acting on staff feedback and monitoring staff motivation.

STAFF ENGAGEMENT

Optum, our confidential Employee Assistance Programme and counselling service is available to staff and their families. Optum offers a wide range of advice and help both in person and online, and the service works with Occupational Health to promote healthy lifestyles and health choices.

Our formal routes for staff engagement remain our Joint Consultative Committee and local staff forums, with staff side representatives joining managers on major committee and project boards.

Our staff side have been fully engaged and committed to work in partnership with the Trust in our bids for commercial contracts. All operational and HR policies are developed in partnership through joint working groups.

We have expanded our team of trained Trauma Risk Management (TRiM) practitioners to support staff who may experience stress in the workplace.

36

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

The team will provide advice on coping strategies and signposting on to other services if required.

Overall, the feedback was positive with 23 graded green (achieving), five graded purple (excelling), two graded amber (developing) and five graded undeveloped.

The team follow established protocols to support staff in the early stages after dealing with distressing or traumatic incidents, and assess whether there is a need for further intervention. All TRiM practitioners are volunteers and receive training and support to fulfil this difficult but essential role.

The amber (developing) and red (undeveloped) were set as objectives for EDS 2012-2016.

We are at the end of year three of the four year plan and we are now 95% achieving (green) on the 2012-2016 EDS strategy.

The Disability Symbol

SCAS has given staff access to online stress training as well as actively promoting health and wellbeing through:

SCAS has for the fifth year running achieved the disability symbol awarded

by Jobcentre Plus to employers who show their commitment to employing disabled people. It demonstrates to disabled people which employers will be positive about their abilities.

èè work out at work days èè physiotherapy at work sessions èè Fruity Fridays èè cycle-to-work scheme èè promoting Dry January and other NHS and national programme initiatives such as stopping smoking

In achieving the disability symbol status SCAS has demonstrated that it will:

The Trust will continue to support national schemes throughout 2015/16 as well as managing attendance and attraction schemes.

èè interview all disabled applicants who meet the minimum criteria for a job vacancy and consider them on their abilities èè ensure that there is a mechanism in place to discuss, at any time but at least once a year, with disabled employees, what both parties can do to make sure disabled employees can develop and use their abilities èè make every effort when employees become disabled to make sure they stay in employment èè take action to ensure that all employees develop the appropriate levels of disability awareness needed to make sure these commitments work èè review these commitments each year and assess what has been achieved, plan ways to improve on them and let employees and JobCentre Plus know about the progress and future plans.

CELEBRATING DIVERSITY Equality Delivery System The Trust has completed three years of the adopted Equality Delivery System designed to support NHS commissioners and providers to deliver better outcomes for patients and communities and better working environments for staff, which are personal, fair and diverse.

The grading was carried out by our staff and staff side on “EDS Objective 3 Empowered, Engaged and Included Staff”.

There were a total of 35 focuses to be considered and graded.

37

What we do

Lesbian, Gay, Bisexual and Transgender Network (LGBT)

The Trust had 1,024 Community First Responders and Co-responders as at 31 March 2015 (946 in 2014).

SCAS has supported the establishment of the LGBT Network now in its fourth year.

The SCAS LGBT network comes together to celebrate the culture and contributions of Lesbian, Gay, Bisexual and Transgender people within SCAS. The network is open to all SCAS staff, volunteers or contractors regardless of sexuality and provides additional focus and resource to celebrate and promote equality and diversity, works to eliminate discrimination experienced by LGBT staff and supports staff with LGBT issues.

The Trust had a total of 83 volunteer car drivers (143 in 2013/14) as at the year ended 31 March 2015.

NHS Staff Survey This year, 76% of staff confirmed in the annual staff survey that they had received equality and diversity training. This results means that SCAS is above the national average when compared to all ambulance trusts for the delivery of equality and diversity training.

WORKFORCE STATISTICS Over the last 12 months over 750 new staff have joined SCAS the majority of whom have been employed in our NHS 111 and Patient Transport Service as a result of significant expansion in these areas following the Trust successfully bidding for a number of new contracts.

The Trust also continues to recruit paramedics both from abroad and within the UK to meet increasing demand for our emergency services.

The following tables show a breakdown of the Trust’s workforce by age, ethnicity and gender, as well as disability information for 2013/14 and 2014/15 respectively.

38

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

ETHNICITY

2013/14

2014/15

SIP

FTE

SIP

FTE

2,417

2,172.86

2,519

2,274.54

B White - Irish

14

13.61

12

10.04

C White - Any other White background

46

41.13

49

42.91

C3 White Unspecified

9

7.92

7

6.61

CA White English

53

50.91

41

39.24

CB White Scottish

3

2.07

3

2.51

CC White Welsh

4

3.80

4

3.80

CD White Cornish

1

1.00

2

1.51

CK White Italian

1

1.00

1

1.00

CP White Polish

1

1.00

1

1.00

D Mixed - White & Black Caribbean

2

1.07

1

0.31

E Mixed - White & Black African

2

2.00

3

3.00

F Mixed - White & Asian

8

8.00

7

7.00

G Mixed - Any other mixed background

8

8.00

10

9.55

GD Mixed - Chinese & White

1

1.00

1

1.00

H Asian or Asian British - Indian

5

5.00

8

6.91

J Asian or Asian British - Pakistani

8

5.05

6

3.97

K Asian or Asian British - Bangladeshi

1

1.00

0

0.00

L Asian or Asian British - Any other Asian background

7

5.96

9

7.72

LH Asian British

1

0.93

1

0.93

LK Asian Unspecified

2

1.43

1

1.00

M Black or Black British - Caribbean

12

10.20

12

9.43

N Black or Black British - African

11

9.23

9

7.35

P Black or Black British - Any other Black background

2

2.00

2

2.00

R Chinese

1

0.48

1

1.00

S Any Other Ethnic Group

3

2.41

2

1.80

SE Other Specified

1

1.00

1

1.00

Z Not Stated

219

193.76

250

213.85

SCAS Total

2,843

2,553.82

2,963

2,660.95

A White - British

KEY: SIP = Staff in post FTE = Full time equivalent

39

What we do

2013/14

AGE

2014/15

SIP

FTE

SIP

FTE

<20

4

2.76

14

12.12

20 - 29

593

549.47

637

579.71

30 - 39

700

612.21

698

607.56

40 - 49

829

737.24

839

753.83

50 - 59

557

517.03

589

552.61

60 - 69

146

126.59

171

146.29

>70

14

8.53

15

8.83

SCAS Total

2,843

2553.83

2963

2660.95

2013/14

GENDER

2014/15

SIP

FTE

SIP

FTE

Female

1,427

1220.61

1,477

1258.42

Male

1,416

1333.21

1,486

1402.53

SCAS Total

2,843

2553.82

2,963

2660.95

2013/14

DISABILITY

2014/15

SIP

FTE

SIP

FTE

Yes

140

124.23

127

113.58

No

1,918

1729.21

2,097

1885.92

Non disclosure

785

700.38

739

661.45

SCAS Total

2,843

2553.82

2,963

2660.95

KEY: SIP = Staff in post FTE = Full time equivalent

40

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

ENVIRONMENTAL REPORTING

In terms of state of readiness, the Trust was ranked as one of the highest scorers amongst the participating Trusts in the Programme.

The Trust continues to take its responsibilities towards the environment very seriously. Last year was year 2 of the revised Sustainable Development Management Plan which is available on our website. The Trust has a dedicated Green Coordinator who is supported internally by a network of volunteers from within the Trust who are known as the Green Team. The Trust has an overseeing Green Committee that meets three times a year and monitors progress against the strategy. The Committee is chaired by the Director of Finance, who is also the Board sponsor, and comprises all of the main functional heads. The Green Coordinator undertakes regular site visits identifying any areas of improvement from an environmental perspective.

Amongst some of the initiatives that have had a direct impact in the reduction of our carbon footprint were:

The Trust is an active member of GREAN (Green Environmental Ambulance Network) which comprises environmental heads from all other ambulance services.

In addition the Trust has played an active part in the Oxford AHSN Energy and Sustainability Cost Improvement Programme which comprises local trusts and other public sector organisations local to the Oxford area.

The Trust continues to work towards Department of Health initiative which is reducing its 2007/08 CO2 emissions by 10% by 2015. The Trust has still managed to reduce its emissions above the 2007/08 baseline despite undertaking increased activity over and above this baseline.

èè all new ambulance vehicles met Euro 6 standards using less fuel èè reduced amount of travel, through the use of video conferencing èè electronic timesheet project launched saving paper èè all rapid response vehicles now have solar panels on roof èè all new ambulances have solar panel connection points on roof for ease of installation of panels èè Green Team membership continues to grow and now stands at 83 èè cycle to work scheme to be launched in 2015/16

FUNCTION

2008/9 ACTUAL CO2

2014/15 FORECAST CO2

Fleet

10,009

11,663

Estates related

5,034

2,973

Total

15,043

14,636

41

Quality Report and Accounts 2014/15

42

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

4 ANNUAL QUALITY REPORT 2014/15

43

Quality Report and Accounts 2014/15

CONTENTS PART 1 èè Engagement èè The Francis report – a move to business as usual èè Regulation, Compliance and Quality Indicators èè Care Quality Commission Regulation èè Incident Reporting and complaints èè Monitor Core Quality Indicators

èè Welcome to our Quality Accounts èè Chief Executive statement on quality èè An overview of what we do and the way we work èè Model of our services èè Our strategy èè New ways of working and personalising care èè How the Board assures itself on Quality

PART 2

PART 3

èè Choosing and prioritising quality improvement initiatives for 2015/16 èè Our priorities for 2015/16 (Patient Safety, Clinical Effectiveness, Patient Experience) èè Statement of Assurance from the Board

èè Looking back and report on progress with 2014/15 quality priorities èè Other Quality successes èè Response letters from Commissioners and HOSP’s

44

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

CHIEF EXECUTIVEâ&#x20AC;&#x2122;S QUALITY STATEMENT I am pleased to present our Quality Report and Accounts for 2014/15. This foreword will set out in summary some of our key strategic themes for continuous quality improvement.

Our Staff Survey response rate was the highest return rate of all Ambulance Trusts, providing our Trust with meaningful and valuable data to use as the basis for tackling issues which matter to our staff.

As with previous years the results of the survey have been broken down into each area of the organisation, allowing us all to be able to see the detail and contribute towards making improvements to our local area and our Trust.

SCAS has been busier than ever in terms of demand in all our services in 2014/15 and we are continuing to work with our partners across health and social care to look at innovative ways of meeting this demand. We will be continuing to support local health and social care systems to ensure that appropriate care pathways are in place so that our patients receive the most appropriate care for their illness or injury.

We have been working hard to ensure staff are versatile across call centre functions and have introduced virtual call centres meaning that calls to PTS, NHS 111 and 999 can be answered quickly from the next available person regardless of location. Our IT infrastructure is continually developing to meet the high demands placed on it. Increased numbers of staff working in many more locations, including outside of our four counties, has required significantly enhanced IT solutions to enable effective and resilient communications channels.

All of this has to be done, of course, against an increasingly challenging financial environment without losing any quality of care and experience for our patients.

The trust welcomed the CQC inspection in September 2014 which piloted the inspection process for ambulance services under the new regulatory regime. This provided a valuable external review and we were pleased with the findings which demonstrated some outstanding areas of practice but also some improvement areas. "Outstanding" was the CQCâ&#x20AC;&#x2122;s verdict on the care and compassion that SCAS staff demonstrated as they cared for their patients, treating them with extreme sensitivity, dignity and respect. Services were deemed to be well led, with a clear focus on caring.

SCAS are now using NHS Pathways in 999 and NHS 111 which means staff are able to use the same systems to ensure our patients receive the right outcome for their call and we continue to work with commissioners on sign posting using the Directory of Services.

To ensure our patients get the right care at the right time we have been introducing a new Health Care Professionals pathway for those patients requiring our services following assessment by a GP for example.

45

Quality Report and Accounts 2014/15

We have also been expanding the SCAS footprint and services through being awarded the Uniting Care Cambridgeshire and Peterborough (UCP) service as a telephone single point of contact. Our NHS 111 service contracts continue to expand in new geographical areas and despite very high levels of demand, performance has been good. With increasing public awareness of the service we are considering new ways of working in NHS 111 to cover our busiest times.

Demand patterns vary across areas and at different times of the week. As one of the largest providers of NHS 111 services in the country, we are moving towards closer integration with our 999 service and to date, have a lower than national average transfer rate from NHS 111 to 999.

We will have to keep transforming in order to continue improving services and meeting demands.

The priorities for quality improvement described in this report reflect our key goals across all services to enhance safety, effectiveness and experience.

This Quality Account has been prepared and written by South Central Ambulance Service NHS Foundation Trust under the National Health Service (Quality Accounts regulations) 2010 statutory instrument No 279, The Trust has reviewed all the data and information available on the quality of care that all the service arms provide on a daily basis. To the best of my knowledge the information in this document is accurate.

We commenced delivery of the new Hampshire PTS contract in October 2014 and won the contract to deliver the Milton Keynes PTS service from 1 April 2015. We conducted a quality governance review of the new service delivery model in Hampshire, to ensure the highest quality service.

Will Hancock Chief Executive

Feedback from staff and patients/carers and other partners remains essential to improving services and we are actively using the quality intelligence to learn and implement service improvements.

SCAS have been rolling out ePR (electronic patient records), which will enable efficiencies when we are on scene and enable the timely use of data â&#x20AC;&#x201C; storage, analysis clinical decision tools, incident reporting, care pathways and will ensure effective streamlining of onward patient referrals.

It is our view that ambulance services can use their unique position in the healthcare system to improve pathways and access for patients.

46

PART

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

47

EXECUTIVE SUMMARY

WHAT IS A QUALITY ACCOUNT?

This Quality Account reviews our performance in the last year and sets out our key priorities for quality improvement in 2015/16. SCAS welcomes you to our Quality Accounts which we are proud to report and present. This report gives an opportunity to celebrate our successes and the staff who work hard to deliver the best care.

Quality Accounts are mandatory annual statements as required by the NHS Act 2009, written for the public by all NHS organisations that provide healthcare.

They are set against the context of three overlapping key themes, which were first identified by Lord Darzi and later enshrined in the Health and Social Care Act. These themes define quality of care and SCAS uses them to form its quality agenda and frameworks for quality governance.

EFFECTIVEN L A E IC

PAT IEN T

SAFETY T N IE

PERIENCE EX

PA T

NCE E I R PE

CL IN

Since our last Quality Account we have worked hard to improve services and have participated in a pilot ambulance service CQC inspection. We have been working with partners to consider how to relieve system wide pressures across health services while ensuring patients get the right care at the right time. This will be an ongoing workstream for us.

SS

STAFF EX

Quality Report and Accounts 2014/15

48

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

A BRIEF OVERVIEW OF WHAT WE DO AND THE WAY WE WORK South Central Ambulance Service NHS Foundation Trust is a high performing and expanding emergency and urgent care service, covering four counties underpinned by 19 Clinical Commissioning Groups.

Bucks Oxfordshire

Berkshire 3,000 staff 1,000 CFRs 40 sites

Hampshire

2 Air Ambulances 540,387 calls to 999

HART

450,577 PTS journeys 1,032,635 calls to 111

49

Quality Report and Accounts 2014/15

On 1 March 2012, SCAS became an NHS Foundation Trust and since that time we have evolved our services, becoming much more than a traditional ambulance service.

We provide three core areas of service provision to provide excellence in patient care.

MOBILE URGENT HEALTHCARE èè Providing 999 responses and care in a community setting

NON EMERGENCY PATIENT TRANSPORT AND LOGISTICS èè Providing routine and nonemergency patient transport services

CLINICAL COORDINATION CENTRES èè Facilitating delivery of the NHS 111 Health Helpline service and 999 and PTS calls

50

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

CURRENT OPERATING MODEL OF SERVICES AND CARE

999

Self-care

Emergency Urgent 111

Advice by Phone

GP and Primary Care

Urgent Care Centre

Paramedic at Home

Community Pharmacy

nc

ge

er

Em rk

wo

et

en

ar

yc

Emergency Centre

Major Emergency Centre

OUR STRATEGY èè Developing the clinical coordination centres Our services will be accessible 24/7, either on the telephone or via online and digital services. These services will be supported by a highly resilient platform and virtual telephony.

SCAS will make proactive welfare calls and monitor the health of people who are frail, at risk of deterioration in their health or who suffer from mental health issues.

51

Quality Report and Accounts 2014/15

èè Enhancing patient transport

We will have rapid, streamlined assessment processes, so that we can identify people in life-threatening situations quickly and dispatch emergency clinicians immediately to scene if needed.

SCAS will enable people to travel safely between home and health care settings.

We will match the nature of the transport to the needs of the patient, and we will help to resettle people at home following discharge from hospital.

Our services will be underpinned by a comprehensive and up-to-date Directory of Services in each local area, with direct access to relevant care pathways.

We will have a single technical operating platform across Patient Transport and Logistics services, which will enable virtual working, dynamic scheduling and improved communications with patients.

èè Mobile Healthcare SCAS will continue to save lives, with emergency responders dispatched immediately and specialist clinical teams equipped to convey a patient to the most appropriate unit if needed.

Our mobile teams will also be available 24/7 to support people in their own homes and local communities, offering advice, assessment, diagnostics and treatment on scene. Our clinicians will work very closely with GPs and other community-based services to keep people safe in their own communities.

Some of our clinicians will have advanced practitioner skills, to enhance the clinical assessment and broaden the range of diagnostics and treatment offered on scene.

Our mobile clinicians will have mobile devices so that they can access multiagency care plans and clinical records electronically whilst on scene.

SCAS clinicians will communicate and keep records electronically.

52

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

NEW WAYS OF WORKING AND PERSONALISING CARE

NHS Pathways is based on a clinical needs assessment and is symptom specific. This means that patients can be directed and signposted to the most appropriate area of the NHS for treatment in a timely way.

The benefits to patients and carers is that a disposition is reached that enhances their experience of receiving the most appropriate outcome safely.

As part of our strategic development we have been exploring ways to offer tailored care for each individual patient, using robust clinical assessment, sign-posting and advice services, whether they are ill, injured or concerned about their health.

In December 2014 SCAS introduced a new process by which other healthcare professionals (HCPs) book ambulance transport. In consultation with our staff, GPs and commissioners, we identified more effective uses of skillsets and vehicle resources which will improve patient experience, ensure appropriate levels of high quality care, reduce pressures on 999 resources, promote integration between services and produce real cost savings.

An audit undertaken as part of the restructure identified that 30% of patients required a frontline ambulance, 40% could be safely transported by an intermediate crew and 30% needed a patient transport type response only.

We work closely with clinical networks in Milton Keynes, Thames Valley and Hampshire Health Partners, and with stroke, heart attack and trauma networks to provide the best possible care for those with life-threatening conditions, both on scene and during their journey to the most appropriate unit.

NHS England’s key objective is to provide personalised care, close to, or in the home, for urgent care patients and to provide specialist care in dedicated units for those with life threatening conditions. SCAS’ current operating model promotes this objective and the process begins before a patient has even made contact. Through the use of a successful media campaign we are encouraging patients to ‘choose well’ and select the most appropriate method of care for themselves.

30%

In 2014/15 SCAS introduced NHS Pathways across our Clinical Coordination Centres and now NHS 111 and 999 services clinically assess patients through this system. This software allows our call takers to guide patients and callers through a series of questions which safely assesses their needs and reaches a treatment outcome for them called a disposition.

30% 40% 53

Quality Report and Accounts 2014/15

The changes in our approach are twofold:

This new model will improve the service for people who need transport for admission to hospital and increase confidence in this service for patients and referring clinicians.

It will also reduce the use of 999 frontline vehicles freeing up ambulances to those needing an emergency response. This forms part of our right care at the right time by the most appropriate resource strategy.

1. In our Clinical Coordination Centres the calls from HCPs are processed through an algorithm which uses questions to establish the clinical need of their patient, the patientâ&#x20AC;&#x2122;s mobility and times scales attached to the transport, in order to select the safest and most appropriate form of transport for each individual need.

2. To preserve frontline resources for the 999 service, dedicated HCP response teams will be based on resource centres which are located in positions best placed to provide excellent cover to all areas of SCAS. These teams will consist of clinical staff, emergency care assistants and ambulance care assistants.

SCAS HEALTHCARE PROFESSIONAL URGENT REDESIGN REFERRAL PATHWAY

54

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

HOW DOES THE BOARD ASSURE ITSELF ON QUALITY?

Part of this program involves the process of benchmarking against other ambulance services so that comparisons can be made and targets set as part of a national ambulance program of improvement in pre-hospital and urgent care.

In order to ensure the Board are assured we are maintaining and improving high quality services for our patients there are a number of strategies we employ.

Management of quality governance is assured through the Executive Management Group (EMG) and further monitored through the Quality and Safety Committee (Q&S). The EMG and Q&S Committee upwardly reports to the Trust Board, and is responsible for monitoring and seeking assurances with regards to clinical quality, patient safety and patient experience. A number of sub groups submit new guidelines, aggregated leaning and other feedback to the EMG and Quality and Safety Committee using a universal upward report template. The template provides a succinct process to ensure and assure the organisation that key issues are highlighted and acted upon. The reports highlight areas of non-compliance, areas of concern or challenge, areas for information and best practice. Actions and timescales are included. It is an auditable trail of actions, assurance, scrutiny and monitoring.

Our Trust Board comprises seven Executive and seven Non-Executive Directors who come from a wide variety of backgrounds, bringing with them a wealth of knowledge from commercial, public, healthcare and other industries. The Board draws assurance from a varied body of information collected through a network of feedback processes to ensure it remains informed and understands where changes can be made to improve services and outcomes for patients. The Board receives an integrated performance report of quality metrics alongside a detailed quality and safety report, made available to the public through our board papers, against which we judge our delivery against key quality goals. This is used to challenge the current performance and drive quality improvement. Additionally the Board receives key reports linked to quality from outside agencies such as the Care Quality Commission.

The Quality Impact Assessment process ensures that all change plans, service developments or cost improvement plans undergo a formal process to assess the potential impact of the change on the quality of care we deliver.

Feedback and Board assurance reports also include:

It is important that Board members have the opportunity to meet staff and patients and hear their stories and experiences.

Board members do regular walkarounds across our call centres, ambulance stations and patient transport sites. The Board also regularly hear patient stories in which a patient (or their relative/carer) attends a public Board meeting to provide a firsthand account of their experiences and the care they received. These stories create a platform to develop actions which drive improvements in the quality of care we provide.

èè Compliments èè Complaints èè Serious incidents èè Appraisals and education èè Staff survey èè Healthcare professional feedback The Board also takes into account qualitative and quantitative data from a continuous program of internal and external audit.

55

Quality Report and Accounts 2014/15

ENGAGEMENT

Anyone living in the SCAS area can run for election to our Council of Governors which is made up of three different types of membership:

SCAS believes strongly in patient and public engagement and regularly undertake promotional activities regarding our Foundation Trust membership across all four counties. These include:

PUBLIC GOVERNORS èè Elected by public Foundation Trust members living in their county

èè NHS 111 roadshows èè Patient Forums èè Constituency meetings èè Speak up if you’re aged 14-16 campaign èè Joint events with other Trusts èè Health events at private companies èè Name the bear competition - 999 awareness campaign in primary schools èè Attendance at major county events and local community events èè Bespoke health awareness talks at local community groups èè Falls prevention pilot schemes across various residential homes and day centres èè Educational talks at secondary schools, colleges and universities

STAFF GOVERNORS èè Elected by SCAS staff members

APPOINTED GOVERNORS èè Elected from organisations that work closely with SCAS such as local charities and CCGs. Strong links have been formed between our governors and our Non-Executive Director (NEDs), through an informal ‘buddying’ arrangement. This ensures that governors can gain a better understanding of the role of the NEDs and the key issues being faced by the Trust.

These events raise awareness about our services and enable us to gather feedback so that we can continue to deliver high quality care.

Membership engagement through our Council of Governors also enables us to engage with, and listen to the local population, reflecting our accountability to the communities that we serve.

56

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

AT 31 MARCH 2015, SCAS HAD 13,230 PUBLIC MEMBERS. è The SCAS mascot 999 Ted at Reading Football Club

57

Quality Report and Accounts 2014/15

THE FRANCIS REPORT - A MOVE TO BUSINESS AS USUAL

SCAS is committed to long term change and to ensure that our response is not an isolated exercise we have adopted a â&#x20AC;&#x2DC;business as usualâ&#x20AC;&#x2122; approach to the Francis recommendations.

SCAS fully acknowledged the seriousness of the findings identified in the Francis inquiry and report into the systemic failings in mid Staffordshire Hospitals.

In the two years since its publication we have made every effort to ensure that permanent lessons relevant to the entire health service are being learnt. A series of internal updates and workshops involving all levels of management, our Council of Governors and our Directors has enabled us to fully understand and respond to all 290 recommendations, in a comprehensive and ongoing action plan which references the reports five key themes.

To help us to achieve this we have embedded key behaviours in to our day to day business.

Openness Transparency

Willingness Pride QUALITY FIRST

Engagement Responsibility

Learning Support Action

The activities of all groups and committees have been reviewed and aligned to the Francis Report recommendations.

All sections which reference the Inquiry and its recommendations are marked with this clear symbol so that they are easily identified as a response or action.

58

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Actions already complete or in progress include:

èè Board minutes relevant to Francis recommendations identified by èè Patient Experience Group chaired by CEO

CANDOUR

èè Introduction of the friends and family test èè A policy and process for identifying potential harm events èè Increased stakeholder engagement èè NED led Quality and Safety Committee èè Quality always first agenda item at Board and senior team meetings èè Strong Board governance and financial controls èè Information governance procedures and information flows reviewed and updated

METHODS OF COMPLIANCE

èè Improved monitoring of hospital handovers to reduce delays èè Partnership agreements made between hospitals, commissioners and SCAS èè Improved match of resources to demand profile to improve response times èè Clinical performance indicators for CFR and co-responder schemes continually monitored èè Strengthened clinical governance arrangements for private providers

COMPASSIONATE CARE

èè Clinical master classes attended by Board members èè Patient stories heard at Board level èè Compassion element included in staff appraisals

59

Quality Report and Accounts 2014/15

èè Announced and unannounced leadership walkabouts providing opportunities to engage with staff and listen to their concerns and stories èè Small operational teams focused on staff development with dedicated team training time èè Regular staff communication through newsletters and other media

LEADERSHIP

èè Operational team management approach to mirror the local health economy èè Trust sponsored study for further academic qualifications or University entry èè Leadership training programme for all managers and supervisors èè Secondment opportunities èè Mandatory training for all staff monitored by the Board èè Updated clinical supervision policy èè Board workshops to review quality assurance arrangements èè Membership Newsletter publication 3-4 times a year

ACCURATE INFORMATION

èè Roll out of the electronic patient record (ePR) to capture clinical data and improve the transfer of information regarding patient specific treatments and care èè Roll out of an electronic incident reporting system to facilitate timely and accurate crossagency information sharing

60

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

REGULATION, COMPLIANCE AND QUALITY INDICATORS

We have also helped to refine and inform the data collection for future CQC inspections. The Quality Summit at which the inspection report was published, gave us an opportunity to align with other providers, commissioners, patient groups and health education with shared objectives going forward.

These Quality Accounts are aligned with the requirements and targets set by the NHS standard contract for ambulance services, the NHS England National Ambulance Indicators, the CQUIN (Commissioning for Quality Improvements) payment framework and those of our regulators, Monitor and the CQC.

During a week-long inspection, the inspectors made multiple visits to stations, Resource Centres and our Clinical Coordination Centres. They spoke to all grades of staff, observed care being given to patients, examined audit and training records, scrutinised our policies and procedures and reviewed our information governance processes.

Care Quality Commission In September 2014 the Care Quality Commission (CQC) carried out a scheduled pilot inspection at SCAS. This was under the new inspection regime and as such we did not receive a rating. We welcomed this external perspective of SCAS as an opportunity to gain level three assurance and to extract learning from both the CQC’s findings and our own extensive internal assessments known as ‘holding the mirror’ which we conducted during the pre-inspection phases. Timely internal reviews of our governance and assurance processes were undertaken on a Trustwide scale and a second more focused review of our Patient Transport Service was also carried out.

The CQC’s findings were shared at the Quality Summit and some areas were described as outstanding, particularly on the exceptional care and compassion that SCAS staff across all services demonstrate in caring for patients, treating them with extreme sensitivity, dignity and respect.

Importantly, most patients whose views were captured as part of the inspection process, echoed this sentiment and there was clear evidence that SCAS is passionate about improving patient care and experience, routinely using patient feedback to inform and improve the services it offers.

As part of the process we engaged with staff to celebrate what we do well and what we need to improve – this resulted in a good response and SCAS produced two booklets for staff and partners. We will continue this process.

Servicet bulance ntral Am NHS Foundation Trus South Ce

T WHAS SCA S DOE L WEL

South Centra l Ambu lance Service NHS Fou nda tion Tru

st

ROO IMPRM FOR OVEM ENT

1

61

Quality Report and Accounts 2014/15

“STAFF WERE EXTREMELY SENSITIVE, SUPPORTIVE AND REASSURING”… “PATIENTS TREATED WITH DIGNITY AND RESPECT”

“STAFF ‘LIVED’ THE VALUES OF THE TRUST” …“CULTURE WAS DRIVEN FIRST BY QUALITY” èè Leadership - “commitment, enthusiasm and passion” èè Culture – “Staff ‘lived’ the values of the trust” …“culture was driven first by quality” èè Caring, kind and compassionate staff – “staff were extremely sensitive, supportive and reassuring”… “patients treated with dignity and respect” èè Working collaboratively with partners to improve patient care - “an effective and responsive service”… “evidence of multi disciplinary working with other organisations èè Innovative with many areas of outstanding practice - “Highly innovative culture” èè Sound governance overall èè “special notes ensured that patients receive safe and appropriate care” ... “Patient records were maintained to a high standard and patients were appropriately identified and escalated for treatment if their condition deteriorated” èè Patient feedback - “PTS patient feedback from surveys being used to improve the service”.

62

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Incident Reporting

SCAS welcomes the report findings and found that the process, while challenging, has reaffirmed our view that we have some of the most dedicated, committed and passionate staff working for us. Both staff and public engagement were identified as being good and we need to promote the commitment that we have had from the rest of the local healthcare system to work together, to provide effective and responsive services to our communities.

In 2013 SCAS introduced an electronic incident reporting system called DATIX. This system is used by other NHS healthcare providers and facilitates information sharing between organisations about multiagency patient safety incidents, which leads to improved aggregated learning. We are pleased to report that since its introduction our staff have engaged with the DATIX system and we have seen our reporting levels continue to rise in 2014/15. This is regarded as a positive change as it demonstrates we are succeeding in creating a culture of reporting which facilitates frequent opportunities for aggregated learning which when acted upon can directly improve patient care.

Whilst we have demonstrated excellence in several areas of what we do, there are also areas we know we need to carry on improving. Having committed, enthusiastic and passionate leadership within SCAS enables and promotes the highly innovative culture that the CQC observed on their visits around the Trust. The areas highlighted as “must” improve were:

The total number of adverse incidents reported internally was 4,319 in 2014/15 Of these there were 17 Serious Incidents Requiring Investigation (SIRIs) which we reported externally to the Department of Health and the Clinical Commissioning Groups.

èè Uptake of statutory and mandatory training èè Staff in CCC and PTS - improve understanding of the Mental Capacity Act 2005 (MCA) èè Staff in CCC and PTS to receive safeguarding training to the required level and there to be robust arrangements for staff to report safeguarding concerns within agreed timescales èè Emergency calls answered and ambulance dispatch within target times Some of these areas for improvement will feature as priorities described in part two of these accounts, others are outlined in internal action plans. All have actions in progress or have already been completed to ensure services are improved for all our patients.

A full report from the inspection is available at www.cqc.org.uk/provider/RYE.

63

Quality Report and Accounts 2014/15

TOTAL NUMBER OF INCIDENTS REPORTED BETWEEN 1/04/2014 AND 31/03/2015 450 400 350 300 250 200 150 100 50

15

15 M

ar

b Fe

15 n Ja

14 c De

ct O

No v1 4

14

14 Se

pt

14 g Au

Ju l1 4

14 Ju n

M ay 14

Ap r1 4

0

During the reporting period SCAS received 540,387 contacts from the public to our 999 service, answered 1,032,635 calls in our 111 contact centres and made 450,577 Patient Transport Service Journeys. This level of activity means that less than 1% of all contacts results in an adverse incident.

There have been 7 referrals to the Parliamentary Health Service Ombudsman by complainants in 2014/15

We received 1,175 compliments which far outweighed our complaints which numbered 599.

64

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Monitor mandated Quality Indicators SCAS considers that the data is as described in the Quality Accounts for the following reasons:

Set by Monitor and NHS England, mandated indicators are intended to strengthen the reporting processes and create a comparable set of targets across all UK ambulance trusts. The mandated core quality indicators are outlined;

èè SCAS has extensive internal and external audits (2a, 2b, 2c) èè A robust clinical quality committee structure with upward reporting to Executive Management Group and Trust Board (1a, 1b, 1c, 3c) èè SCAS work in partnership with commissioners to share data, learning, analysis and improvement actions (1c, 2a, 2c, 2d, 3a) èè SCAS upload weekly patient safety incidents to the National Reporting Learning System (1c) èè National staff surveys (3c) èè Integrated Performance Reports (1a, 2b, 3a) èè National verification of clinical quality indicators data uploaded to Unify (2a, 2b, 2c)

For ambulance trusts mandated indicators for quality remain the same as the previous year as described in the “Detailed Requirements for Quality Reports” 2014/15. (Monitor) èè The percentage of Category A telephone calls (Red 1 and Red 2 calls) resulting in an emergency response by the Trust at the scene of the emergency within 8 minutes of receipt of that call during the reporting period. èè The percentage of Category A telephone calls resulting in an ambulance response by the Trust at the scene of the emergency within 19 minutes of receipt of that call during the reporting period.

SCAS intends to take the following actions to improve the quality of its services, by:

èè The percentage of patients with a pre-existing diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle from the Trust during the reporting period.

èè Developing clinical quality campaigns to drive improvements (1c, 2d, 3a, 3c) èè Develop a clinical strategy to share direction of travel on enhancing quality services (1a, 2a, 2b) èè Upload patient FFT data to Unify (3c) èè Benchmark further with other ambulance services on incidents and complaints (1c, 3a) èè Complete ePR rollout (1a, 1b, 2a, 2c, 2d) èè Strengthen our leadership walkarounds and triangulate with other quality intelligence to develop improvements (3a, 3b).

èè The percentage of patients with suspected stroke assessed face to face who received an appropriate care bundle from the Trust during the reporting period. èè The number and, where available, rate of patient safety incidents reported within the Trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.

65

PA RT

Quality Report and Accounts 2014/15

66

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

CHOOSING AND PRIORITISING QUALITY IMPROVEMENT INITIATIVES

We engage with our Clinical Commissioning Groups and other external partners when defining our goals for quality improvement and we place high importance on the feedback we receive from patients and other healthcare professionals who tell us that they want safe, timely care delivered by competent, professional and caring staff members.

In this part of the report we will outline a number of areas where we have identified that quality improvements can and should be made. Priorities are identified through scrutiny of a wealth of information collated through robust operational and engagement practices which are shared at Board level through our governance structure.

QUALITY ACCOUNT PRIORITIES

Leadership walk-rounds by the Executive and Non-Executive Directors also provide intelligence to develop areas for improvement and help to engage frontline and support staff in discussions and debates about our clinical and patient priorities. Internal and external audit programs and aggregated learning outcomes from incidents and claims are another vital aid to shaping our priorities.

Francis Keogh Berwick

Internal audit External audit

Aggregated learning from incidents and claims

Leadership Walkabouts

Complaints, Compliments, Concerns & Feedbacks

NHS Operating Framework

Patient and Staff Surveys

Contract Schedules

CQC Essential Standards

67

Quality Report and Accounts 2014/15

C

CARING?

R

RESPONSIVE?

E

EFFECTIVE?

W

WELL LED?

S

SAFE?

èè Measurability Can the priority we have set be measured accurately in order that we can show improvements

Finally as a Foundation Trust we are fortunate to be able to draw on the input of our Council of Governors who provide a picture of the needs of the communities which we serve.

èè Outcomes Will the initiative improve patient outcomes in the areas of safety, effectiveness and experience.

Priorities were assessed in terms of: èè Impact By considering the likely improvement in safety, outcomes and experience

Furthermore to aid us in our review of our priorities and to provide structure for our quality agenda we have introduced a self-assessment tool - C.R.E.W.S. This tool aligns with the regulatory requirements of the Care Quality Commission:

èè Feasibility The ease of implementation, resources required and likely time to completion or delivery

68

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

SCAS QUALITY PRIORITIES FOR 2015/16 Following consultation with the Trust Board, our Council of Governors, Quality and Safety Committee, the senior leadership team and staff representation the following priorities have been approved and confirmed for the Quality Accounts:

1 PATIENT SAFETY 1a

To implement the Sepsis Care Pathway, and then to review its effectiveness and patient outcomes

1b

To ensure staff across all our services receive appropriate training in making safeguarding referrals to ensure the protection of vulnerable adults and children and understand the use of the Mental Capacity Act.

1c

To review incidents involving medicine administration errors, identify key themes and cascade aggregated learning outcomes on a Trust- wide basis

1d

To ensure patients receive the right treatment, in the right place by the right health care professional and the decisions are clinically safe and appropriate

1e

To report on the number of patient safety incidents that resulted in severe harm or death (mandated indicator)

Each of our priorities and our proposed initiatives for 2015/16, are described in detail on the following pages. They will be monitored through the quality improvement plans that are presented to the executive and senior management teams and the Quality and Safety Committee. External audit assurance is provided by KPMG and through an internal audit programme.

69

Quality Report and Accounts 2014/15

2 CLINICAL EFFECTIVENESS 2a

To report on the percentage of patients with Stroke and heart attacks who receive an appropriate care bundle (mandated indicators)

2b

To report on the percentage of patients receiving an emergency ambulance response within 8 minutes and 19 minutes (mandated indicators)

2c

To review the reasons for delays in the Patient Transport Service which lead to service users missing appointments, and then to implement changes required to prevent future occurrences

3 PATIENT EXPERIENCE 3a

To analyse themes and ensure aggregated learning outcomes are routinely extracted from incidents, claims, feedbacks, SIRIs, compliments and concerns, with effective cascade throughout all areas of service provision

3b

To increase awareness of dementia within the Trust and improve the experience for patients and carers by providing additional training for all staff, including the coordination centres, in order to ensure all our patients with dementia are provided with the highest standards of care

3c

To review and improve the process for receiving and acting on healthcare profession feedback in NHS111 and the Patient Transport Service, in order to ensure learning and service improvements are maximised to improve patient experience and outcomes

70

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PRIORITY 1 > PATIENT SAFETY èè 1a To implement the Sepsis Care Pathway, and then to review its effectiveness and patient outcomes

RATIONALE

Through effective distribution and application of these tools SCAS aims to reduce adverse incidents relating to sepsis and reduce patient harm.

Sepsis is a time-critical condition that can lead to organ damage, multi-organ failure, septic shock and eventually death. It is caused by the body’s immune response to a bacterial or fungal infection. It commonly originates from the lungs, bowel, skin and soft tissues and urinary tract. Rarer sources include the lining of the brain (meningitis), liver, or indwelling devices such as catheters.

TO ACHIEVE THIS WE NEED TO: èè Cascade the sepsis tools throughout all SCAS areas and ensure staff understanding èè Create a sepsis campaign approach that aligns to the calendar of trust wide campaign events

Sepsis is one of the leading causes of death in the developed world, rivalling myocardial infarction (heart attack) in its annual toll and resulting in substantial costs to the health economy .

èè Deliver face to face training for frontline staff

Early recognition of life threatening sepsis is essential to enable the Ambulance Service to initiate life-saving therapy and issue a pre-arrival alert to the hospital.

Crews use a systematic handover tool called ATMIST (age, time, mechanism, injury, signs, treatment) to convey details of septic symptoms to the receiving Emergency Department which will trigger the activation of Surviving Sepsis Clinical Care Pathway upon arrival at the Emergency Department. This pathway has been demonstrated to significantly improve patient survival.

èè Monitor the use of the tool through audit of adverse incident data and patient clinical records

èè Assess staff understanding of the tools and their application through leadership walkarounds

èè Attend multidisciplinary sepsis management seminars to engage with acute providers and primary care in line with the Patient Safety Collaborative

BOARD SPONSOR èè John Black Medical Director

To aid early recognition of sepsis by our front line ambulance clinicians the Trust has developed both a paediatric and adult sepsis screening tool. These tools promote appropriate management of septic patients using a structured and systematic ‘checklist’ approach; they do not however replace clinical judgment or clinical experience.

IMPLEMENTATION LEADS èè Mark Ainsworth-Smith Consultant Pre-Hospital Practitioner

71

Quality Report and Accounts 2014/15

PRIORITY 1 > PATIENT SAFETY èè 1b To ensure staff across all our services receive appropriate training in making safeguarding referrals to ensure the protection of vulnerable adults and children and understand the use of the Mental Capacity Act.

RATIONALE The Trust recognises its legal and moral duty and responsibility to protect the welfare of children and adults by working in partnership and informing social services and other healthcare partners and police of any incidents where children or adults are perceived to be vulnerable or at risk.

In order that staff are able to promptly recognise the signs of abuse and other safeguarding concerns it is necessary for them to be trained to Level 2 safeguarding standards in all areas of service provision which involve patient contact. While many staff have already reached this level of training some staff in our Patient Transport Service and our Clinical Coordination Centres require further training.

SCAS has embedded a safeguarding structure which aligns with central Government guidance and is driven by a dedicated safeguarding lead. The Trust works in partnership with health, local authority, voluntary and statutory groups to protect the interests of children and adults, through a network of professional groups and safeguarding boards.

The Mental Capacity Act 2005 (MCA) provides a statutory framework to empower and protect vulnerable people (aged 16 years and over), who may not be able to make their own decisions. The Act makes it clear who can take decisions, in which situations and how they should go about this. It also allows for people with capacity to plan ahead for a time when they may lose capacity.

Due to the ‘frontline’ nature of all our services, SCAS staff may be one of the first contacts with families or carers who may be experiencing difficulties in looking after their children or adults. We are in a unique position to note predisposing factors in the home and the history of events in each case. Lessons have been learned from high profile cases such as the Victoria Climbie enquiry and it is recognised that passing concerns to hospital staff is not sufficient action to ensure children and adults are protected from the risk of significant harm.

The Act enshrines in statute current best practice and common law principles concerning people who lack mental capacity and those who take decisions on their behalf. It provides for lasting powers of attorney and Court of Protection receivers. A national Code of Practice has been drawn up and forms the basis for this guidance.

The SCAS safeguarding policy requires that all staff who have a safeguarding concern record full details on a referral form and send it to a single point of access.

For the purposes of the Act, “A person lacks capacity in relation to a matter if at the material time he/she is unable to make a decision for him/herself in relation to the matter because of an impairment of, or a disturbance in the functioning of the mind or brain.”

It does not matter whether the impairment is temporary or permanent.

72

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

The MCA applies to all staff who work in health and social care and are involved in the care, treatment and support of people over the age of 16 (living in England or Wales) who are unable to make all - or some - decisions for themselves. All NHS Trusts and local authorities are required to ensure that practices and procedures relating to patients, carers and members of the public who lack capacity are compliant with the MCA; and all staff receive training relevant to their role within the organisation. All ambulance clinicians have a duty to be aware of, and act in accordance with, the Code of Practice.

èè Undertake a quarterly audit of a sample of safeguarding referrals to ensure the appropriateness, timeliness and quality of the referrals made èè Monitor on a monthly basis the number and timeliness of referrals made by area and service èè Attend all adults and children’s safeguarding boards within the SCAS footprint èè Provide staff training in the use of the MCA èè Review MCA training for new staff through induction training and existing staff through refresher training

During an internal review and the recent CQC inspection in September 2014, it was identified that some staff had received insufficient training relating to the Mental Capacity Act and were not confident in its application. SCAS is committed to ensure that this gap is addressed in order to protect vulnerable service users.

èè Include Mental Capacity Act Policy information in the Patient Transport Service, Ambulance Care Assistant three week training course èè Create a MCA campaign approach that aligns to the calendar of Trust wide communications

TO ACHIEVE THIS WE NEED TO: èè Assess the level of mental capacity training undertaken by staff by service to ensure that it is commensurate to role

BOARD SPONSOR èè Deirdre Thompson Director of Patient Care and Quality

èè Assess the level of safeguarding training undertaken by staff by service to ensure it is commensurate to role

IMPLEMENTATION LEADS

èè Develop a forward plan to address the identified gaps in training across staff group and service

èè Ian Teague Assistant Director of Education

èè Deliver Level 2 safeguarding training to all staff

èè Sue Putman Mental Health Lead

èè Review safeguarding training for new staff through induction training

èè Tony Heselton Safeguarding Lead

èè Create a safeguarding campaign approach that aligns to the calendar of Trust wide communications

73

Quality Report and Accounts 2014/15

PRIORITY 1 > PATIENT SAFETY èè 1c To review incidents involving medicine administration errors, identify key themes and cascade aggregated learning outcomes on a Trust wide basis

RATIONALE

It has been identified that there could be improved sharing of organisational learning using a variety of methods to feedback to staff including the SCAScade series. SCAScade focuses on real cases where things have gone wrong and shares them with all staff across the Trust to ensure learning is captured for the organisational memory. Learning through reflective practice as part of ongoing Continuous Professional Development (CPD) is widely applied to ensure recognition of errors and share learning for the benefits of staff and patients.

A medicine administration error occurs when a patient has received: èè the wrong medicine èè the wrong dosage of the intended medicine èè a dose at the wrong time èè a medicine administered by the wrong route èè a medicine that is wrongly prescribed or given without an authorised prescription or a current authorised Patient Group Direction

TO ACHIEVE THIS WE NEED TO: èè Present quarterly audits of adverse incidents raised through DATIX which identify those involving medicine administration errors and establish key themes, to the Patient Safety Group

èè the medicine is omitted without a documented clinical reason Such events will have a wide variety of possible causes which may include human factors, prescribing procedures, communication issues, product labelling or packaging, dispensing and distribution methods, administration routes, and educational factors. SCAS has used the Failure Mode and Effects Analysis (FMEA) to develop processes to support the safe administration of medicines in the Trust and improvements to date include modular medicines bags, prefilled syringes and syringe labels.

èè Ensure DATIX medicine administration error information informs organisational learning themes and action plans èè Utilise SCAScade regularly and effectively to communicate learning themes to staff èè Create and deliver a medicines campaign approach that aligns to the calendar of Trust wide communications.

SCAS remains committed to reducing medication errors further by frequent analysis of adverse incidents relating to medicine administration, understanding of the causes of medicine administration errors, effective cascade of learning and the design of appropriate interventions to minimise recurrence. The SCAS pharmacist monitors medicine administration incidents quarterly through our Patient Safety Group and reports on common themes.

BOARD SPONSORS èè John Black Medical Director

IMPLEMENTATION LEADS èè Ed England Medicines and Research Manager

74

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PRIORITY 1 > PATIENT SAFETY èè 1d To ensure patients receive the right treatment, in the right place by the right health care professional and the decisions are clinically safe and appropriate

RATIONALE èè Audit (sample) conveyance rates of patients referred from NHS 111 to 999 to identify if those patients could have been treated and seen by other health services.

As described in Part 1 of this report it is imperative we strive to deliver high quality care in a timely way with the right resource whether that be an ambulance or a disposition reached through NHS Pathways.

We are using a variety of models of care to try and get it right each time such as referrals to GPs and other community healthcare professionals, our clinical networks to ensure patients who need hospital treatment go to the right centre.

BOARD SPONSORS èè Sue Byrne Chief Operating Officer

IMPLEMENTATION LEADS

TO ACHIEVE THIS WE NEED TO:

èè Operations Directors North and South

èè Measure the number of patients that we return to within 24 hours after first contact.

èè Kat Jenkin Head of Clinical Governance

èè Measure attempts at GP triage and outcomes

èè Tim Churchill Head of Demand Management

èè Review cases where SCAS refer to “GP triage” but subsequently reattend to take the patient to hospital after GP review. èè Measure and review learning from Time Critical Transfers (TCTs) / secondary transfers from Trauma Units (TUS) to Major Trauma Centres (MTCs). Review HCP transport model and recontact rates èè Work with appropriate clinical networks to review and implement patient pathways èè Audit (sample) crew referrals to Emergency Care Practitioners (ECPs) to ensure clinically safe non conveyance decisions

75

Quality Report and Accounts 2014/15

PRIORITY 1 > PATIENT SAFETY èè 1e To report on the number of patient safety incidents that resulted in severe harm or death (mandated indicator)

RATIONALE SCAS takes any incident resulting in severe harm extremely seriously and we already have a robust incident reporting system in place. Although this indicator is mandated SCAS wants to expand it to ensure that lessons are learned across the whole system to prevent reoccurrences.

èè Adhere to the duty of candour as outlined in the Francis Report and our contractual requirements èè Triangulate SIRIs with complaints to maximise learning èè Further improve our partnership working on serious incidents which cross health and social care boundaries

Adverse incidents are logged through our DATIX reporting system and can be reported by any staff. Early review of submitted DATIX incidents by a dedicated management team means that any incident classified as a serious incident requiring investigation (SIRI) can be rapidly ‘flagged up’ and acted on appropriately.

BOARD SPONSORS èè Deirdre Thompson Director of Patient Care and Quality

SIRIs are registered on the Strategic Executive Information System (STEIS) and fully investigated in a timely manner with resolution to be completed in no longer than 60 days. All actions relating to SIRIs are monitored by the SIRI Review Group.

IMPLEMENTATION LEADS èè John Dunn Head of Risk and Security

This indicator covers all our services and DATIX affords SCAS the opportunity to triangulate information where incidents cross service boundaries.

èè Debbie Marrs Assistant Director of Quality

TO ACHIEVE THIS WE NEED TO: èè Report on patient safety incidents (numbers and severity) èè Reduce incidents which result in major or severe harm by 10% èè Benchmark nationally with other ambulance services to enable best practice to be shared and improve outcomes for patients

76

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PRIORITY 2 > CLINICAL EFFECTIVENESS èè 2a To report on the percentage of patients with Stroke and Heart Attacks who receive an appropriate care bundle (mandated indicators)

RATIONALE This multi-faceted project aims to address the issue by first understanding the reasons behind oligoanalgesia, both at a local and a national level. From this understanding, meaningful solutions may be developed.

Stroke - SCAS is committed to improve its performance for conveying FAST +ve Stroke patients with symptom onset less than four hours to a Hyper Acute Stroke Unit (HASU) in less than 60 minutes. This is a trust priority and features on the Risk Register at corporate and operational level.

A dedicated resource has been identified to assist with this project creating links across all directorates.

Previous studies suggest that emergency management of pain varies according to patient factors as well as clinician attributes (Lord et al, 2009; Siriwardena et al, 2010).

A variety of differing attitudes and beliefs may also underlie this variation (Jones & Machen, 2003). In order to improve prehospital pain management we need to understand what the factors, barriers and facilitators are currently.

This work stream is supported through a plan that has a significant number of actions both internal and external and fit under the themes of: èè Early identification of stroke in the control room

At a local level a tested and published questionnaire (Pocock, 2013) has been circulated to frontline staff, analysis of which will be reported in terms of themes.

It is likely that a campaign approach rather than traditional education methods will be informed by the results. Ultimately the Clinical Performance Indicatoers (CPIs) will provide the highest level of impact evaluation. SCAS is also contributing to the national picture by supporting the development of a bid for funding for a large scale national project Exploring factors increasing Paramedics’ Likelihood of initiating Analgesia IN pre-hospital Pain (EXPLAIN).

èè Immediate appropriate dispatch èè Supported recognition of FAST +ve patients at face to face assessment èè HASU (Hyper Acute Stroke Unit) location awareness. èè Swift conveyance to nearest HASU. SCAS perform well at ensuring the stroke care bundle is delivered to our patients but we continue to strive to improve.

Heart Attack - SCAS recognises that the pain management part of the care bundle still requires improvement. This doesn’t necessarily mean that heart attack patients do not receive pain relief, but we don’t always use the analgesics set out in the care bundle such as Entonox.

In addition to the project other work streams are focusing on: èè Support and training in pain assessment

Therefore we have conducted an audit around this and have launched a project to understand pain management behaviour.

èè Face to face training for all operational staff èè Clinical review

77

Quality Report and Accounts 2014/15

èè PCi feedback through MINAP data. èè PCi unit location awareness èè Swift conveyance to nearest appropriate open PCi

TO ACHIEVE THIS WE NEED TO: èè Benchmark with other ambulance services as per the national mandatory indicators and be in the top national quartile for clinical performance indicators. èè Complete the paramedic pain management behaviour project and extract key themes èè Re-audit pain management for these patients èè Create a STEMI pain management campaign approach that aligns to the calendar of Trust wide communications

BOARD SPONSORS èè John Black Medical Director

IMPLEMENTATION LEADS èè Dave Sherwood Clinical Excellence Lead èè Operational Directors North and South Divisions

78

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PRIORITY 2 > CLINICAL EFFECTIVENESS èè 2b Red ambulance response times – report on the percentage of patients receiving an emergency response within 8 minutes and 19 minutes. (mandated indicators)

RATIONALE

TO ACHIEVE THIS WE NEED TO: èè Report on the response times as per the indicator

To ensure patients in the SCAS region receive quality care from their ambulance service a set of key performance indicators and ambulance quality indicators have been set nationally. These help set our policies and guidelines and develop our organisational culture that places quality at the top of the Trust’s agenda. Although reporting of this information is mandatory, SCAS believes we should monitor and improve response times routinely.

èè Review response rates daily èè Utilise data on high demand times to match our resources èè Learn from complaints and incidents relating to response times èè Develop a forward plan to address the drop in performance for call answering and dispatch time

SCAS implemented a new triage system during 2014, NHS Pathways, which is a software system of clinical assessment for triaging telephone calls from the public, based on the symptoms they report when they call. This system uses clinical decision making to make choices about the type of resource needed to respond to 999 calls.

BOARD SPONSOR èè Sue Byrne Chief Operating Officer

IMPLEMENTATION LEADS

NHS Pathways is used in both 999 and NHS 111 triage and this provides greater integration between parts of the business, improved access to NHS numbers for patients and provides access to a universal Directory of Services for better signposting for patients. SCAS plans to optimise benefits of closer working between NHS 111 and 999 and also deliver more hear and treat.

èè Mark Ainsworth and Steve West Operations Directors

It is a key objective for SCAS to ensure that as this system is embedded we are able to maintain achievement of Red 2 ambulance operational response standard (8 minute response category of call) for quarterly periods 2, 3 and 4 for the 2015/16 year.

79

Quality Report and Accounts 2014/15

PRIORITY 2 > CLINICAL EFFECTIVENESS èè 2c To review the reasons for delays in the Patient Transport Service which lead to service users missing appointments, and then to implement changes required to prevent future occurrences

RATIONALE Both the internal review and external CQC inspection report identified that an area requiring improvement for PTS service users is delays and missed appointments.

The SCAS Patient Transport Service (PTS) has provided non-emergency transport across Buckinghamshire, Berkshire, Hampshire and Oxfordshire for more than 40 years. We provide transport for people who meet eligibility criteria because they are unable to use public or other transport due to their medical conditions. This includes people who are:

Each day thousands of people entrust the SCAS PTS to transport them in a safe and timely manner to their scheduled healthcare appointments at a variety of medical facilities. Some of these appointments are vital to their ongoing health with serious consequences if missed, all are very important to the individual patient. SCAS understands the frustrations that service users feel if they miss an appointment which they may have been waiting weeks or months for, and as such is committed to addressing the reasons for delays and missed appointments.

èè attending hospital outpatient clinics èè being admitted to or discharged from hospital wards èè requiring life-saving treatments such as radiotherapy, chemotherapy or renal dialysis or DVT treatment.

Our non-emergency PTS provides much needed support to patients and is an extremely important part of our service.

SCAS works under 15 individual PTS contracts to ensure the needs of service users in each geographical area are met.

In September 2014 PTS launched its new service delivery model to coincide with the launch of our new contract in Hampshire.

This also prompted a timely internal review of patient experience data, current clinical governance processes, key risks and actions required within the PTS to improve our service delivery for all our patients.

Shortly after this project commenced the CQC conducted a scheduled week long inspection of SCAS compliance set against their essential standards.

TO ACHIEVE THIS WE NEED TO: èè Continue to work with partners and ensure the planning and scheduling of PTS improve, to prevent delays and missed appointments, and to reduce the impact on the clinical care, treatment and welfare of patients. èè Ensure monthly audit of long waits and delays and report to the Patient Experience Review Group which actions and recommendations to improve

80

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

èè Complete a deep dive review of experience and incidents relating to missed appointments to extract themes that can ensure service improvement èè Undertake thematic analysis of trends relating to missed appointments and delays with appropriate action planning arising

BOARD SPONSORS èè James Underhay Director of Strategy, Communications and Business Development

IMPLEMENTATION LEADS èè Paul Stevens Assistant Director Commercial Services

81

Quality Report and Accounts 2014/15

PRIORITY 3 > PATIENT EXPERIENCE èè 3a To analyse themes and ensure aggregated learning outcomes are routinely extracted from incidents, claims, feedback, SIRIs, compliments and concerns, with effective cascade throughout all areas of service provision

RATIONALE SCAS is continually striving to reduce avoidable harm and to improve the quality of care to the population it serves. To achieve this we must work collaboratively across all services, encourage an open reporting culture and a culture which supports safety and learning within the organisation.

èè Candour – any patient harmed by the provision of a healthcare service is informed of the fact and an appropriate remedy offered, regardless of whether a complaint has been made or a question asked about it.

SCAS has embraced this ethos and has worked hard to ensure all our staff understand this approach. We strongly encourage reporting of all incidents and near misses, and we welcome feedback in every format. Our robust governance structure is being further developed to ensure we are well placed to extract aggregated learning from feedback and we want to improve the consistency of practice and ensure that outcomes are effectively cascaded to all levels, of all services, to maximise their impact on quality and reduction of avoidable harm.

When things go wrong it really matters, both to the individuals involved and to the Trust as a whole. It matters for people using services, who deserve an explanation and want to know that steps have been taken to make it less likely to happen to anyone else. It matters to the Trust because every incident, concern or complaint is an opportunity to improve for the benefit of all our service users.

Since the publication of the Francis Report and subsequent Public Enquiry, the NHS as a whole has moved its focus to that of creating a culture of learning supported by a Duty of Candour which calls for openness and transparency:

The CQC has introduced a new regulations relating to the handling of complaints and concerns. It covers all aspects of the complaint handling process but specifically in reference to learning, asks us to demonstrate:

èè Openness – enabling concerns and complaints to be raised freely without fear and questions asked to be answered.

èè How do you disseminate learning from complaints?

èè Transparency – allowing information about performance and outcomes to be shared with staff, patients, the public and regulators.

èè Can you point to any changes made as a result of learning from complaints?

82

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Sharing of learning outcomes extracted and approved through our governance structure will occur through SCAScade, the new staff intranet and other methods yet to be developed. Launched in March 2014 the new intranet enables SCAS staff across all locations to share information and knowledge more easily.

èè Utilise all quality intelligence demonstrating key themes and trends across the organisation (and at service level) demonstrating lessons learned and changes to practice for patients and staff identified and implemented èè Use the friends and family test response rate and proportion of positive responses to both questions and themes from narrative to inform learning

In addition to concerns we receive feedback from patient forums, coroners’ hearings, claims and incidents and have commenced an aggregated learning approach to triangulate this intelligence for improving services.

èè Report on numbers, categories and level of harm (including near miss) associated with all incidents and subcategories if relevant

TO ACHIEVE THIS WE NEED TO: èè Embed a robust clinical governance structure with aggregated learning processes throughout of all areas of SCAS service provision

BOARD SPONSORS èè Deirdre Thompson Director of Patient Care and Quality

èè Implement the use of regular aggregated learning reports which communicate themes and facilitate organisational learning at all levels

IMPLEMENTATION LEADS

èè Improve information sharing between services to ensure learning outcomes are understood

èè Kat Jenkin Head of Clinical Governance

èè Use SCAScade and our new intranet to share outcomes and changes to practice arising from them with patient facing staff

èè Simon Holbrook Head of Compliance èè Debbie Marrs Assistant Director of Quality

èè Regularly review Healthwatch feedback and NHS Choices

83

Quality Report and Accounts 2014/15

PRIORITY 3 > PATIENT EXPERIENCE èè 3b To increase awareness of dementia within the Trust and improve the experience for patients and carers by providing additional training for all staff, including the coordination centres, in order to ensure all our patients with dementia are provided with the highest standards of care

RATIONALE The National Dementia Strategy came to a close at the end of 2014 and the Prime Minister’s campaign entitled ‘Challenge on Dementia’ will only be sustained until 2015. SCAS has recognised the need for dementia to remain a high priority within the Trust. To achieve this we are supporting a Health Education Thames Valley (HETV) funded project group, ‘Dementia care in the Ambulance Service’, to develop a training plan to ensure our continued focus on dementia education beyond 2014/15.

As set out above, SCAS will continue to work towards the wider Health Education England Mandate which aims to ensure every NHS staff member is dementia trained by 2018.

TO ACHIEVE THIS WE NEED TO: èè Provide dementia awareness training for new starters at corporate induction (Tier 1). èè Support the training of our existing staff by continuing to provide dementia awareness e-learning for all staff, alongside face-to-face training for patient facing staff (Tier 1).

The project group is also responsible for planning the training of Dementia Champions and producing pre-hospital Technology Enhanced Learning (TEL) dementia learning materials. The planned Dementia Champion training will exceed the Health Education England (HEE) Core Skills and Knowledge Framework for Dementia Tier 2. This is in response to the HEE Mandate to ‘support tier 2 dementia training over the next 24 months to ensure that NHS staff continue to receive the most advanced support available’.

The SCAS Dementia Champion role will be supported by our Mental Health and Learning Disability Lead and will launch in April 2015.

èè Implement the plans set out in our Dementia Strategy 2014-17, to train and support a Dementia Champion (Tier 2) for every SCAS resource centre by 2017. èè Continue to report dementia training completion figures to HETV, working towards our mandatory targets for Tier 1 as set out by HETV. èè Ascertain feedback as to the effectiveness of our care of patients with dementia through pre-and-post training audits of staff knowledge and confidence

SCAS is the only ambulance trust to have a full time dedicated mental health and learning disability lead. SCAS currently also has a dedicated clinician working on the ‘Dementia Care in the Ambulance Service’ project and supporting the mental health lead to plan the 2015/16 dementia training.

èè Incorporate dementia awareness training into the corporate induction for new starters in all areas of service provision from 1 April 2015

84

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

èè Ensure all staff are able to access a dementia e-learning module as part of their annual statutory and mandatory training programme èè Ensure all our future dementia training is fully accredited and fit for purpose èè Engage with a two year research project by the Dementia Academic Action Group (DAAG) in partnership with HETV The Institute of Health and Wellbeing, University of Bedfordshire, University of West London and Oxford Brookes University

BOARD SPONSORS èè Sharon Walters Director of HR

IMPLEMENTATION LEADS èè Ian Teague Assistant Director of Education èè Sue Putman Mental Health Lead

85

Quality Report and Accounts 2014/15

PRIORITY 3 > PATIENT EXPERIENCE èè 3c To review and improve the process for receiving and acting on healthcare profession feedback in the NHS111 and the Patient Transport Services, in order to ensure learning and service improvements are maximised to improve patient experience and outcomes

RATIONALE

TO ACHIEVE THIS WE NEED TO: èè Create and implement a universal HCP process and feedback form for all services which facilitates maximum data capture

Healthcare professional (HCP) feedback supports the aim of improving quality and safety of patients by identifying areas of concern and highlight areas of good practice. It also supports the development of future services.

èè Create dedicated email addresses and central points of contact for each service

SCAS has identified challenges in utilising and processing all the strands of HCP feedback partly due to a lack of clarity and inconsistency in reporting procedures used across the Trust. We recognise the need to standardise this going forward.

èè Ensure the process used to review and respond to feedback is robust, facilitates aggregated learning practices and adheres to Trust policy. èè Engage with our HCP partners to ensure they are aware of and able to access our feedback processes across all areas of service provision

Our NHS 111 services have robust HCP feedback processes which utilise:

èè Ensure all managers are trained in the use of DATIX and HCP feedback processes

èè Dedicated email addresses for receiving feedback èè Standardised feedback forms which successfully identify all information needed to instigate an investigation and response to it

èè Report on feedback themes and triangulate any learning èè Use HCP feedback to improve service delivery and outcomes

èè A central point of contact for collation of HCP feedback which allows identification of themes and trends as well as generation of individual responses.

BOARD SPONSORS èè Deirdre Thompson Director of Patient Care and Quality

SCAS propose to replicate these processes across all areas of service provision to ensure that HCP feedback is collated effectively and analysis of themes and trends is adopted across the organisation.

IMPLEMENTATION LEADS èè Senga David Head of Patient Experience èè Kat Jenkin Head of Clinical Governance

86

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

STATEMENT OF ASSURANCE FROM THE BOARD

1

Along with qualitative data, the Board has sought assurance from a variety of sources: èè Patient surveys èè Staff surveys èè Narrative from complaints and feedback and their resolution

During 2014/15 South Central Ambulance Service NHS Foundation Trust (SCAS) provided and/or sub contracted three relevant services:

èè Patient stories at public Board meetings èè Root cause analysis of incidents and identified leaning

èè Emergency 999 Ambulance Service

èè Internal audit reports

èè Non-Emergency Patient Transport Service

èè External reviews of quality including the CQC

èè NHS 111 Telephone Advice Service

èè Leadership walk-rounds SCAS has reviewed all the data available to it on the quality of care in these three services.

èè Bi-monthly committee meetings èè Staff meetings The income generated by the relevant services reviewed in 2014/15 represents 100% of the total income generated from the provision of relevant services by SCAS for 2014/15.

All NHS Foundation Trusts are asked to provide common areas of information which demonstrate assurance on the Trust’s commitment and actions to improve the quality of their service and provision of care. This section provides the requirements and statements as specified by the Quality Account regulations.

87

Quality Report and Accounts 2014/15

2

èè Ambulance Service Clinical Quality Indicator ST elevation Myocardial Infarction Care Bundle èè Ambulance Service Clinical Quality Indicator Primary Percutaneous Coronary Intervention (pPCI) call to Balloon within 150 minutes.

During 2014/15, 11 national clinical audits and nil national confidential enquiries covered relevant health services that SCAS provides.

The national clinical audits and national confidential enquires that SCAS participated in during 2014/15 were as follows:

During 2014/15, SCAS participated in 100% national clinical audits and 0% national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.

èè Acute Myocardial Infarction and other ACS (MINAP) èè National Clinical Performance Indicator Asthma èè National Clinical Performance Indicator Elderly Falls

The national clinical audits and national confidential enquires that SCAS was eligible to participate in during 2014/15 were as follows:

èè National Clinical Performance Indicator Febrile Convulsions

èè Acute Myocardial Infarction and other ACS (MINAP)

èè National Clinical Performance Indicator Below Knee Fractures

èè National Clinical Performance Indicator Asthma

èè National Ambulance NonConveyance Audit

èè National Clinical Performance Indicator Elderly Falls

èè Ambulance Service Clinical Quality Indicator Stroke Care Bundle

èè National Clinical Performance Indicator Febrile Convulsion

èè Ambulance Service Clinical Quality Indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)

èè National Clinical Performance Indicator Below Knee Fractures

èè Ambulance Service Clinical Quality Indicator Cardiac Arrest Survival to Discharge (STD) Rates (and separate witnessed arrest STD rates

èè National Ambulance NonConveyance Audit èè Ambulance Service Clinical Quality Indicator Stroke Care Bundle

èè Ambulance Service Clinical Quality Indicator ST elevation Myocardial Infarction Care Bundle

èè Ambulance Service Clinical Quality Indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)

èè Ambulance Service Clinical Quality Indicator Primary Percutaneous Coronary Intervention (pPCI) call to Balloon within 150 minutes.

èè Ambulance Service Clinical Quality Indicator Cardiac Arrest Survival to Discharge (STD) Rates (and separate witnessed arrest STD rates)

88

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

The national clinical audits and national confidential enquiries that SCAS participated in, and for which data collection was completed during 2014/15, are listed below alongside the numbers of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.

NUMBER OF CASES

% SUBMITTED

1,969 Apr to Dec 14

100%

National Clinical Performance Indicator Asthma

564

100%

National Clinical Performance Indicator Elderly Falls

300

100%

National Clinical Performance Indicator Febrile Convulsions

149

100%

National Clinical Performance Indicator Below Knee Fractures

132

100%

Ambulance Service Clinical Quality Indicator Stroke Care Bundle

4,577 Apr to Dec 14

100%

Ambulance Service Clinical Quality Indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)

1,095 Apr to Dec 14

100%

Ambulance Service Clinical Quality Indicator Cardiac Arrest Survival to Discharge (STD) Rates (and separate witnessed arrest STD rates)

1,040 Apr to Dec 14

100%

873 Apr to Dec 14

100%

758 as at Apr 14

100%

NATIONAL CLINICAL AUDIT Acute Myocardial Infarction and other ACS (MINAP) - entered in to the audit by acute trusts data quality checked by South Central Ambulance Service NHS Foundation Trust.

Ambulance Service Clinical Quality Indicator ST elevation Myocardial Infarction Care Bundle Ambulance Service Clinical Quality Indicator Primary Percutaneous Coronary Intervention (pPCI) call to Balloon within 150 minutes

89

Quality Report and Accounts 2014/15

The reports of 11 national clinical audits were reviewed in 2014/15 and the Trust intends to take the following actions to improve the quality of health care provided:

èè Review incidents where there is a delayed response to ensure that the response was appropriate based on patient need and the most appropriate resource was used. èè To use technology to identify alternative care pathways and referral routes to reduce conveyance to ED.

èè Use ePR data to ensure timely and efficient referral and transfer of information to improve the patient care i.e. GP informed of all patient contacts èè Work with commissioners to improve stroke performance and ensure effective pathways are in place geographically to ensure patients arrive at a Hyper Acute Stroke Unit within 60 Minutes of calling 999

AUDIT

IDENTIFIED ISSUES

ACTIONS

Delayed responses

èè Appropriateness of resource utilisation èè Increase in demand

èè Review the use of solo response vehicles and the skill mix of the double crewed vehicle to match the needs of the patient. èè Resources being reviewed against demand

Trauma Pathway

èè Trauma unit bypass tool not being used

èè Crews use mobile phone app created to encourage use of the tool

Transient Ischemic Attack Pathway

èè Time taken to fax referral improved but needs further improvement

èè Referral is being built into electronic patient record to effect real time referral

ACQI data quality

èè Improvement needed in identifying patients for inclusion

èè Multi system review has highlighted new methodologies that are in use to ensure a complete dataset

90

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

3

èè Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther AM, Woollard M, Carson A, Smyth M, Whitfield R, Williams A, Pocock H, Black JM, Wright J, Han K, Gates S, and PARAMEDIC trial collaborators. Mechanical versus manual chest compression for out-of-hospital cardiac arrest: a pragmatic, cluster-randomised trial.

Lancet 2014; 385: 947-955. Selected by the Society for Clinical Trials (SCT) as the ‘2014 Trial of the Year’.

The number of patients receiving NHS services provided or sub contracted by SCAS in 2014/15 that were recruited to participate in research, approved by a research ethics committee, was 10.

Participation in clinical research demonstrates the Trust’s commitment to improving the quality of care we offer and to making our contribution to wider health improvement. By enabling clinical staff to stay abreast of the latest treatment possibilities, we optimise patient outcomes.

èè Pocock H, Evans P (2014) Introducing the Simbualnce: high fidelity mobile simulation for ambulance clinicians.

International Emergency Nursing 2014 22; 283-284. èè SCAS staff contributed chapters to: Willis. S Darymple. R. (2015).

Fundamentals of Paramedic Practice.

A Systems Approach. Wiley Blackwell

Conference presentations and publications demonstrate our commitment to transparency and desire to improve patient outcomes and experience across the NHS:

Our engagement with clinical research also demonstrates the Trust’s commitment to testing and offering the latest medical treatment and techniques. The areas of engagement are outlined below:

èè Deakin CD, Shewry E, Gray HH. Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest. Heart 2014. doi:10.1136/ heartjnl-2013-305030. (Attached)

èè Collaborating with Universities of Warwick and Surrey and four other ambulance trusts in the PARAMEDIC 2 trial (Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug administration in Cardiac arrest);

èè Deakin CD, Fothergill R, Moore F, Watson L, Whitbread M. Level of consciousness on admission to a heart attack centre is a predictor of survival from out-of-hospital cardiac arrest. Resuscitation 2014 In press.

èè Integration with the Wessex Comprehensive Research Networks (CRN) and working with the Thames Valley and South Midlands CRN;

èè Lindner T, Deakin CD, Aarsetøy H, Rubertson S, Heltne HJ, Søreide, E. Does angiotensin converting enzyme (ACE) gene polymorphism influence return of spontaneous circulation following out-of-hospital cardiac arrest? A prospective observational pilot study. Open Heart. 2014 Aug 14;1(1):e000138. doi: 10.1136/ openhrt-2014-000138

èè Working with National Ambulance Research Sub Group: ›› To develop a proposal to “Widen the Impact of the Ambulance Services Cardiovascular Quality Initiative (ASCQI) project”;

91

Quality Report and Accounts 2014/15

5

›› To participate in “Understanding variation in rates of ‘nonconveyance to an emergency department’ of emergency ambulance users”. èè Contributing data to the “Out of Hospital Cardiac Arrest Outcomes” study

SCAS is required to register with the Care Quality Commission (CQC) and is currently registered without conditions in all essential standards.

4

The Care Quality Commission has not taken enforcement action against SCAS during 2014/15.

6

A proportion of the Trust’s income in 2014/15 was conditional upon achieving quality improvement and innovation goals agreed between SCAS and our clinical commissioning groups, and any person or body they entered into a contract, agreement or arrangement with for the provision of relevant health services, through the Commissioning for Quality and Innovation (CQUIN) payment framework.

Removed from the legislation by the 2011 amendments

7

CQUINS achievements show that SCAS actively engages in quality improvements that cross the boundaries of our organisation. For this year the goals relate to:

SCAS had not participated in any special reviews or investigations by the Care Quality Commission during the reporting period.

èè Training staff in urinalysis (Thames Valley) èè Friends and family test roll out èè Managing frequent callers èè Supporting patients to make good choices (West Hampshire) The total for CQUIN related income for 2014/15 is expected to be around £2,400,000. The income from CQUIN in 2013/14 was £2,247,182.

92

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

8

11

SCAS did not submit records during 2014/15 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

SCAS will be taking the following actions to improve data quality: èè Provision of an Integrated Performance Report that outlines all quality, operational and financial data

9

èè Challenge and scrutiny of data at all levels within the organisation within the performance management framework èè Timeliness of patient data improvements with ePR

The Trust’s Information Governance Assessment Report overall score for 2014/15 was 71% and was graded green from the IGT Grading scheme.

èè Ensure alignment and consistency across contract schedules èè Internal clinical audit plan to validate relevant data

10

èè Regular review by the Clinical Review Group (CRG) of reliability and accuracy of data èè Board Assurance Framework and Corporate Risk Register to escalate data quality concerns.

The Trust was not subject to the Payment

by Results clinical coding audit during the reporting period by the Audit Commission.

93

Quality Report and Accounts 2014/15

PART 94

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

An overview of our achievements on last year’s priorities can be seen in the table below. Part 3 of the report looks back at what we have achieved against what we said we would do.

PRIORITY

PROGRESS

1a. To ensure that decisions to keep patients ‘at home’ are consistently clinically safe and appropriate for the patient condition with referral to accessible / available community services.

1b. To reduce potential harm or poor patient experience as a result of waiting too long for a response.

Red 8 and 19 improving

1c. To report on the number of patient safety incidents and the percentage and number that resulted in severe harm or death.

2a. To report on the percentage of patients with stroke who receive an appropriate care bundle

98.5%

(as above for heart attack)

70.6%

2b. Comply with the DH core indicators for Red1 and Red 2 calls

Red 1 75% Red 2 74.5%

2c. To improve the responsiveness of consistently identifying and appropriately transferring stroke patients to a hyper acute unit within 60 minutes.

55.5% YTD

2d. To ensure patients receive adequate pain relief.

3a. To ensure that all patient complaints and concerns are consistently responded to within a mutually agreed timeframe.

3b. To learn from concerns by using ‘face to face / end to end reviews’ with partners and patients and publish the findings and actions to improve our services.

3c. To proactively seek patient feedback through surveying patients to improve our services; including the friends and family test and gaining feedback from harder to reach groups.

95

78%

Quality Report and Accounts 2014/15

PRIORITY 1 > PATIENT SAFETY èè 1a To ensure that decisions to keep patients ‘at home’ are consistently clinically safe and appropriate for the patient condition with referral to accessible/available community services.

We achieved this indicator but have continued the theme in priorities for this year as we know it’s important to continue to get it right every time. (see indicator 1d)

The organisation’s IPR report provides data on a monthly basis in regards to the organisation’s KPI’s and other clinical and non-clinical measures. This includes the rates of conveyance and non-conveyance and re-contact rates.

èè The table below shows the percentage of non-conveyed patients

PERFORMANCE MEASURE

2014/15

2013/14

Actual

Plan

RAG

Actual

Plan

RAG

% calls with telephone advice only (Hear & Treat)

5.8%

5.1%

G

5.2%

4.6%

G

% resolved without conveyance to type 1/2 A&E

42.1%

42.0%

G

42.2%

41.6%

G

èè The table below shows the number of re-contacts for the first six months of 2014/15

PERFORMANCE MEASURE

2014/15

2013/14

Actual

Plan

RAG

Actual

Plan

RAG

% Hear & Treat re-contacts in 24 hours

11.6%

15.0%

G

12.1%

15.0%

G

% See & Treat re-contacts in 24 hours

5.0%

5.0%

G

4.8%

5.0%

G

96

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

These demonstrate that the organisation is meeting its expectations in regards to nonconveyance and re-contact rates.

GP triage audits are undertaken in response to concerns raised and the rates of accepted GP triage are collated.

All complaints responses are reviewed by senior management. An aggregated learning report is being developed for each quarter to include triangulation of learning from complaints, incidents, SIRIs and claims.

Health Care Professionals (HCP) are encouraged to inform the service if / when they have any comments positive or negative. These include non-conveyance.

As with complaints and incidents these are looked at by the senior management team.

The organisation is looking at new processes to collate HCP feedback from across all its services and then analyse this data to pick up any themes and trends and to respond accordingly.

The introduction of electronic patient records (ePR) is currently underway with the intention to have this fully implemented across all areas of the organisation by December 2015. There are only two areas that the system is not fully in use at present.

97

Quality Report and Accounts 2014/15

PRIORITY 1 > PATIENT SAFETY èè 1b To reduce potential harm or poor patient experience as a result of waiting too long for a response.

We partially achieved success in this indicator

Work is being carried out locally, within each area looking at health care professional (HCP) admissions using the ambulance service. The organisation is going to implement a dedicated HCP tier and as part of this, education of GPs on appropriate use of the service will be undertaken.

SCAS has reduced the number of long waits for red calls but there is still work to do on lower acuity calls. We have introduced a monthly audit of long waits triangulating findings with experience data and incident reports.

The Clinical Support Desk contact patients who have a delayed response, so as to address issues as they arise. To ensure that the organisation learns from long waits the following processes have been implemented. These are audited monthly and severity of harm is reviewed and reported externally through contract review meetings.

To support solo responders the current system has been reviewed and a pilot of a categorisation system has been completed in the South west dispatch area. Moving forward the plan is to implement this across the organisation.

Learning from incidents and complaints around long waits is fed back to individual members of staff and the local team.

Moving forward, incidents, complaints and claims will be collated across the organisation and learning from themes and trends will be pulled out and looked at in more depth and the learning shared Trust wide. This will also support the implementation of any actions and the review of action plans.

Monthly long wait meetings are held with CCCs, operations and clinical staff to identify any required learning or actions from the long wait audits. These audits and learning are shared with commissioners at Contract Quality Review Meetings (CQRM). As well as this, data is compiled into ‘heat maps’ which are reviewed at operational performance review meetings. A daily list of red long waits is also reviewed.

98

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

èè The charts below show the long wait times. They show a reduction in the numbers of long waits for Red 1 and 2

RED 8 LONG WAITS 1.40% 1.20% 1.00% 0.80% 0.60% 0.40% 0.20%

ar M

Fe Fe

b

n Ja

De c

n

2014/15 ACTUAL

No v

ct O

Se pt

Au g

y Ju l

e Ju n

M ay

Ap ril

0.00%

2014/15 PLAN

RED 19 LONG WAITS 2.00% 1.80% 1.60% 1.40% 1.20% 1.00% 0.80% 0.60% 0.40% 0.20%

2014/15 ACTUAL

99

2014/15 PLAN

ar M

b

Ja

De c

No v

ct O

Se pt

Au g

y Ju l

e Ju n

M ay

Ap ril

0.00%

Quality Report and Accounts 2014/15

SCAS use a system of Unit Hour Utilisation (UHU) to determine the levels of resource we require per hour of the day. The UHU looks at historical demand profiles for the same day of week and time of year and we build in uplift in demand, dependant on historic demand rises. We split the geographical areas SCAS covers in to sectors as the demand levels and demand profiles can vary. This enables us to flex our UHU by smaller areas and increase resources locally where required.

This provides us a framework we can follow to increase staffing levels by restricting activities and changing our response to patients. We have a local escalation process which is followed by hour of day and as we experience demand increases, we increase our escalation level, which provides additional clinical resources from the clinical and operational management team.

We now have our plans for the next 12 months which will take into account the greater than predicted demand levels during the winter and this will influence the resources we deploy this year. We are implementing new rotas for our staff over the first quarter of 2015/16 which will align our resourcing levels with our demand, to enhance our response to patients. We are also recruiting additional specialist Paramedics to treat patients at home and avoid them being conveyed to hospital. We are deploying a specific group of staff to target our GP admission calls to ensure these patients receive a more timely response with the appropriate skill level of staff. All these actions will enable us to provide a more efficient response to all our patients.

We have seen year on year annual increases in demand and this forms part of our planning assumptions. Should demand rise above this we re-model our UHU to take into account the increase.

To assist us with short term increases in demand, we have a nationally recognised escalation plan (REAP) which has six levels of escalation.

REAP Level 6

Potential Service Failure

REAP Level 5

Critical

REAP Level 4

Severe Pressure

REAP Level 3

Pressure

REAP Level 2

Concern

REAP Level 1

Normal service

SCAS are actively recruiting additional community responders who are volunteers who respond to the life threatening calls for SCAS ahead an ambulance or rapid response car. We currently have 1,024 community and co-responders across SCAS and we hope to increase this by 50% during the next 24 months.

100

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PRIORITY 1 > PATIENT SAFETY èè 1c To report on the number of patient safety incidents and the percentage and number that resulted in severe harm or death We achieved this indicator

èè The table below shows the number of patient safety incidents reported to the National Reporting and Learning System (NRLS) for 2014/15 split by quarter.

PATIENT SAFETY INCIDENTS REPORTED TO NRLS 2014/15 Categories

Q1 14/15

Q2 14/15

Q3 14/15

Q4 14/15

Total

NHS 111

47

6

0

0

53

Clinical

59

95

153

84

391

Clinical Equipment

34

38

41

35

148

Control of Infection

0

1

2

0

3

Feature Request

1

0

1

0

2

Ill Health

1

1

1

0

3

Information Governance

4

0

3

4

11

Inter-Agency: Clinical

1

0

2

2

5

Medication

40

34

36

49

159

Office Information Technology & Equipment

0

0

4

8

12

Operational

44

34

51

47

176

Operational Radio & ICT

2

4

3

3

12

Patient Abuse/Aggression (by staff/third party)

0

2

2

1

5

Patient Self-Harm

0

0

1

0

1

Personal Accident

36

21

31

35

123

Security

0

1

0

0

1

Vehicle

9

11

10

8

38

Welfare

0

1

0

2

3

278

249

341

278

1,146

Total

101

Quality Report and Accounts 2014/15

SEVERITY OF INCIDENTS IN QUARTER 1 AND 2 OF 2014/15 The chart below illustrates the numbers of incidents which affected patients and which have been reviewed and re-graded for severity by the Investigating Managers in quarter 1 and 2 of 2014/15.

160 151

140 120

130 124

130 122

100 80

146 139

132 124

119

115 106

104

105

107

102

101

92

89

89

84

81 72

69

60

63

59

54

40 20

133

52

58

57

52

48

40 20 0

0 Apr 14

17 5

May 14

25

19 2

Jun 14

34

5 4

10 1

Jul 14

Aug 14

Low Risk

Moderate Risk

Minor Risk

Significant Risk

10

Sep 14

9

1

Oct 14 High Risk

Most of the incidents reported are low or no harm and significant and moderate incidents have reduced.

As can be seen from the chart above: èè The high risk incidents peaked in May and fluctuated and decreased to 1 incident in September èè The significant incidents fluctuated from 11 to 4 èè The moderate incidents fluctuated from a peak of 89 to 32 èè The minor risk incidents fluctuated from a peak of 54 to 36 èè The low risk incidents fluctuated from a peak of 35 to 11

102

7

Nov 14

2

5 1

Dec 14

9

Jan 15

1

9 0

Feb 15

8

Mar 15

2

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

DUTY OF CANDOUR

Any identified shared learning is then shared either with the relevant directorates or throughout the Trust. If the learning is Trust wide then it will be done via ‘Cascade’ system.

In accordance with the requirements of the Francis Report, the Trust, since October 2014 has had a duty to identify all incidents that would meet the ‘Duty of Candour’ criteria. These are incidents were patients have been severely harmed in some way, but which may not be classed as serious incidents requiring investigation (SIRI).

Further improve our partnership working on serious incidents which cross health and social care boundaries.

The SIRI investigation policy is currently being reviewed to incorporate a clear guide to staff around multiagency working. This is of particular importance in our 111 services. As part of this work, consultation with some of the CCGs and other provider organisations is being undertaken. This will ensure that the processes across all the agencies are consistent, equitable and aligned.

To assist the Trust in identifying and recording incidents which would meet this criteria, the Trust’s Incident Reporting System, Datix has been amended and now includes a ‘Duty of Candour’ field / box which either the Investigating Manager or the Risk Team would tick if ‘Duty of Candour’ applied.

The Trust has also devised and a Duty of Candour policy and process.

Triangulation of SIRIs and complaints to maximise learning The Trust triangulates and identifies any incidents which have been declared a SIRI and which may have originated as a complaint or vice versa.

In quarter 1 and 2 of 2014/15, there was one SIRI declared in May 2014 that originated as a complaint.

For every SIRI that is declared and investigated by the Trust a report is produced which identifies any areas of shared learning and contains an action plan. The report and the action plan is shared with the SIRI Review Group and the Clinical Commissioners; and the completion of actions is monitored by the former.

103

Quality Report and Accounts 2014/15

PRIORITY 2 > CLINICAL EFFECTIVENESS èè 2a To report on the percentage of patients with stroke and heart attacks who receive an appropriate care bundle We achieved this indicator

èè The organisation consistently achieves the expected targets for the stroke care bundle which is demonstrated in the charts below

The organisation is benchmarked against other Ambulance services as per the Department of Health’s mandatory indicators. To improve the position of the organisation there has been a systematic approach and campaign which included the review and update SOPs and the highlighting of targets and achievements to frontline staff. This resulted in SCAS being in the upper quartile for five out of eight of the indicators. This includes the Stroke care bundle.

The organisation consistently achieves the expected targets for the stroke care bundle which is demonstrated in the chart below.

STROKE - CARE 102.00% 101.00% 99.0% 98.0% 97.0% 96.0% 95.0%

2014/15 ACTUAL

2014/15 TARGET

104

2013/14 ACTUAL

14 v No

14 O

ct

14 p Se

14 Au g

Ju l1 4

M

Ju

n

14

14 ay

4 r1 Ap

M ar 14

14 Fe b

14 Ja n

De c1 3

94.0%

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

STEMI - CARE 90.0% 80.0% 70.0% 60.0% 50.0% 40.0%

2014/15 ACTUAL

2014/15 TARGET

STEMI care bundle performance is currently not within the upper quartile, but the organisation has a systematic approach to improving this metric. This is achieved through the monthly metric reporting available to all team leaders in our clinical database called Qlikview to provide a platform for discussion on improvements.

All STEMI patients are audited to ensure that care they receive is compliant with the standards expected.

14 v No

14 O

ct

14 p Se

14 g Au

Ju l1 4

Ju

n

14

14 M

ay

4 r1 Ap

M ar 14

14 Fe b

14 Ja n

De c1 3

30.0%

2013/14 ACTUAL

The table above demonstrates the organisationâ&#x20AC;&#x2122;s performance against the targets and against last yearâ&#x20AC;&#x2122;s performance.

SCAS continues to submit data to the commissioning groups which is then shared with the clinical networks to help shape regional and national care pathways.

105

Quality Report and Accounts 2014/15

PRIORITY 2 > CLINICAL EFFECTIVENESS èè 2b To report on the data of responses to Red 1 and 2 calls, and calls requiring a 19 minute response and benchmark nationally (core mandated indicators) We partially achieved this indicator

In terms of response targets we are monitored nationally in regards to our response criteria we have five types / categories of Emergency responses and they are as follows:

Red performance in light of high demand has been a real challenge in 2014/15. èè Red 1 calls are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions.

For Red 1 calls, the clock starts immediately when the operator puts the call through to the ambulance service, ensuring that patients who require immediate emergency ambulance care will continue to receive the most rapid response.

èè Red1 = 8 Minutes Emergency Response. èè Red2 = 8 Minutes Emergency Response. èè Red19 = 19 minutes Emergency Response èè Green 30 = 30 Minutes Emergency Response.

èè Red 2 calls, which are serious but less immediately time critical and cover conditions such as stroke and fits, the clock start will allow call handlers to get more information about patients so that they receive the most appropriate ambulance resource based on their specific clinical needs.

èè Green 60 = 60 Minutes Emergency Response.

The tables below shows SCAS performance compared against other ambulance services across the year.

RED1 8 MINUTE PERFORMANCE APRIL 2014 - FEBRUARY 2015

80 75 75 70 65

Ambulance Services

106

l tio na Na

M W id la est nd s Yo rk sh ire

W So es uth te rn

Ce Sou nt th ra l So ut h Co Eas as t t

No W rth es t

No r Ea th st

Lo nd on

En Eas gl t o an f d

M id Ea lan st ds

60

Ambulance Services

107

95

90

85

80 M

W So es uth te rn

Ce Sou nt th r S o al ut h E Co as as t t

No W rth es t

No r Ea th st

Lo nd on

En Eas gl t o an f d

M id Ea lan st ds

tio na l

l

na

tio

Na

100

Na

RED19 PERFORMANCE APRIL 2014 - FEBRUARY 2015 id We la st nd s Yo rk sh ire

Ambulance Services

id We la st nd s Yo rk sh ire

M

W So es uth te rn

Ce Sou nt th r S o al ut h E Co as as t t

No W rth es t

No r Ea th st

Lo nd on

En Eas gl t o an f d

M id Ea lan st ds

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

RED2 8 MINUTE PERFORMANCE APRIL 2014 - FEBRUARY 2015

75

70

65

60

55

50

Quality Report and Accounts 2014/15

The organisation monitors performance daily via area conference calls as well as the 999 Score card on Qlikview. Senior managers are also alerted by hourly texts highlighting dispatch areas that are not achieving 75% each day.

To ensure that the service meets demand needs the unit hour utilisation (UHU) model matches resources against historical demand. It matches resource against demand for the previous six weeks.

We now have our plans for the next twelve months which will take into account the greater than predicted demand levels during the winter and this will influence the resources we deploy this year. We are implementing new rotas for our staff over the next three months which will align our resourcing levels with our demand to enhance our response to patients.

We are also recruiting additional specialist Paramedics to treat patients at home and avoid them being conveyed to hospital.

We are deploying a specific group of staff to target our GP admission calls to ensure these patients receive a more timely response with the appropriate skill level of staff. All these actions will enable us to provide a more efficient response to all our patients.

108

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PRIORITY 2 > CLINICAL EFFECTIVENESS èè 2c To improve the responsiveness of consistently identifying and appropriately transferring stroke patients to a hyper-acute unit within 60 minutes.

We partially achieved this indicator

To support the work undertaken locally the organisation shares information regularly with the Clinical Review Meetings and the Clinical Quality and Review Meetings, which feed in to the network groups and help inform regional and national protocol.

The Stroke Pathway issued by the clinical network for stroke is currently undertaking a review of this pathway; until the updated version is released the current pathway has been re-released to frontline staff and communicated through team meetings.

To enable early recognition of potential stroke by EOC staff NHS Pathways has been introduced for 999 call handlers and the process for stroke management has been reviewed and updated to reflect and support this. A campaign approach, led by a senior clinician, has been in place in Q1 and Q2 to highlight and drive improvement.

As part of the SOP update, patients with symptoms of stroke for more than five hours have also been added to the inclusion criteria for increased priority of response. The NHS Pathways system has shown a 35% increase in sensitivity in identification of stroke.

èè The chart below shows the current performance against the call to door time and call to leave scene time (Please note: quality indicators are validated nationally and have a few months lag time

120.00% 100.00% 80.00% 60.00% 40.00% 20.00%

CALL TO DOOR 60 MIN

CALL TO DEPART SCENE 39 MIN

109

STROKE CARE BUNDLE

HASU 60 TRAJECTORY

ar M

b Fe

n Ja

De c

No v

ct O

Se pt

Au g

y Ju l

e Ju n

M ay

Ap ril

0.00%

Quality Report and Accounts 2014/15

STROKE 60 MIN TO STROKE CENTRE 80.00% 70.00% 60.00% 50.00% 40.00% 30.00%

2014/15 ACTUAL

2014/15 TARGET

A mapping exercise has been undertaken to look at whether the 21 minute run time is possible for all stroke patients. The exercise determined that 20% of patients live outside of the 21 minute radius; therefore emphasis is placed on FAST applies to all aspects of the pathway â&#x20AC;&#x201C; from call to arrival at the HASU. The organisation currently achieves above 50% in the expected response times against the target of 56%. There is a month on month increase with one month achieving 61%.

SCAS aims to reduce the on scene time to less than 32 minutes for FAST positive patients. The results show a 7% increase in achieving this.

110

2013/14 ACTUAL (Dec 12 to Nov 13)

ar M

Fe b

n Ja

De c

No v

ct O

Se pt

Au g

y Ju l

e Ju n

M ay

Ap ril

20.00%

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

èè SCAS has improved its response time to potential stroke patients and SCAS benchmarks itself against other ambulance organisations. The results are presented in Table 4 below

Q1

Q2

Q3

England

63%

60%

58%

East Midlands Ambulance Service NHS Trust

62%

60%

56%

East of England Ambulance Service NHS Trust

57%

56%

58%

Isle of Wight NHS Trust

57%

53%

49%

London Ambulance Service NHS Trust

62%

59%

58%

North East Ambulance Service NHS Foundation Trust

77%

68%

69%

North West Ambulance Service NHS Trust

71%

70%

66%

South Central Ambulance Service NHS Foundation Trust

55%

58%

51%

South East Coast Ambulance Service NHS Foundation Trust

70%

67%

65%

South Western Ambulance Service NHS Foundation Trust

58%

60%

52%

West Midlands Ambulance Service NHS Foundation Trust

53%

45%

44%

Yorkshire Ambulance Service NHS Trust

57%

57%

54%

ORGANISATION

111

Quality Report and Accounts 2014/15

A number of actions are being implemented to ensure ongoing improvement in stroke care performance.

This has helped staff to navigate the STEMI and Stroke care bundles and allow real time feedback to support learning in realtime.

These include: The ePR also allows the recording of exceptions for example a patient declining analgesia. This means where previously the declining of analgesia (or other exceptions) would not have be recorded and the care would have been deemed as non-compliant, we are now able to record information more accurately allowing a more accurate recording of compliance levels.

èè Sharing stroke wait charts with call takers and dispatchers to increase their understanding èè Manage and train new call takers on key word identification which will improve recognition of stroke patients èè Review ratio of responses to conveyances èè Dispatchers to use intelligent dispatching - single response versus double manned ambulance èè Rolling out priority back up process (following pilot). èè Reinforce the priority of stroke patients. èè Call takers refinement of response and conveying ratio during periods of high demand by dispatch area. èè Winter funding to mitigate demand pressure. èè Mop up face-to-face training commencing November 2014 èè Removing HCP jobs as recognised exceptions enabling 999 resources to be deployed appropriately.

As well as the above the organisation has implemented the electronic patient record (ePR) system.

112

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PRIORITY 2 > CLINICAL EFFECTIVENESS èè 2d To ensure patients receive adequate pain relief.

We achieved this indicator

Training èè All paramedics receive training on the pain scale in relation to differential medicines and pain relief. This is included as part of the “paracetamol” session. Emergency Care Assistants receive training in basic pain relief (i.e. recognition of pain and suitable management – Entonox) as part of their induction.

The requirements for national submission are four months in arrears; therefore quarter FOUR data will not be available until July 2015.

Two pain scores recorded as per protocol

Q1

Analgesia given as per protocol

Incidents and Complaints: èè All incidents and complaints relating to pain management are reviewed and lessons learnt are shared amongst the operational teams.

There have been 16 incidents in relation to pain management and one complaint for quarter one and two combined. Complaints are reviewed and signed off by the Assistant Director of the EOC in which the complaint originated.

Q2

Q3

69.59%

96.7%

89.8%

77.42%

80.0%

81.4%

èè Table 4: Results for pain management STEMI patients

Reflective practice reports are anonymised and shared as learning tools. This is monitored through the Patient Safety Group.

The requirements for national submission are four months in arrears; therefore quarter four data will not be available until July 2015.

Audit: èè An audit on STEMI patients in regards to pain scoring and pain management has been undertaken.

The results are shown on the right:

The data was split by area within the data collection tool to enable identification of local variation to allow targeted input in to that area or to identify good practice and share this organisation wide.

113

Quality Report and Accounts 2014/15

As part of the actions from the survey and audit, training was undertaken with frontline crews.

All paramedics receive training on the pain scale in relation to differential medicines and pain relief. This is included as part of the â&#x20AC;&#x153;paracetamolâ&#x20AC;? session.

Emergency Care Assistants receive training in basic pain relief (i.e. recognition of pain and suitable management â&#x20AC;&#x201C; Entonox) as part of their induction.

All incidents and complaints relating to pain managements are reviewed and lessons learnt are shared amongst the operational teams. There have been 16 incidents in relation to pain management and one complaint for the year.

Complaints are reviewed and signed off by the Assistant Director of the CCC in which the complaint originated. Reflective practice reports are anonymised and shared as learning tools. This is monitored through Patient Safety Group.

114

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PRIORITY 3 > PATIENT EXPERIENCE èè 3a To ensure that all patient complaints and concerns are consistently responded to within a mutually agreed timeframe.

We partially achieved this indicator

The organisation is in the process of initiating an aggregated learning approach which will not only ensure that learning from complaints is cascaded throughout the organisation, but that this is used together with learning from risk, patient experience surveys and claims, to ensure that the learning recognises themes from across the previously mentioned areas, but that it demonstrates how this learning is implemented and embedded.

The Patient and Public Experience Policy was reviewed in Quarter 1 (2014/2015) to ensure that it is fit for purpose and reflects the needs of the organisation, but, at the same time provides assurance of openness, honesty and duty of candour when dealing with patients complaints. The policy sets out the responsibility of all those employed by the organisation who are involved in managing complaints and concerns expressed by patients and member of the public. Unless requested otherwise the aim is to respond within 25 working days to all complaints. The organisation will review the response time once the Department of Healthâ&#x20AC;&#x2122;s updated guidance has been released.

Complaints are monitored by service area and an update is sent every other week to ensure awareness of outstanding, and new complaints.

The organisation ensures that responses to complaints provide the complainant with a full explanation of where things have gone wrong, if they have, and how the organisation has learned and implemented necessary change.

The organisation reports on KPIs for patient experience monthly to the Executive Management Committee and Trust Board. Performance against the 25 day response for complainants has fluctuated over the year and SCAS plan to remodel the patient experience indicators for 2015/16 and will continue to strive to improve response rates.

The organisation uses an aggregated learning approach which will not only ensure that learning from complaints is cascaded throughout the organisation, but that this is used together with learning from risk, patient experience surveys and claims, to ensure that the learning recognises themes from across the previously mentioned areas, but that it demonstrates how this learning is implemented and embedded.

Complaints are monitored by service area and an update is sent every other week to ensure awareness of outstanding and new complaints.

The organisation ensures that responses to complaints provide the complainant with a full explanation of where things have gone wrong, if they have, and how the organisation has learned and implemented necessary change.

115

Quality Report and Accounts 2014/15

COMPLAINTS RESPONDED TO WITHIN 25 DAY TARGET 100% 90% 80% 70% 60% 50% 40% 30% 20% 10%

15 M

ar

15 b Fe

15 n Ja

14 c De

ct O

“…as you candidly admit in your letter the response time was unacceptable I have to say that I was both surprised and pleased by the detail and candour of your letter. You have clearly investigated the matter thoroughly and written me an honest, accurate appraisal.

No v1 4

14

14 Se

pt

14 g Au

Ju l1 4

14 Ju n

M ay 14

Ap r1 4

0%

“I am extremely pleased that you have changed your process to let callers know if an ambulance is on its way or not and to give an estimated wait time.

“Had this been in place at the time it would have helped our situation enormously. I am sure that other feedback helped you to decide to change your process but I feel at least that my feedback has been listened to.”

The quote shown is from a complainant following a complaint response.

116

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PRIORITY 3 > PATIENT EXPERIENCE èè 3b To learn from concerns by using ‘face to face/end to end reviews’ with partners and patients and publish the findings and actions to improve our services.

We achieved this indicator

SCAS has instigated 'WIGFY' (Was it Good for You?), which provides the opportunity to give direct comment to operational staff. Information gathered from these comments is provided in a published report to the Quality and Safety Committee.

This will continue to be used as a way of gaining direct ‘live’ feedback from patients.

The organisation also notes comments requested from callers using the Clinical Support Desk located within our Emergency Operations Centres and will use this feedback to update Standard Operating Procedures (SOPs) to improve the services provided.

The 111 Clinical Governance meetings which include SCAS participate in end to end reviews and listen to calls and work with out of hours partners to review the patient journey in order to learn.

Meetings with Healthwatch partners have taken place and links are being further developed across SCAS. In Hampshire Healthwatch and SCAS have worked to deliver a workshop and fun day with young carers and in Oxfordshire a multi agency partner quality and patient experience group has been established.

117

Quality Report and Accounts 2014/15

PRIORITY 3 > PATIENT EXPERIENCE èè 3c To proactively seek patient feedback through surveying patients to improve our services; including the friends and family test and gaining feedback from harder to reach groups..

We achieved this indicator

We have incorporated the Friends and Family test question into the patient survey available on the SCAS website and our current results show that more than 86% of our service users would be likely or extremely likely to recommend our service to a friend or family member.

HOW LIKELY ARE YOU TO RECOMMEND OUR SERVICE TO FRIENDS AND FAMILY IF THEY NEEDED SIMILAR CARE OR TREATMENT?

Extremely likely

66.1 20.4

likely

Neither Unlikely or likely

2 6.5

Unlikely

3.6

Extremely Unlikely

1.2

Don't know 0

10

20

30

40

% of respondents

118

50

60

70

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

An on-going process of patient experience surveys for our Patient Transport Service patients continues to provide rich data for use in the improvement of our services.

Bedfordshire and Luton

Hampshire

Bucks

Q2

Q2

Q1

Q2

Q4

Q3

50%

61.11%

29.62%

45.54

62.5%

87%

Likely

39.96%

1.39%

55.56%

36.63

34.4%

0%

Neither Likely or Unlikely

8.70%

31.94%

3.7%

3.96%

3.1%

0%

Unlikely

2.17%

4.17%

0%

9.90%

0%

5%

0

0

7.41%

3.96%

0%

0%

2.17%

1.39%

3.70%

0%

0%

8%

How likely are you to recommend our 111 service to friends and family if they needed care or treatment?

Extremely Likely

Extremely Unlikely Donâ&#x20AC;&#x2122;t know

119

Berkshire

Oxfordshire

Quality Report and Accounts 2014/15

èè Staff FFT surveys have commenced and the results are below:

2014/15 SAMPLE SIZE

TARGET

Q1

Q2

Q3

Q4

Question 1: How likely are you to recommend this organisation to friends and family if they needed care or treatment?

372

54%

74%

71%

Staff survey

84%

Question 2: How likely are you to recommend this organisation to friends and family as a place to work?

374

38%

27%

32%

Staff survey

55%

The staff FFT will continue to be rolled out across the whole organisation by Q1, 2015/2016 and each team will analyse and discuss their own results and create actions.

Each survey undertaken by the organisation results in an action plan to be used within the service area (111, 999, EOC and PTS) to proactively use the comments provided to improve the services provided by the organisation.

The national ambulance ‘hear and treat’ survey has now been completed and resulted in SCAS comparing well with other ambulance services. The results have been considered by Patient Experience Review Group (PERG).

A response rate of 41% has been achieved.

120

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

OTHER IMPROVEMENTS WE HAVE MADE IN 2014/15 The next section of this report highlights other successes in quality improvement which SCAS has made to improve the quality of our services to patients.

èè SCAS has introduced Mental Health Street cars in Berkshire to work in collaboration with mental health practitioners, our call centres and crews and the police. èè SCAS has a Simbulance - a specially designed ambulance for training in 'real life”' scenarios.

èè SCAS has developed and implemented a flowchart for recognition of diabetic health episodes, issued to nightclubs.

èè SCAS provide medical support with the Voluntary Services at Southampton, Reading and Portsmouth football clubs. This initiative has been incredibly successful with low conveyance rates and fantastic partnership working.

èè SCAS has successfully implemented and delivered GP training including visits to our call centres and feedback has been extremely positive. èè SCAS are currently working on a single standard operating procedure document to bring together the 999 and 111 standard operating procedures into one version controlled document. This will standardise the services in the contact centres to be working to the same processes and deliver consistent standards and messages to our patients.

èè SCAS has a new safeguarding referral form that captures all elements of safeguarding which has included highlighting female genital mutilation, sexual exploitation, Deprivation of Liberty and selfneglect. SCAS has also developed closer links with our fire colleagues to identify fire risk to some of our patients.

èè Customer Service Training has been introduced into the induction training for all staff. A bespoke course has been designed and written to deliver to all new staff coming into the contact centre environment. The training focuses on giving excellent customer service to callers often in a traumatic or stressful situation and dealing with people with empathy and respect.

èè The SCAS safeguarding team is also a vertical member of MASH (multi agency safeguarding hubs); these are in Oxfordshire, Reading, Hampshire and Southampton. This means that we are now at the front line of the multi-agency arena working with our partner agencies safeguarding children and adults throughout these areas. Further safeguarding hubs will be coming on line very soon and SCAS has already been approached to be part of the multi-agency team.

121

Quality Report and Accounts 2014/15

è The SCAS Simbulance

122

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

123

Quality Report and Accounts 2014/15

èè We had a record response from SCAS staff to the 2014 NHS Staff Survey, with 1,517 of us returning completed staff survey forms. This was an increase on the amount of people who chose to feedback last year; thank you so much for taking the time to share your thoughts. The 58.4% response rate was the highest return rate of all ambulance trusts, providing our Trust with meaningful and valuable data to use as the basis for tackling issues which matter to our staff.

èè SCAS has Enhanced Care Response Units (ECRU). ECRU responds to emergency calls either by a rapid response car, or by the Thames Valley Air Ambulance carrying specialist pre-hospital care doctors and paramedics on board. Specialist emergency care physicians from the John Radcliffe Hospital (JRH) have joined SCAS crews on ECRU too.

A huge strength of ECRU is how the crews can attend an incident and deliver rapid critical care at the scene to the most seriously injured or ill patients, helping to drastically change patient outcomes following serious accidents. At the same time, ECRU has the capability to reduce hospital admission with its advanced diagnostic and direct referral capability.

èè We are very pleased to be rolling out specialist nurse and paramedic roles. èè SCAS has been rolling out electronic patient records across the organisation. This will enable information to be stored real time on tablets and be shared with receiving hospitals.

èè SCAS are working to utilise Summary Care Records or SCR for short, which is a secure electronic record, which contains key patient information and data that is accessed in emergency and unplanned care scenarios.

The key information that is held is extracted from a patient’s GP record making it relevant and up to date.

Everyone in NHS England will have an SCR unless they choose to opt out via their GP surgery (the opt out rate is 1.4% nationally). Currently SCR’s contain the patient’s medication, allergies and adverse reactions. SCAS is one of three Ambulance Trusts taking part in a pilot to give access to the SCR to its clinicians. SCR is now being used within the emergency control rooms by both 999 CSD and 111 Clinical Advisors with positive results. SCR will soon be embedded into the ePR application enabling SCAS crews to be the first in England to access the SCR on mobile devices.

èè Virtualisation of call centres has been rolled out so calls are taken in order by the next available call handler which has improved call answer performance. èè In NHS 111 we have introduced individual scorecards and monthly feedback to staff which has reduced outliers, improved quality and reduced attrition and sickness.

124

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

STATEMENTS FROM HEALTHWATCH, THE OVERVIEW AND SCRUTINY PANELS, AND COMMISSIONERS A letter was sent to all Health and Overview and Scrutiny Panels, Healthwatch and commissioners in February 2015 outlining our progress with our Quality Accounts and the proposed priorities for 2015/16 which asked for any comments or suggestions. The following statements were received:

125

Quality Report and Accounts 2014/15

OXFORDSHIRE COUNTY COUNCIL Re: Quality Accounts 2014-15 Thank you for your email requesting comments on your proposed areas and priorities for quality improvement from April 2015.

As you know the Oxfordshire Joint Health Overview and Scrutiny Committee takes great interest in the service provision by South Central Ambulance Service to its residents. In this light you will be aware of the Committeeâ&#x20AC;&#x2122;s concerns about ambulance response times within rural areas.

Good patient experience is paramount to us, and it is clear that issues remain with the service being received by our residents. We would like to see improving response times in rural areas included within your priorities for the next year.

Your efforts to improve response rates have been noted by the Committee in the past but careful consideration needs to be given to the targets you set, taking into account the rural nature of Oxfordshireâ&#x20AC;&#x2122;s population.

Additionally the Committee would like to see South Central Ambulance Service making strides to develop close operational working with other health care professionals and emergency services to ensure patients receive the very best treatment possible. We note with approval and encourage SCAS to continue to develop emergency responses with other available professionals.

I hope you will give these aspects of service provision serious consideration when finalising your priorities and look forward to discussing your performance in future meetings.

Yours faithfully, Cllr Yvonne Constance Chairman Oxfordshire Joint Health Overview & Scrutiny Committee

126

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

HAMPSHIRE COUNTY COUNCIL Thank you for sharing with the Hampshire Health and Adult Social Care Select Committee (HASC) the draft quality improvement priorities for the 2014/15 Quality Accounts for South Central Ambulance Service NHS Foundation Trust.

I have circulated these priorities to Members of the HASC for their comments, and have received general feedback which suggests that the Committee are supportive of the approach taken.

We therefore do not wish to recommend any additions to these priorities. We do however request and look forward to receiving the action plan that will be drafted following the publication of your Quality Accounts, in order to ensure that the priorities raised can be monitored, and progress against them can be reviewed.

Please do not hesitate to contact me should you require any additional information on my comments above.

Yours sincerely Councillor Patricia Stallard Chairman, Health and Adult Social Care Select Committee

127

Quality Report and Accounts 2014/15

NHS CENTRAL SOUTHERN COMMISSIONING SUPPORT UNIT Thanks for sending us your quality improvement priorities to be included in your 14/15 Quality Accounts.

We have reviewed and feel that the priorities you have selected are entirely appropriate. You have clearly pulled from areas identified as requiring development through the year, as well as incorporating key recommendations of CQC. Please see the attached where I have added a couple of suggestions.

They are more about the wording than the essence of the priority area.

Kind regards Anna Dorothy Clinical Quality and Transformation Lead - NHS Central Southern Commissioning Support Unit

128

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

FAREHAM AND GOSPORT CCG Thank you for your letter dated 26th January 2015 setting out the proposed quality account priorities for South Central Ambulance Service NHS Foundation Trust.

The CCGs have considered your proposals and would like to make the following comments: Priority 1 - Patient Safety:

Commissioners support the safety priorities of: èè Sepsis management èè Safeguarding training for all staff. It would also be valuable to include a commitment to review the capacity for safeguarding within the organisation. èè Drug administration errors – it would be valuable to include the element of security of controlled drugs within this priority. èè Delays in the Patient Transport Service – it would be good to strengthen this to review reasons for all delays including the 999 service.

Priority 2 – Clinical Effectiveness The priorities around dementia awareness and improving the understanding of the Mental Capacity Act are supported.

Commissioners consider this may be strengthened by including a priority around improving management of patients with mental health needs and those with learning disabilities.

Priority 3 – Patient Experience Commissioners are supportive of the continued development of aggregated learning, using the triangulation of quality intelligence.

Within this priority it would be good to see how the 111 clinical audit process is also maximised to provide quality improvements and that tangible outcomes are demonstrated through this process.

In addition, it would be good to see how the organisation is continuing to support staff engagement and feedback. The priority stated around response to complaints and surveys within the NEPTS contract, is an area for continued development, however this is within the priority around aggregated learning across the whole organisation.

129

Quality Report and Accounts 2014/15

Commissioners support the intention to utilise healthcare professional feedback as a source of intelligence. This may be strengthened by including a statement to improve meaningful engagement and partnership working to drive forward improvements to patient outcomes.

I hope you find the above comments helpful.

Yours Sincerely Wendy Ball Head of Quality & Patient Experience NHS Fareham & Gosport and South Eastern Hampshire CCGs

130

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

BERKSHIRE WEST CLINICAL COMMISSIONING GROUP (CCG) Executive Summary Berkshire West Clinical Commissioning Group (CCG) Federation has reviewed the South Central Ambulance Service NHS Foundation Trust Quality Account and is providing this response as lead commissioner for the Thames Valley and on behalf of the associate commissioners across Thames Valley. The Quality Account 2014/15 provides information across a wide range of quality measurers and gives a comprehensive view of quality of care provided by the Trust. There is evidence that the Trust has relied on both internal and external assurance mechanisms.

The CCGs are satisfied as to the accuracy of the data contained in the Account and also that the Trusts 2014/15 Quality Account Priorities are those that were set out in the Trusts Vision and Strategic Objectives and five year plan. The CCGs agree that the 11 key priorities identified by the Trust are appropriate and in line with findings and discussions we have had with them throughout the year.

History South Central Ambulance Service (SCAS) became an NHS Foundation Trust in March 2012 and has subsequently evolved services to become more than a traditional ambulance service. The Trust covers four counties, underpinned by 19 Clinical Commissioning Groups providing three core areas of service: èè Mobile Urgent Healthcare - Providing 999 responses and care in a community setting èè Non-emergency patient transport and logistics - Providing routine and nonemergency patient transport services èè Clinical coordination centres - Facilitating delivery of the NHS 111 Health Helpline service and 999 and PTS calls Underneath their “Vision” sits their strategic objectives and their five year plan which details how they aim to achieve their objectives. The Trust very much values the partnership working across the local health economy, and with their patients and the public. Berkshire West CCGs, on behalf of Thames Valley commissioners are pleased to continue working in partnership with them.

Quality Account 2014/15 Their Quality Account for 2014/15 clearly identified their successes to date and also areas for further improvement. The CCG’s support the Trust’s openness and transparency and is committed to working with the Trust to achieve further improvements and successes in the areas identified within the Quality Account. This will be carried out through a number of both proactive and reactive mechanisms and collaborative and integral working.

131

Quality Report and Accounts 2014/15

PRIORITY 1: PATIENT SAFETY 1a: To implement the Sepsis Care Pathway, and then to review its effectiveness and patient outcomes We are pleased that the Trust has chosen this as a priority area for 2015/16. Sepsis is one of the leading causes of death in the developed world, rivalling myocardial infarction (heart attack). Early recognition of life threatening sepsis is essential to enable the Ambulance Service to initiate life-saving therapy and issue a pre-arrival alert to the hospital.

During 2014/15 the Trusts has developed both a paediatric and adult sepsis screening tool, to aid recognition of sepsis by frontline ambulance clinicians; assisting and supporting clinical judgement. We welcome the Trusts plans to reduce adverse incidents relating to sepsis and reduce patient hard through effective distribution and application of these tools.

1b: To ensure staff across all our services receive appropriate training in making safeguarding referrals to ensure the protection of vulnerable adults and children and understand the use of the Mental Capacity Act. As commissioners, we are confident that the Trust recognises its legal and moral duty and responsibility to protect the welfare of children and adults by working in partnership and informing social services and other Heath care partners and police of any incidents where children or adults are perceived to be vulnerable or at risk. The Trust has safeguarding policies in place and has embedded a safeguarding structure which aligns with central government guidance and is driven by a dedicated safeguarding lead. However, during an internal review and the recent CQC inspection in September 2014, it was identified that some staff had received insufficient training relating to the Mental Capacity Act and were not confident in its application. We therefore welcome SCAS choosing this as a priority in 2015/16 to ensure that this gap is addressed in order to protect vulnerable service users.

1c: To review incidents involving medicine administration errors, identify key themes and cascade aggregated learning outcomes on a trust wide basis.

During 2014/15 the Trust has worked hard to reduce medication errors, identify themes and share learning outcomes. This has included the Trust using the Failure Mode and Effects Analysis (FMEA) to develop processes to support the safe administration of medicines in the trust and improvements to date include modular medicines bags, prefilled syringes and syringe labels. Despite this effort, medicine administration errors remain one of the Trusts recurrent themes outlined in incident reporting and we therefore support the Trusts commitment to reducing medication errors further and choosing this as a priority area in 2015/16, as there is still work to be done in this key area.

132

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

1d: To ensure patients receive the right treatment, in the right place by the right health care professional and the decisions are clinically safe and appropriate We recognise that it is imperative that as an ambulance Trust, SCAS strives to deliver high quality care in a timely way with the right resource whether that is an ambulance or a disposition reached through NHS Pathways. The Trust are already using a variety of models of care to try and get it right each time such as referrals to GPâ&#x20AC;&#x2122;s and other community healthcare professionals to ensure patients who need hospital treatment, go to the right centre and the Trusts new HCP transport model is utilised effectively. However, the Trust recognise that there is still work to be done, which cannot be done alone, but needs to be undertaken with partners across the health economy and we are subsequently please the Trust has chosen this as a priority for 2015/16 and look forward to working with the trust to progress this key area of work.

1e: To report on the number of patient safety incidents that resulted in severe harm or death (mandated indicator) We recognise that SCAS takes any incident resulting in severe harm extremely seriously and that they already have a robust incident reporting system in place. Although this indicator is mandated SCAS wants to expand on it to ensure that lessons are learned across the whole system to prevent occurrences and this is welcomed by commissioners.

We know that SCAS register all SIRIs on the Strategic Executive Information System (STEIS) and that a full investigated is undertaken, meeting the requirements in national guidance. It is always essential to continue to strive to improve and we therefore welcome the Trust aiming to reduce incidents which result in major or serious harm in 2015/16 by 10%.

PRIORITY 2: CLINICAL EFFECTIVENESS Priority 2a: To report on the percentage of patients with Stroke and Heart Attacks who receive an appropriate care bundle (mandated indicators) Stroke - SCAS has worked hard in 2014/15 to improve its performance for conveying FAST +ve Stroke patients with symptom onset less than 4 hours to Hyper Acute Stroke Unit (HASU) in less than 60 minutes.

133

Quality Report and Accounts 2014/15

We acknowledge the work already undertaken and the Trusts plan to further progress this work which includes: èè Early identification of stroke in the control room èè Immediate appropriate dispatch èè Supported recognition of FAST +ve patients at face to face assessment èè HASU (Hyper Acute Stroke Unit) location awareness. èè Swift conveyance to nearest HASU. SCAS have performed extremely well at ensuring the stroke care bundle is delivered to their patients and we welcome continuing this work programme to gain further improvements during 2015/16.

Heart Attack – We support the Trusts recognition that the pain management part of the care bundle still requires improvement, acknowledging that this doesn’t necessarily mean that heart attack patients do not receive pain relief but that they don’t always use the analgesics set out in the care bundle such as Entonox.

The Trust has undertaken work in 2014/15 to improve their performance in this area, which has included an audit and the launch of a project to understand pain management behaviour. We welcome the continuation of this project, as well as the plan to create a STEMI pain management campaign approach that aligns to the calendar of trust wide campaigns events in 2015/16.

2b: Red ambulance response times – report on the percentage of patients receiving an emergency response within 8 minutes and 19 minutes. (mandated indicators) During 2014/15 SCAS has fulfilled its requirement to report against a set of key performance indicators and ambulance quality indicators that have been set nationally. We acknowledge that during 2014, SCAS implemented a new triage system, NHS Pathways, which is a software system of clinical assessment for triaging telephone calls from the public, based on the symptoms they report when they call. This system uses clinical decision making to make choices about the type of resource needed to respond to 999 calls. The use of NHS Pathways in both 999 and 111 triage has provided greater integration between parts of the business, improved access to NHS numbers for patients and provides access to a universal Directory of Services for better signposting for patients, which has been welcomed by commissioners.

This also allows SCAS to optimise benefits of closer working between NHS 111 and 999 and also deliver more hear and treat during 2015/16.

We welcome SCAS setting a priority to ensure that as this system is embedded they continue to maintain achievement of Red 2 ambulance operational response standard (8 minute response category of call) for quarterly periods, 2, 3 and 4 for the 2015/16 year.

134

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

2c: To review the reasons for delays in the Patient Transport Service which lead to service users missing appointments, and then to implement changes required to prevent future occurrences We welcome a review of Patient Transport Service (PTS) and this being set as a quality priority area in 2015/16. The Trusts non-emergency PTS provides much needed support to patients and is an extremely important service for patients.

We acknowledge the challenge that SCAS faces whilst working with 15 individual PTS contracts (largely across the Thames Valley area) to ensure the needs of service users in each geographical area are met.

We also acknowledge the work undertaken in 2014/15 to undertake an internal review which included a review of patient experience data, current clinical governance processes, key risks, and actions required within the PTS to improve service delivery for patients receiving the service. That said, we accept the CQC findings of the need for improvements to be made with PTS services and therefore are pleased to see this as a priority area for the Trust in 2015/16 PRIORITY 3: PATIENT EXPERIENCE 3a: To analyse themes and ensure aggregated learning outcomes are routinely extracted from incidents, claims, feedbacks, SIRIâ&#x20AC;&#x2122;s, compliments and concerns, with effective cascade throughout all areas of service provision We believe it is of extreme importance for all our providers to adopt an open reporting culture which supports safety and learning within the organisation and we welcome the trusts vision to ensure this is embedded across the organisation and to strive to reduce avoidable harm, continuously improving the quality of care to the population it serves.

We acknowledge the trust has a robust governance structure and welcome this being further developed to ensure aggregated learning can be extracted from all feedback mechanisms, to enable further improvement through shared learning. We welcome the work the trust has undertaken post Francis to ensure a culture of openness and transparency and their full commitment to comply with the duty of candour.

We are pleased the trust has chosen to further develop this area as a key priority, implementing regular aggregated learning reports and improve information sharing across all services in 2015/16.

135

Quality Report and Accounts 2014/15

3b: To increase awareness of dementia within the trust and improve the experience for patients and carers by providing additional training for all staff, including the coordination centres, in order to ensure all our patients with dementia are provided with the highest standards of care.

We acknowledge that SCAS is the only ambulance trust to have a full time dedicated mental health and learning disability lead and that the trust currently also has a dedicated clinician working on the ‘Dementia Care in the Ambulance Service’ project and supporting the mental health lead to plan the 2015/16 dementia training. We are pleased the trust has chosen this priority area for 2015/16 and we are supporting the trust through a CQUIN scheme in 2015/16 to increase staff awareness of Dementia through training and support.

3c: To review and improve the process for receiving and acting on healthcare profession feedback in the NHS 111 and the Patient Transport Services, in order to ensure learning and service improvements are maximised to improve patient experience and outcomes We support the importance of staff feedback at all levels in improving quality and safety of patients by identifying areas of concern and highlighting areas of good practice. SCAS has identified challenges in utilising and processing all the strands of Healthcare Practitioner (HCP) feedback partly due to a lack of clarity and inconsistency in reporting procedures used across the Trust. We welcome this being chosen as a priority area, with a focus on standardising processes going forward.

SCAS have developed robust HCP feedback in their 111 service and we welcome their plans to replicate these processes across all areas of service provision to ensure that HCP feedback is collated effectively and analysis of themes and trends is adopted across the organisation.

Overall In September 2014, the trust was subject to a CQC pilot inspection which was to inspect ambulance services under the new regulation regime. This provided a valuable external review and we were pleased with the findings which demonstrated some outstanding areas of practice but also some improvement areas and we felt was an extremely accurate reflection of the trust we knew. It was particularly encouraging that the CQC viewed the trust as ‘outstanding’ on the care and compassion that SCAS staff demonstrated as they cared for their patients, treating them with extreme sensitivity, dignity and respect. We are pleased that the trust has chosen priorities relating to improving PTS services and increasing staff Mental Capacity Act training and awareness, as these were key areas for improvement outlined by the CQC in their inspection report.

136

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

We support the Trust in its continuing focus on the positive results from 2014/15 priorities and their continuing work to further those improvement and strengthen priorities next year. Overall there have been many positive highlights for the Trust and assurance that they continue to offer high quality and safe care to our patients.

The information in this Quality Account is provided from the Trusts data management systems and their quality improvement systems and to the best of our knowledge is accurate, and provides a true reflection of the organisation.

Debbie Daly Director of Nursing for Berkshire CCGâ&#x20AC;&#x2122;s on behalf of TV commissioners

137

Quality Report and Accounts 2014/15

FAREHAM & GOSPORT CLINICAL COMMISSIONING GROUP Fareham & Gosport Clinical Commissioning Group (CCG) and its associate commissioners welcome the opportunity to participate in the governance “sign off” process for the 2014/15 Quality Account of South Central Ambulance Service NHS Foundation Trust (SCAS) for 999, 111 and Non-Emergency Patient Transport Services.

Commissioner Statement Commissioners welcome the commitment of SCAS to engage in positive partnerships within the health and social care systems to enable delivery of high quality care or patients. This year the entire health and social care system has experienced increased demand for urgent care, and it is imperative we continue to work collaboratively to ensure provision and quality of services so that patients get the right care at the right time and that services are as efficient and effective as possible. This is a shared quality agenda and commissioners recognise the impact of the challenges across all parts of the health system where there are sustained operational pressures.

The quality account demonstrates the expansion of the service SCAS provide for our local population to include 999, 111 and, since October 2014, non–emergency patient transport services. It is essential that whilst the co-ordination of these services under one provider enables a more seamless service for patients, the pace of expansion is undertaken with the appropriate resilience, skilled resources, and support to deliver the highest performance and quality of care. This has presented the trust with challenges, given the national shortage of paramedic staff and other skilled clinical and non-clinical staff across these services. This resilience will include continuing to ensure that clinical assessments, despatch decisions, sign-posting, virtual and compatible IT platforms, transport and advice services are effectively used to determine the most appropriate service (111, 999 and non-emergency transport) to meet the needs of the patient 24/7. In addition, the impact of staff vacancies will require constant vigilance. This is equally dependent upon close working relationships with other providers of health and social care.

To enable better integrated working and affect patient outcomes, it is essential that clinical data is accessed and utilised to inform care decisions. Work has progressed this year on using the “Hampshire Health Record” for sharing clinical information and the electronic patient record for recording data. It is imperative that this remains a focus for 2015/16.

Commissioners were pleased to note the outcomes of the trust’s CQC pilot inspection undertaken in September 2014. This provided an external review of quality and governance across all the services provided by SCAS. The process has been instrumental in re-affirming the organisation’s internal quality priorities for 2015/16 and has also recognised the actions required across the health system to maximise resilience in times of operational pressures.

138

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

The CQC found SCAS services to be caring and compassionate, a sentiment echoed through local patient feedback. Commissioners are fully sighted on the improvements plans which address the findings of the CQC pilot inspection and have established processes to ensure the delivery of these are monitored. Likewise it is positive to see the strategy, drawn from NHS England’s key objectives and local priorities, reflects new models of working to enable a more seamless service to be provided for the urgent and non- emergency needs of our population. In 2014/15 we have seen the implementation of NHS pathways in the 111 and 999 services, a nationally based tool intended to offer greater consistency and safety in clinical needs assessment decisions and treatment. In addition, a dedicated resource for healthcare professionals to book ambulance transport is continuing to be implemented. This may further assist in the effective use of resources and commissioners will continuously monitor the impact.

The quality account is clearly under-pinned by the recommendations from the Francis report and it is good to see the range of quantitative and qualitative intelligence considered by the board to determine quality assurance. This includes both external performance measures, such as national audits and surveys offering comparative benchmarking data, through to an internally determined set of quality metrics covering, patient and staff views, performance outcomes and safety measures. In addition, commissioners are aware of the leadership walk-rounds across services, offering greater engagement with staff and teams. There is opportunity within 2015/16 to further develop the work programmes on safety culture across all service teams. The programme of engagement set out in the quality account is positive and supports the findings of the CQC inspection. As part of the quality assurance process, commissioners intend to continue with quality visits to services. It is also positive to see referenced the formal process for reviewing quality impact in relation to service developments or cost improvement plans. Commissioners are engaged in reviewing plans and monitoring the progress throughout the year.

This account rightly recognises the role of the “independent” voice in quality processes and includes details of the external assurance mechanisms, such as audit outcomes, the public view through feedback/council of governors, staff views through leadership walkrounds and commissioner engagement in priority setting.

Report Structure The quality account provides information across the elements of quality. These are: èè Patient safety èè Patient experience & staff experience èè Clinical effectiveness.

139

Quality Report and Accounts 2014/15

The account incorporates the mandated elements required and SCAS has used a variety of quality intelligence and external consultations with stakeholders to support the development of the quality priorities for 2015/16. External assurance mechanisms have also featured in the assessment of the quality position to date, for example audits.

Quality Improvement Priorities for 2015/16 SCAS has outlined its priorities for 2015/16 and commissioners support the process the trust has used to identify these and in principle, agree with the priorities chosen. Some priorities are those which are mandated, for example reporting of incidents resulting in severe harm or death, stroke and heart attack care bundle performance and response times to emergency calls. Commissioners have established monitoring processes in place.

Patient Safety Commissioners welcome the focus on improving sepsis management.

This reflects both national and local priorities and improvements will be incentivised through the Commissioning for Quality & Innovation (CQUIN).

Commissioners have received feedback in-year regarding improvements required to maximise effectivity in safeguarding for adults and children.

Insufficient training in relation to the Mental Capacity Act was also highlighted in the CQC inspection report. We fully support this as a safety priority. In addition to the actions identified, commissioners would recommend that SCAS ensure engagement with all sub-groups of the local safeguarding boards and commissioners will continue to work with SCAS to monitor the delivery of this.

Building on the priorities set in 2014/15, it is positive to note that SCAS have made it a priority to ensure patients receive the right treatment, in the right place by the right health care professions and that the decisions are clinically safe and appropriate. It is particularly important to ensure patient needs, addressed through advice or discharging to another service, are clinically safe and that staff are suitably skilled to facilitate this. SCAS will monitor re-contacts to the service and, additionally audit non-conveyance decisions. Commissioners will monitor the delivery and quality intelligence for this.

Commissioners support the intention to reduce safety incidents which result in severe harm or death and the pledge within the quality account to prevent future occurrences by ensuring lessons are learnt across the health system. In light of the current pressures on the urgent care system it is essential that the commitment to partnership working on early identification of quality concerns and solutions continues to retain priority status in the forthcoming year.

140

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Clinical Effectiveness SCAS has set a priority for reporting on care bundle performance for stroke and heart attacks (mandated indicator). It would be good to see a specific quantifiable target. In addition SCAS has set its commitment to improve performance for conveying FAST positive stroke patients with symptom onset of than 4-hours to hyper acute stroke units (HASU) in less than 60 minutes. Whilst commissioners are sighted on the work undertaken to improve performance in-year, delivery has been challenged and rightly requires a continued or enhanced priority status. Improving performance on pain management for patients suffering heart attacks continues to be a priority and commissioners are keen to see improvements demonstrated early in 2015/16, including some of the challenges of data collection.

Commissioners remain aware of the real challenge, and potential quality concerns arising when people wait too long for an emergency response. Operational challenges have further challenged the sustained delivery of improvements across all categories of calls.

This remains a key quality priority and is reflected through patient feedback (complaints and concerns) and organisational performance.

Commissioners are sighted on the safety metrics and interventions SCAS have in place to minimise harm, for example prioritisation of resources and despatch decisions based on acuity, the continuation of welfare checks on patients to monitor any changes in patient condition. For 2015/16 commissioners would like to see further assurance of how this intelligence affects planning for “peak demand times”. Delays need to be minimised across both higher and lower acuity calls. System resilience is essential to maximise effectivity and commissioners will continue to work with SCAS in year and ensure that lessons learnt from quality analysis feed into future planning and safety interventions. Another significant element for future delivery will be availability of appropriately skilled staff.

Commissioners are pleased to see the quality analysis undertaken for the non–emergency transport service has contributed to the setting of a priority to prevent patients missing appointments as a result of transport delays or non- attendance. The impact of missed appointments remains a key area of concern. Commissioners look forward to reviewing the continued analysis of quality, enhanced quality assurance and early delivery of improvements.

Patient Experience Commissioners are pleased to note the continued intention to utilise a variety of quality intelligence to monitor and improve patient experience. The positive work achieved with health care professional feedback in the 111 services will be replicated across the 999 and non–emergency patient transport services. This is underpinned by a commitment to further enhance the learning culture throughout the organisation and commissioners are aware of the interventions which have been progressed in year.

141

Quality Report and Accounts 2014/15

An area for further development may be through embedding the staff safety culture feedback collected in 2014/15 into all services and commissioners look forward to reviewing the outcomes achieved. SCAS have increased their patient experience team capacity in 2014/15. This is a necessary development and we anticipate seeing an improvement in response times to complaints. In addition it will be good to see the improvements made in connection with key themes from complaints, such as staff attitude and delays. These are continued themes from 2014/15.

It is essential that staff continue to be engaged in the delivery of improvements and their engagement is supported through a variety of forums such as dedicated team meetings and leadership walk-rounds.

In addition, the findings of the NHS Staff Survey 2014 will feed into any future opportunities.

Commissioners support the focus on “seldom heard groups” and SCAS has set out intentions to improve staff awareness of the needs of patients with dementia. Commissioners would welcome a similar intervention for patients with mental health needs and, as patients with mental health needs are regular users of the emergency services, it is imperative that all staff are versed in alternative services to ensure that patients receive the appropriate intervention. Unfortunately the CQUIN for 2014/15, aimed at improving the process to meet the needs of patients with mental health needs has not been fully achieved in year.

Commissioners will continue to monitor the delivery of the Mental Health Concordat in 2015/16.

Achievements reported against 2014/15 priorities and overall quality performance Achievements against objectives and targets in 2014/15 are outlined in part 3 of the account. Commissioners note that SCAS report they have not fully met all the priorities or 2014/15: èè “Reducing potential harm or poor patient experience as a result of waiting too long for a response.” Commissioners are keen to see a continued focus on reducing delays across all call categories and the enhanced quality assurance/prevention through the review of all elements of quality intelligence and resilience measures. SCAS have highlighted a number of interventions to support an actual reduction in delays, for example implementing new rotas, recruitment programmes, and a designated health care professional response. It will be good to see the national comparators and significance of variations, and to make clearer the reported figures as “levels of harm” or “risk status” as these two elements are referred to in the graph and narrative respectively. Where serious incidents have been reported, which involve clinical decision-making as a factor; commissioners have received robust investigations and identification of preventative actions.

142

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

èè “Performance against Red 1 and Red 2 calls and calls requiring a 19 minute response.” The quality account demonstrates the red performance to be challenged. The quality account currently only contains data up to February 2015 and may have been better presented by clearly showing the targets. In addition, no graphic demonstration of “green” performance is shown. Commissioners acknowledge the continued demand on urgent care services. èè “Responsiveness of transferring stroke patients to a hyper acute unit within 60 minutes.” The data presented indicates an under performance against plan since October 2014. It is helpful to see the benchmarked data. Commissioners acknowledge the positive increased sensitivity of NHS Pathways to support identification of stroke patients and remain concerned that this crucial response target remains off trajectory. It is acknowledged that SCAS indicate their commitment to improve this and the quality account would have been strengthened through a quantifiable improvement target being set in addition to the on scene time. In addition, commissioners anticipate a continued commitment to clinical leadership for driving improvement across the organisation. èè “Ensuring that patient complaints are responded to within an agreed timeframe.” SCAS has indicated that a 25-day response target has not been met. Commissioners acknowledge the impact of operational pressures and the new services in year which have affected the delivery of this. SCAS should ensure they are setting realistic complaint resolution targets with individual complainants in accordance with the NHS Complaints Regulations (2009).

It is good to see the overall top quartile performance in the stroke care bundle (with two missed months reported in October and November 2014). However, for patients suffering from heart attacks, performance does not reach the upper quartile. SCAS have identified the reporting of pain management needs to improve and they have several internal work programmes in place.

In addition it has been good to see the roll out of the Friends & Family Test for patients and staff this year and that SCAS intend to continue utilising and enhancing this method of feedback for 2015/16.

This is in conjunction with national surveys which demonstrates positive response rates from the 2014 NHS staff survey, and other methodologies for gaining insights into the experience of patients across the 999, 111 and non - emergency transport services. The list of other improvements made within 2014/15 is welcomed.

Mandatory data is given around performance against national targets and regulatory requirements. However, from the quality account version reviewed, more data presented at CCG level would have been beneficial as this would enable greater public clarity on variances and impact of rurality on overall performance. This was highlighted in the previous quality account.

143

Quality Report and Accounts 2014/15

SCAS reference the Commissioning for Quality (CQUIN) incentive schemes, although detail on quality achievement is not included, only the financial information. SCAS did not fully meet all the CQUIN schemes for 2014/15.

Data Quality It is imperative that data quality remains a priority for SCAS. SCAS have identified ongoing work with scrutiny and timeliness of data at all levels of the organisation. With the full implementation of the electronic patient record and utilisation of the Hampshire Health Record, it is anticipated that data flows will be improved. In addition, commissioners will continue to work with SCAS on the analysis of data to determine meaningful intelligence on the quality of services.

Clinical Audit and Research The clinical audit section demonstrates SCAS have participated in 100% of eligible national clinical audits and that zero national confidential enquiries were applicable. The data contribution to these audits is shown at 100%. In addition, SCAS provide evidence of where staff have contributed to research and the collaborative networks they support. Commissioners have used national data sets to verify the numbers presented in the quality account and, where any variance exists, this has been communicated to SCAS. Commissioner Assessment Summary This account demonstrates the many positive initiatives and achievements within a challenging year for urgent care across the health system. The collaborative working relationship SCAS have demonstrated in the quality arena is welcomed and we look forward to continuation of this in 2015/16.

For 2015/16 there is the national challenge of shortage of paramedic staff and it is essential that SCAS, in partnership with other health providers, continuously explore how effective utilisation of finite resources are best managed to deliver the quality of service required for the population. They have quite rightly referenced new models of working, essentially supported by shared IT platforms to enable better sharing of information and to enable care to be delivered in the right place. Commissioners are committed to working with SCAS to maximise any effective opportunities in 2015/16.

We would like to see continued focus on improving delays across all call categories and assurance of delivery against stroke performance.

To under-pin this, we would encourage SCAS to enhance their data quality, and as intended, utilise a variety of quality data to give meaningful intelligence around the quality of services it delivers.

144

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Commissioners welcome the opportunity to continue to work with SCAS as a health care partner who takes quality seriously for the benefit of our population.

Richard Samuel Chief Officer Fareham & Gosport and South Eastern Hampshire Clinical Commissioning Groups

145

Quality Report and Accounts 2014/15

STATEMENT OF DIRECTORS’ RESPONSIBILITIES IN RESPECT OF THE QUALITY REPORT Directors responsibilities in respect of the quality report as outlined in the NHS Foundation Trust Annual Reporting Manual 2014/15 (Monitor).

èè the content of the Quality Report is not inconsistent with internal and external sources of information including: ›› board minutes and papers for the period April 2014 to March 2015

The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for each financial year.

Monitor has issued guidance to NHS foundation trust boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that NHS foundation trust boards should put in place to support the data quality for the preparation of the quality report.

›› papers relating to Quality reported to the board over the period April 2014 to March 2015 ›› feedback from commissioners dated 13 May 2015 ›› feedback from governors dated 25 March 2015 ›› feedback from local Healthwatch organisations dated February to March 2015

In preparing the Quality Report, directors are required to take steps to satisfy themselves that:

›› feedback from Overview and Scrutiny Committee dated February to March 2015

èè the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2014/15 and supporting guidance

›› the trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated 30 April 2015 ›› the national patient survey N/A ›› the national staff survey dated 31 March 2015

146

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

›› the Head of Internal Audit’s annual opinion over the trust’s control environment dated 30 April 2015

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.

›› CQC Intelligent Monitoring Report dated 06 January 2015

By order of the board

èè the Quality Report presents a balanced picture of the NHS foundation trust’s performance over the period covered

NB: sign and date in any colour ink except black;

èè the performance information reported in the Quality Report is reliable and accurate èè there are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm that they are working effectively in practice

Trevor Jones Chairman Date: 27 May 2015

èè the data underpinning the measures of performance reported in the Quality Report is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review and

Will Hancock Chief Executive

èè the Quality Report has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Accounts regulations) (published at www.monitor.gov.uk/ annualreportingmanual) as well as the standards to support data quality for the preparation of the Quality Report (available at www.monitor.gov.uk/ annualreportingmanual).

Date: 27 May 2015

147

Quality Report and Accounts 2014/15

INDEPENDENT AUDITOR’S REPORT TO THE COUNCIL OF GOVERNORS OF SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST We have been engaged by the Council of Governors of South Central Ambulance Service NHS Foundation Trust to perform an independent assurance engagement in respect of South Central Ambulance Service NHS Foundation Trust’s Quality Report for the year ended 31 March 2015 (the ‘Quality Report’) and certain performance indicators contained therein.

èè the Quality Report is not consistent in all material respects with the sources specified in the Detailed Guidance for External Assurance on Quality Reports 2014/15 (‘the Guidance’); and èè the indicators in the Quality Report identified as having been the subject of limited assurance in the Quality Report are not reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Guidance.

Scope and subject matter The indicators for the year ended 31 March 2015 subject to limited assurance consist of the following two national priority indicators: èè category A call – emergency response within eight minutes; and

We read the Quality Report and consider whether it addresses the content requirements of the NHS Foundation Trust Annual Reporting Manual and consider the implications for our report if we become aware of any material omissions.

èè category A call – ambulance vehicle arrives within 19 minutes.

We refer to these two national priority indicators collectively as the ‘indicators’.

Respective responsibilities of the directors and auditors

We read the other information contained in the Quality Report and consider whether it is materially inconsistent with:

The directors are responsible for the content and the preparation of the Quality Report in accordance with the criteria set out in the NHS Foundation Trust Annual Reporting Manual issued by Monitor.

èè board minutes for the period April 2014 to May 2015 èè papers relating to quality reported to the board over the period April 2014 to May 2015

Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention that causes us to believe that:

èè feedback from Commissioners, dated May 2015 èè feedback from governors, dated March 2015

èè the Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual;

èè feedback from local Healthwatch organisations, dated February to March 2015

148

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

èè feedback from Overview and Scrutiny Committee dated February to March 2015

We permit the disclosure of this report within the Annual Report for the year ended 31 March 2015, to enable the Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the indicators. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors as a body and South Central Ambulance Service NHS Foundation Trust for our work or this report, except where terms are expressly agreed and with our prior consent in writing.

èè the trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, April 2015 èè the national staff survey, March 2015 èè the Head of Internal Audit’s annual opinion over the trust’s control environment, April 2015 We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the ‘documents’). Our responsibilities do not extend to any other information.

We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team comprised assurance practitioners and relevant subject matter experts.

This report, including the conclusion, has been prepared solely for the Council of Governors of South Central Ambulance Service NHS Foundation Trust as a body, to assist the Council of Governors in reporting the NHS Foundation Trust’s quality agenda, performance and activities.

Assurance work performed We conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 (Revised) – ‘Assurance Engagements other than Audits or Reviews of Historical Financial Information’, issued by the International Auditing and Assurance Standards Board (‘ISAE 3000’).

Our limited assurance procedures included: èè evaluating the design and implementation of the key processes and controls for managing and reporting the indicators èè making enquiries of management èè testing key management controls èè limited testing, on a selective basis, of the data used to calculate the indicator back to supporting documentation

149

Quality Report and Accounts 2014/15

INDEPENDENT AUDITOR’S REPORT TO THE COUNCIL OF GOVERNORS OF SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST èè comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to the categories reported in the Quality Report.

The scope of our assurance work has not included governance over quality or non-mandated indicators, which have been determined locally by South Central Ambulance Service NHS Foundation Trust.

èè reading the documents.

Conclusion

A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering sufficient appropriate evidence are deliberately limited relative to a reasonable assurance engagement.

Based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2015: èè the Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual;

Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods used for determining such information.

èè the Quality Report is not consistent in all material respects with the sources specified in the Guidance; and èè the indicators in the Quality Report subject to limited assurance have not been reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Guidance.

The absence of a significant body of established practice on which to draw allows for the selection of different, but acceptable measurement techniques which can result in materially different measurements and can affect comparability. The precision of different measurement techniques may also vary.

Furthermore, the nature and methods used to determine such information, as well as the measurement criteria and the precision of these criteria, may change over time. It is important to read the quality report in the context of the criteria set out in the NHS Foundation Trust Annual Reporting Manual.

KPMG LLP Chartered Accountants 100 Temple Street Bristol BS1 6AG 29 May 2014

150

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

151

Quality Report and Accounts 2014/15

GLOSSARY AACP

Ambulance Anticipatory Care Plan

ACP

Anticipatory Care Plan

ACS

Acute Coronary Syndrome

AMPDS

Advanced Medical Priority Dispatch System

ATP

Adenosine Triophosphate Testing

BASICS

British Association for Immediate Care

BMJ

British Medical Journal

CAD

Computer Aided Dispatch System

CARS

Clinical Audit Record System

CBRN

Chemical, Biological, Radiological, Nuclear

CCG

Clinical Commissioning Group

CEO

Chief Executive Officer

CF

Clinical Fellow

CFR

Community First Responder

CNST

Clinical Negligence Scheme for Trusts

CPD

Continuous Professional Development

CPI

Clinical performance indicator

CQC

Care Quality Commission

CQUIN

Commissioning for Quality and Improvement

CSD

Clinical Support Desk

DCA

Double Crewed Ambulance

DH

Department of Health

DOS

Directory of Services

ECA

Emergency Care Assistant

ECP

Emergency Care Practitioner

ECT

Emergency Call Taker

EOC

Emergency Operations Centre

EoLC

End of Life Care

ePR

Electronic Patient Record

FFT

Friends and Family Test

FT

Foundation Trust

HALO

Hospital Ambulance Liaison Officer

152

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

HART

Hazardous Area Response Team

HCP

Health Care Provider

HOSC

Health Overview and Scrutiny Committee

JRCALC

Joint Royal Colleges Ambulance Liaison Committee

LD

Learning Disability

MCA

Mental Capacity Act

MH

Mental Health

MINAP

Myocardial Ischaemia National Audit Project

NED

Non-executive director

NHSLA

NHS Litigation Authority

PALS

Patient Advice and Liaison Service

PCI

Primary angioplasty

PCT

Primary Care Trust

PCR

Patient Clinical Record

PERG

Patient Experience Review Group

PRF

Patient Report From

PPCI

Primary Percutaneous Coronary Intervention

PTS

Patient Transport Services

RAG

Red, Amber, Green

RCN

Royal College of Nursing

ROSC

Return of spontaneous circulation

SCAS

South Central Ambulance Service NHS Foundation Trust

SCIE

Social Care Institute for Excellence

SID

Serious Incident Desk

SIRI

Serious Incidents Requiring Investigation

SLA

Service Level Agreement

SOP

Standard Operating Procedure

STEIS

Strategic Executive Information System

STEMI

ST elevation Myocardial Infarction (Heart Attack)

TARN

Trauma Audit and Research Network

TUB

Trauma Unit Bypass

uDNACPR

Unified Do Not Attempt Cardio-Pulmonary Resuscitation

153

Quality Report and Accounts 2014/15

INVITATION TO FEEDBACK ON THE QUALITY ACCOUNT

Please tell us what you thought of this report: èè Did you find it useful? èè Did the report tell you what you wanted to know? èè Do you agree with our priorities for 2015/2016? èè Is there anything else you would like to see included in future reports?

You can tell us by contacting SCAS in the following ways: Email:

patientexperience@scas.nhs.uk

Phone:

0300 123 9280

Post: Debbie Marrs

Assistant Director of Quality

South Central Ambulance service NHS Foundation Trust

Unit 7 & 8 Talisman Business Centre Talisman Road Bicester Oxfordshire OX26 6HR

154

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

è AED at The University of Portsmouth

155

Directorâ&#x20AC;&#x2122;s Report

156

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

5 DIRECTORâ&#x20AC;&#x2122;S REPORT

157

Director’s Report

BOARD OF DIRECTORS

èè set the Trust’s visions, values and standards of conduct and ensure that its obligations to patients and other key stakeholders are delivered.

All Board members (executive and nonexecutive) have joint responsibility for decisions of the Board and share the same liability. All members also have responsibility to constructively challenge the decisions of the Board and help develop proposals on priorities, risk mitigation, values, standards and strategy.

The Trust’s Board of Directors (the 'Board') held six Board meetings in public between 1 April 2014 and 31 March 2015. The agendas, papers, presentations, and minutes of Board meetings are available on the Trust’s website.

The Board delegates certain powers to its sub-committees (not including executive powers unless expressly authorised). The executive team is responsible for the dayto-day running of the organisation and implementing decisions taken at a strategic level by the Board.

Decisions taken by the Board and delegated to management.

The Board has overall and collective responsibility for the exercising of the powers and the performance of the Trust, and its duties include to:

BOARD OF DIRECTORS BALANCE

èè provide effective and proactive leadership of the Trust èè ensure compliance with the provider license, constitution, mandatory guidance issued by Monitor, and other relevant statutory obligations

The Board continually reviews its composition to ensure that it reflects the skills and competencies required to enable the Trust to fulfil its obligations.

èè set the Trust’s strategic aims at least annually, taking into consideration the views of the Council of Governors, ensuring that the necessary resources are in place for the Trust to meet its main priorities and objectives

The Board started 2014/15 with eight Non Executive Directors including the Chairman, and six Executive Directors including the Chief Executive. One Non Executive Director left, as planned, in June 2014, and for the rest of the year there were seven Non Executive Directors including the Chairman, and six Executive Directors including the Chief Executive. All thirteen members had voting rights.

èè ensure the quality and safety of healthcare services for patients, education, training and research delivered by the Trust, applying the relevant principles and standards of clinical governance èè ensure that the Trust exercises its functions effectively, efficiently and economically, including in relation to service delivery

158

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

BOARD OF DIRECTORS PERFORMANCE EVALUATION AND REVIEW

In addition, to the three formal processes in 2014/15 outlined above, the Board has a systematic approach to assessing its collective performance including through appraisal and away days. Reviews of the effectiveness of the key Board committees (e.g. Audit, Quality and Safety and Remuneration) are undertaken annually and presented to the Board.

The Board was subject to performance evaluation through three key independent processes during the year:

GOVERNANCE

èè a review of Board governance was commissioned in June 2014, and this was undertaken by an independent consultant (with extensive knowledge of the ambulance sector and corporate governance), shaped

by Monitor’s Well-Led Framework for Governance Reviews: Guidance for NHS Foundation Trusts

The Board uses Monitor’s NHS Foundation Trust Code of Governance as best practice advice to improve governance practices across the Trust. Furthermore the effectiveness of the Trust’s governance arrangements is regularly assessed, including through internal audit.

èè in September 2014, the Trust was subject to a pilot inspection by the Care Quality Commission under the new A Fresh Start for the Regulation of Ambulance Services approach; this looked at aspects of Board and management leadership

The Trust had no areas of non-compliance with the Monitor Code during 2014/15. It will start 2015/16 with one area of noncompliance; one of the Non Executive Directors is leaving the Trust on 1 April 2015 and, whilst the Board carries out a formal succession planning review, the vacancy will not be filled immediately.

To mitigate the fact that there will be an equal number of Non Executive Directors and Executive Directors, the Chairman will have a second/casting vote should any Board decisions require a vote.

èè a Board Evaluation Review was commissioned in November 2014, and this was undertaken by an independent body (NHS Thames Valley and Wessex Leadership Academy), using consultants with extensive knowledge of NHS Boards and leadership. The review was commissioned to obtain an independent view on the functioning of the Board and its effectiveness, and also to provide further information to support ongoing executive and non-executive succession planning arrangements

The Trust was compliant with its Constitution at all times throughout 2014/15.

The Board operates within a comprehensive structure and with robust reporting arrangements, which facilitates good information flows between the Board of Directors, various committees, and the Council of Governors.

All three processes reached positive conclusions about the effectiveness of the SCAS Board of Directors. Some areas for further improvement were identified, and these are being addressed through development and implementation of appropriate action plans.

The Trust maintains a register of Board members interests, gifts and hospitality, and this is presented on an annual basis at one of the Trust’s Board meetings in public.

159

Director’s Report

Board members are also asked to declare any new interests at each meeting of the Board, or highlight any existing interest that might be relevant to the discussions at that meeting.

èè satisfy themselves as to the integrity of financial, clinical and other information, and that financial and clinical quality controls and systems of risk management and governance are robust and implemented

The Board also considered the new Fit and Proper Person Requirement regulations during the year, and satisfied itself that all current Board members fulfil the requirements.

èè be responsible for determining appropriate levels of remuneration of executive directors and have a prime role in appointing, and where necessary removing, executive directors, and in succession planning.

At each Board meeting in public, Board members are asked to declare whether there are any new factors which may impact on their ability to be regarded as ‘fit and proper’.

The Chair is one of Non Executive Directors and is personally responsible for the leadership of the Board of Directors and the Council of Governors, ensuring their effectiveness on all aspects of their role and setting their agenda.

NON EXECUTIVE DIRECTORS Non Executive Directors are members of the Board of Directors. They are not involved in the day to day running of the business, but are instead guardians of the governance process and monitor the executive activity as well as contributing to the development of strategy. They have four specific areas of responsibility – strategy, performance, risk and people – and should provide independent views on resources, appointments and standards of conduct.

Non Executive Directors have a particular duty to ensure appropriate challenge is made, and that the Board acts in the best interests of the public. They should: èè bring independence, external skills and perspectives, and challenge strategy development èè scrutinise the performance of, and hold to account, the executive management in meeting agreed objectives, receive adequate information, and monitor the reporting of performance

160

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

èè During 2014/15 the Trust had eight serving and voting Non Executive Directors, all of whom are independent:

NED

DATE APPOINTED TO FT BOARD

CURRENT TERM OF OFFICE

TERM (RESET AT FT)

Trevor Jones (Chair)

1 March 2012

31 March 2017

Second

Alastair Mitchell-Baker (Vice-Chair / Senior Independent Director)

1 March 2012

28 February 2016

Second

Ilona Blue

1 March 2012

28 February 2018

Second

Claire Carless

1 March 2012

31 December 2015

First

Mike Hawker

1 January 2014

31 December 2017

First

Keith Nuttall

1 March 2012

31 March 2017

Second

Eddie Weiss

1 March 2012

7 June 2014

First (extended)

Professor David Williams

1 March 2012

31 December 2017

Second

Eddie Weiss left the Trust in June 2014, as planned, following a successful handover of Audit Committee Chair duties to Mike Hawker.

Claire Carless resigned from the Board, due to work commitments, with effect from 1 April 2015, and before her scheduled term of office expired.

Details of each Non Executive Director Board member, including any declared interests, can be seen on the Trust’s website at www.scas.nhs.uk.

161

Director’s Report

EXECUTIVE DIRECTORS The Executive Directors are responsible for the day-to-day running of the organisation, and the Chief Executive, as Accounting Officer, is responsible for ensuring that the organisation works in accordance with national policy and public service values, and maintains proper financial stewardship. The Chief Executive is directly accountable to the Board for ensuring that its decisions are implemented. èè At the end of the 2014/15 financial year there were six voting Executive Directors on the Trust Board

EXECUTIVE DIRECTOR

POSITION

Will Hancock

Chief Executive

John Black

Medical Director

Sue Byrne

Chief Operating Officer

Charles Porter

Director of Finance

Deirdre Thompson

Director of Patient Care

James Underhay

Director of Strategy, Business Development, Communications and Engagement

John Nichols (former Director of NHS111) and Sharon Walters (Director of Human Resources) have also attended Board meetings during 2014/15 but did not have voting rights.

BOARD COMMITTEES

Details of each Executive Director Board member, including any declared interests, can be seen on the Trust’s website at www.scas.nhs.uk

The Audit and Quality and Safety Committees jointly oversee governance, quality and risk within the organisation and provide assurance to the Board.

The Board has four committees: Audit, Quality and Safety, Remuneration and Nominations, and Charitable Funds.

The Audit Committee also seeks assurance that financial reporting and internal control principles are applied.

162

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Its members at the end of 2014/15 were Mike Hawker (Chair), Ilona Blue, and Keith Nuttall (who was replaced by Professor David Williams with effect from 1 April 2015), and five meetings were held during 2014/15.

The main focus of the Quality and Safety Committee is to enhance Board oversight of quality performance, and probe quality and care issues. Its members at the end of 2014/15 were Keith Nuttall (Chair), Professor David Williams, and Alastair Mitchell-Baker, and four meetings were held during 2014/15. Professor David Williams became chair on 1 April 2015 and Keith Nuttall reverted to member status.

The Remuneration Committee is responsible for ensuring that a policy and process for the appointment, remuneration and terms of service, and performance review and appraisal, of the Chief Executive, Executive Directors and senior managers are in place. Its members at the end of 2014/15 were Alastair MitchellBaker (Chair), Trevor Jones, and Claire Carless, and six meetings were held during 2014/15. As disclosed above, Claire Carless left the Trust on 1 April 2015 and Ilona Blue joined the committee as a member.

The Charitable Funds Committee acts with delegated authority from the Board as the Corporate Trustee on all issues relating to the administration and use of Trust Funds (or non exchequer funds), Its members at the end of 2014/15 were Claire Carless (Chair), Mike Hawker and Keith Nuttall, and three meetings were held during 2014/15. Keith Nuttall became chair with effect from 1 April 2015.

163

Director’s Report

THE AUDIT COMMITTEE

External Audit

The Audit Committee is a statutory committee of the Board comprising non executive directors of the Trust, all of whom are considered independent. There were five meetings during 2014/15 and all of its members attended each of those meetings. Other members included Ilona Blue and Keith Nuttall. Eddie Weiss was the previous chairman of the Audit Committee and he left the Trust in June.

The Trust appointed KPMG as its auditors, following a competitive tender process, timed for the 2012/13 financial statements for an initial period of three years with an option to extend for a further two years. Following a recommendation made from the Committee to the Council of Governors (COG), KPMG’s term of office has been extended for a further two years.

KPMG attend every committee reporting on progress and developments that are likely to impact on the final accounts. The effectiveness of internal and external audit is reviewed on a periodic basis by the Audit Committee. KPMG have attended COG meetings from time to time. The value of non - audit work undertaken by KPMG on behalf of the Trust was £8k compared to an audit fee of £59k. The nature of non – audit work was for review of emergency and urgent care.

Other managers are regular attendees of the Audit Committee which include the Director of Finance, Director of Patient Care and the Company Secretary.

Representatives of External Audit, Internal Audit and the Counter Fraud Team are also in regular attendance. Other managers also attend the Audit Committee on an irregular basis.

The Audit Committee’s responsibilities include:

Significant Issues At its meeting on 6 May 2015, the Audit Committee considered matters relating to the 2014/15 accounts which included the following:

èè Review Trust’s draft accounts and make recommendations with regard to their approval to the Board èè Provide assurance to the Board as to the effectiveness of internal controls and the risk management processes that underpin them

èè Absorption of NHS Direct (NHSD) Activities SCAS took on the responsibility as LMO for NHS Direct that ceased operating as at the 31 March 2014.

These activities were transferred by absorption. The accounting for this and future expected liabilities was discussed at length by the Committee and a treatment agreed subject to audit.

èè Agree annual plans for external audit, internal audit and counter fraud èè Make recommendations to the Council of Governors regarding the appointment of the External Auditors In discharging its responsibilities, the Committee review taking into account the Board Assurance Framework, the Trust’s Risk Registers and the work of other Board Committees such as the Quality and Safety Committee.

164

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

èè Analysis of Notes relating to Analysis of Income and Expenditure The Committee discussed at length the presentation of the notes to the accounts as it impacted on the analysis of income and expenditure.

It was agreed that further work would be undertaken in 2015/16 to provide further analysis of income and expenditure in order to make the accounts more meaningful to the reader.

Mike Hawker Audit Committee Chairman 27 May 2015

165

Director’s Report

ATTENDANCE AT MEETINGS DURING 2014/15 èè The attendance at meetings during 2014/15 of those who have served on the Board, and reflecting their membership of the various committees, is shown below

NON EXECUTIVE DIRECTORS Name

Trust Board

Audit Committee

Quality and Safety Committee

Remuneration Committee

Charitable Funds Committee

Total meetings

6

5

4

6

3

Trevor Jones

6

N/A

N/A

6

N/A

Alastair Mitchell-Baker*

3

N/A

4

4

N/A

Ilona Blue

6

5

N/A

N/A

N/A

Claire Carless

4

N/A

N/A

5

3

Mike Hawker

5

5

N/A

N/A

3

Keith Nuttall

6

5

4

N/A

1/1

Eddie Weiss

0/1

2/2

N/A

N/A

N/A

6

N/A

4

N/A

N/A

Professor David Williams

* undertook a sabbatical for part of 2014/15, as agreed with the Trust Chairman.

166

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

EXECUTIVE DIRECTORS Name

Trust Board

Audit Committee

Quality and Safety Committee

Remuneration Committee

Charitable Funds Committee

Total meetings

6

5

4

6

3

Will Hancock

6

N/A

N/A

N/A

N/A

John Black

5

N/A

1

N/A

N/A

Sue Byrne

5

N/A

N/A

N/A

N/A

Charles Porter

6

5

N/A

N/A

3

Deirdre Thompson

5

N/A

4

N/A

N/A

James Underhay

6

N/A

N/A

N/A

N/A

167

Director’s Report

TWENTY SIX GOVERNORS

168

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

COUNCIL OF GOVERNORS BACKGROUND

MEMBERSHIP OF THE COUNCIL OF GOVERNORS

The Trust’s Council of Governors (CoG) play an essential role in the governance of South Central Ambulance Service NHS Foundation Trust, providing a forum through which the Board of Directors is accountable to the local community.

The CoG is chaired by the Trust Chairman, and the full composition of governors numbers twenty six, as follows:

The Trust’s Constitution sets out the key requirements in respect of the functioning of the CoG. Its general functions are to:

èè fifteen elected public governors across four constituencies (Hampshire, Berkshire, Oxfordshire and Buckinghamshire)

èè hold the non-executive directors individually and collectively to account for the performance of the Board of Directors, and

èè five elected staff governors èè three appointed Local Authority governors

èè represent the interests of the members of the Trust as a whole and the interests of the public

èè two appointed Clinical Commissioning Group governors èè one appointed charity governor

The period 1 April 2014 to 31 March 2015 represents the third full year of working for the CoG and the delivery of its statutory duties.

There were a number of movements in the composition of the governors during the year and at 31 March 2015 twenty four governors were in place with two vacancies.

The CoG elects a lead governor and Melanie Hampton served in this position for most of 2014/15 (until her term of office ended on 28 February 2015). Bob Duggan was elected to succeed her as lead governor from 1 March 2015.

169

Director’s Report

FORMAL MEETINGS OF THE COG

During 2014/15, there have been the following changes to the composition of the CoG: èè two of the fifteen elected public governors – both from the Hampshire constituency - resigned and these positions remain vacant at 31 March 2015 (their resignations came subsequent to the elections in December 2014)

Five formal meetings of the CoG have been held during 2014/15: in May 2014, July 2014, October 2014, December 2014, January 2015 and March 2015.

All meetings have been held in public, and fully in accordance with the Trust’s Constitution.

èè public governor elections were held in December 2014 to fill seven vacancies; two governors were successful in seeking re-election, and five new governors were elected

All meetings were chaired by the Trust Chairman, with a good representation of Board members, including Non Executive Directors, in attendance.

èè staff governor elections were also held in December 2014 to fill five vacancies; one governor was successful in seeking re-election, and four new governors were elected

Appendix A reports on the attendance of governors at formal meetings of the CoG.

OTHER MEETINGS OF THE COG

èè two new appointed Local Authority governors joined the CoG during 2014/15

The CoG has had two formal subcommittees during 2014/15; the Nominations Committee, and the Membership and Engagement Committee.

Details of their meetings and work programmes are explained below.

èè a new governor joined the CoG during 2014/15 as the appointed Charity representative.

Details about each governor, including biographies and declared interests, can be seen on the Trust’s website.

Two governor workshops were held during the year; in September 2014, to consider how the Trust could expand its use of volunteers, and in January 2015, to obtain the views of the governors on the Trust’s future strategic priorities.

A number of the Trust’s governors also contributed to the Care Quality Commission (CQC) inspection process, taking part in one of the CQC’s focus group meetings.

170

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

DUTIES AND FUNCTIONS Delivery of specific statutory duties The governors have a range of specific statutory duties, and all of the statutory duties relevant to 2014/15 were satisfactorily discharged.

DUTY

COMMENTS

Receive annual accounts, auditor’s report and annual report

P

Received at July 2014 meeting

Appoint and, if appropriate, remove the external auditor

P

The CoG approved the extension of the external audit contract (KPMG) in September 2014 for a further two years

Directors must have regard to governors’ views when preparing the forward plan

P

A specific workshop was held on 22 January 2015 to obtain the views of the governors

Appoint and, if appropriate, remove the Chair

P

Applying the procedures agreed in January 2013, the CoG reappointed the current Chairman for a further two year period, to 31 March 2017

Appoint and, if appropriate, remove the other Non Executive Directors (NEDs)

P

Applying the procedures agreed in January 2013, the CoG reappointed two NEDs for further terms of office

Decide remuneration and terms of conditions for Chair and other NEDs

P

During 2014/15 the CoG accepted a recommendation from the Nominations Committee that remuneration levels for the Chairman and NEDs should remain unchanged

Approve appointment of Chief Executive

n/a

No new appointment was made in 2014/15

Approve significant transactions

n/a

No significant transactions required approval in 2014/15

Approve an application by the Trust to enter into a merger, acquisition, separation or dissolution

n/a

No such applications occurred in 2014/15

Decide whether the Trust’s non-NHS work would significantly interfere with its ‘principle purpose’

n/a

This was not required during 2014/15

Approve amendments to the Constitution

P

Constitutional amendments were approved by the CoG in July 2014 (including changing the model election rules to enable electronic voting)

171

Director’s Report

Delivery of other duties and functions of the CoG

During 2014/15, most of the Trust’s governors attended at least one of the Board meetings in public, and two of the six Board meetings in 2015/16 will again be held in the evening to help facilitate greater governor attendance.

There are general duties for the governors in relation to holding the Board of Directors to account for the performance of the Trust via the Non Executive Directors, and representing the interests of the members and the public.

The work of the Membership and Engagement Committee (see below) has been key to the governor’s other general duty of representing the interests of the members and the public.

A range of mechanisms have been in place to support the governors with their holding to account role, including:

During the course of the year, governors have attended a range of membership recruitment and engagement events, and used other opportunities to meet with Trust members and members of the public to ascertain their views on the Trust.

èè six Board meetings in public have been held (two in the evening), and governor attendance at these has been strongly promoted. There has been good attendance at Board meetings, with an average of eight governors attending each meeting

The Council of Governors also considered public and membership engagement, and how to strengthen the Trust’s arrangements, as the main topic at its meeting in January 2015.

èè the Trust ensures that the governors receive the papers for Board meetings one week ahead of the meeting, and the minutes on a timely basis subsequent to the meeting having taken place

COG SUB-COMMITTEES

èè governors have been invited to ‘buddy up’ with one of the Trust’s NEDs to help develop their understanding of how the NEDs seek assurance over the day to day running of the organisation

Nominations Committee One of two formal sub-committees, and a statutory requirement, the CoG has established a Nominations Committee, which is chaired by the Trust Chairman and has four other governor members (the Lead Governor and one governor each from the categories of Local Authority, Staff and Public).

èè all formal meetings of the CoG include an update from the Chief Executive on operational performance and other key issues, with an opportunity for governors to ask questions. In addition, there have been specific sessions on financial management and cost improvement programmes, demand management, and CQC action plan implementation where the NEDs have outlined how they seek assurance and hold the Executive Directors to account.

The Nominations Committee has met on four occasions during 2014/15, and meeting attendance levels can be seen at Appendix A.

172

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

During the year, and with delegated authority from the CoG, the Nominations Committee has:

During the year, the Membership and Engagement Committee has: èè agreed a Foundation Trust Membership Plan for 2014/15, and monitored progress throughout the year

èè overseen the process for the reappointment of the Chairman and two new NEDs, making recommendations as appropriate to the full CoG

èè contributed to the development of the Trust’s annual Member Satisfaction and Patient Care survey

èè considered NED succession planning arrangements, and agreed a way forward with the CoG which will help facilitate the appointment of a new Chair, Vice-Chair/Senior Independent Director, and other NEDs over the next two years

èè overseen the arrangements for the Trust’s third Annual Members Meeting in September 2014.

GOVERNOR SUPPORT, TRAINING AND DEVELOPMENT

èè implemented a process to ensure governor input into the independent, external Board assessment review that took place during the year èè considered the new Fit and Proper Person Requirement regulations that came out during the year, noting that the Trust was wellplaced but could make some further refinements to its arrangements for NED recruitment

Support, training and development The Trust has a formal duty to ensure that governors are equipped with the skills and knowledge they require to undertake their role. During the course of the year, the Trust has supported governors extensively in this respect. In addition to the mechanisms outlined in section 6 to support the general duties of governors, the Trust has:

èè reviewed Chair and NED remuneration levels against the Policy approved by the CoG in 2013/14, recommending that no adjustments should be made in 2014/15 (accepted by the CoG)

èè provided a comprehensive and tailored induction programme for all new governors;

Membership and Engagement Committee

èè provided access to relevant external training as provided by Monitor, the Foundation Trust Network and the Foundation Trust Governors Association (both now merged to form NHS Providers);

The CoG has established a Membership and Engagement Committee, whose main role is to recommend strategies to the CoG for the recruitment of, and engagement with, Trust members.

èè further extended its informal ‘buddying’ scheme between individual governors and NEDs;

The Membership and Engagement Committee ended the year with eight members, comprising seven public governors, and one appointed partner Charity governor.

173

Director’s Report

Priorities for 2015/16

èè provided the opportunity for governors to participate in Emergency Operations Centre tours, crew ride-outs, and ambulance station visits to help support their understanding of the Trust and its business;

The CoG has identified the following priorities for 2015/16: èè with a continually growing membership that now stands at over 15,000 (public and staff), further developing arrangements for engaging with the Trust’s membership and ensuring that the interests of members are suitably represented and that their views are brought to the attention of the Trust

èè issued regular briefings and bulletins.

CONCLUSIONS AND PRIORITIES FOR 2015/16

èè given the challenges, including financial, faced by the NHS, continuing the strong focus that the governors have in terms of holding the Board to account, via the Non Executive Directors, for the performance of the Trust;

Conclusions The Council of Governors has overseen some major achievements during 2014/15 and helped contribute to the overall success of the Trust. Additionally, all of the relevant statutory duties have been effectively delivered.

èè overseeing the appointment processes for the Non Executive Director positions that are due to expire both in 2015/16 and the subsequent year

In September 2014, the SCAS CoG was runner-up in the category of best governing body in the Thames Valley and Wessex NHS Leadership Academy Awards.

It is considered that the Council of Governors has a good working relationship with the Board of Directors, and directors regularly attend Council of Governors meetings to answer questions, participate in discussions, and help the governors deliver their statutory duties. In turn, the Trust has benefited from the perspectives brought by a diverse group of governors, and this has been demonstrated by the governor’s input to the annual planning and CQC inspection processes.

èè contributing to the development of the Trust’s future strategic priorities and forward plans èè continuing to review the effectiveness of the Council of Governors to ensure that the governors are appropriately supported to deliver their roles, that value is added where appropriate, and the functioning of the CoG is delivered in the most cost effective way.

174

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

è SCAS Annual General Meeting / Annual Members Meeting 2014

175

Public – Hampshire

Staff - EOC

Staff - Operational

Public – Bucks/Lead

Staff – Contact centres

Staff – Support

Partner – LA

Public – Berkshire

Jon Cotterell

Eddie Cottrell 2

John Donne 2

Bob Duggan

Michele Foote

Christina Fowler 2

Allan Glass 4

Colin Godbold

Public – Hampshire

Paul Carnell

Public – Oxfordshire

Partner – LA

David Burbage

Patrick Conafray 2

Public – Hampshire

Jeni Bremner 3

Partner - CCG

Staff – 999 North

James Birdseye

David Chilvers

Public – Hampshire

Andy Bartlett

Partner – CCG

Public - Hampshire

Kemi Adenubi 2

Sabrina Chetcuti

CONSTITUENCY

GOVERNOR

176 1/3/2015 – 28/2/2018

1/8/2013 – 28/2/2015

1/3/2012 – 28/2/2015

1/3/2015 – 28/2/2018

1/3/2015 – 28/2/2018

1/3/2012 – 28/2/2015

1/3/2012 – 28/2/2015

1/3/2014 – 28/2/2017

1/3/2012 – 28/2/2015

1/7/2013 - 30/6/2016

1/8/2013 – 30/6/2016

1/3/2015 – 28/2/2018

1/10/2014 – 30/9/2017

1/3/2014 – 16/3/2015

1/3/2015 – 28/2/2018

1/3/2015 – 28/2/2018

1/3/2012 – 28/2/2015

TERM OF OFFICE

1/1

3/4

4/4

1/1

4/5

1/4

0/4

5/5

2/4

2/5

3/5

5/5

2/3

2/4

1/1

1/1

3/4

COG MEETINGS

Appendix A: Attendance at meetings for governors who served during 2014/15 1

N/A

2/2

N/A

N/A

3/4

N/A

N/A

4/4

4/4

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

MEMBERSHIP AND ENGAGEMENT COMMITTEE

N/A

N/A

N/A

N/A

4/4

N/A

0/4

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

NOMINATIONS COMMITTEE

Director’s Report

CONSTITUENCY

Public – Berkshire

Public – Berks

Partner – LA

Public – Bucks

Public – Hampshire

Partner – LA

Partner – Charity

Staff - PTS

Staff - 999 South

Public – Bucks

Public – Hampshire

Staff – Corporate/ support

Public - Berkshire

Public – Oxfordshire

Partner – Charity

Partner – LA

Staff - Operational

Public - Oxfordshire

Public - Oxfordshire

GOVERNOR

Ian Hammond

Melanie Hampton 5

Keith House

Dave Johnson

Tricia Kelly 6

Steve Lacey 7

Barry Lipscomb 8

Katharine Naylor

David Palmer

David Ridley

Ray Rowsell

177

Debbie Scott

Martin Shea

Mike Shread

Sue Thomas

Jan Warwick

Carol Watts 2

Emily Williams

Tim Windsor-Shaw

1/3/2014 – 28/2/2017

1/3/2015 – 28/2/2018

1/3/2012 – 15/5/2014

1/3/2015 – 28/2/2018

1/10/2014 – 30/9/2017

1/3/2014 – 28/2/2017

1/3/2015 – 28/2/2018

1/3/2015 – 28/2/2018

1/3/2015 – 28/2/2018

1/3/2014 – 28/2/2017

1/3/2015 – 28/2/2018

1/3/2015 – 28/2/2018

1/3/2012 – 30/9/2014

1/3/2014 – 20/6/2014

1/3/2014 – 23/1/2015

1/3/2014 – 28/2/2017

1/3/2015 – 28/2/2018

1/3/2014 – 28/2/2015

1/3/2014 – 28/2/2017

TERM OF OFFICE

4/5

1/1

0/1

1/1

3/3

2/5

0/1

1/1

1/1

5/5

4/5

1/1

2/3

0/1

2/4

4/5

2/5

2/4

5/5

COG MEETINGS

2/4

N/A

0/1

N/A

1/1

3/4

N/A

N/A

N/A

3/4

N/A

N/A

2/2

N/A

N/A

3/4

N/A

N/A

4/4

MEMBERSHIP AND ENGAGEMENT COMMITTEE

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

4/4

4/4

N/A

NOMINATIONS COMMITTEE

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Directorâ&#x20AC;&#x2122;s Report

EN TE ND W DR ND IR PU

NOTES FOR APPENDIX A 1.

This is a full record of the governors who served during 2014/15. Those highlighted in bold were in post at the end of the 2014/15 year (i.e. on 31 March 2015)

2.

Governors with a term of office that expired on 28 February 2015, and did not seek re-election

3.

Resigned on 16 March 2015 (term of office was until 28 February 2017)

4.

Term of office expired on 28 February 2015, and was not reappointed by the South East England Councils body

5.

Resigned on 28 February 2015 (term of office was until 28 February 2017)

6.

Resigned on 23 January 2015 (term of office was until 28 February 2017)

7.

Resigned on 20 June 2014 (term of office was until 28 February 2017)

8.

Term of office ended on 30 September 2014, as no longer continued to be a Trustee of the Hampshire and Isle of Wight Air Ambulance Charity.

178

South Central Ambulance Service NHS Foundation Trust // Annual AnnualReport Reportand andAccounts Accounts2014/15 2014/15

NTHIRTEENTHOU EENTHOUSANDTW DTWOHUNDREDA WOHUNDREDANDT REDANDTHIRTYP DTHIRTYPUBLICM RTYPUBLICMEMBE UBLICMEMBERST 179

Directorâ&#x20AC;&#x2122;s Report

MEMBERSHIP REPORT SCAS has a total membership of 16,484 people as of 1 March 2015. We have 13,230 public members and 3,254 staff members.

SCAS membership is well represented with the exception of Asian and Black where members remain under-represented in comparison with the population of the South Central region. The Trust will continue to target and encourage participation from these ethnic groups.

MEMBERSHIP ELIGIBILITY Public Constituency Members of the public aged 14 and over are eligible to become public members of the Trust if they live in the area (or have a connection with) where SCAS provides services (Buckinghamshire, Berkshire, Oxfordshire and Hampshire).

Staff Constituency Any SCAS staff member with a permanent contract or a fixed term contract of 12 months or longer is able to become a member of the Trust. Staff who join the Trust are automatically opted into membership and advised how they can opt out if they wish.

Analysis of Public Membership as at March 31 2015 The profile of SCAS public membership is compared against the records held by the Office of National Statistics (ONS) to determine how representative the Trustâ&#x20AC;&#x2122;s membership is of the South Central population.

The public membership breakdown by category on 31 March 2015 is shown in the table on the right.

180

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PUBLIC CONSTITUENCY

NUMBER OF MEMBERS

POPULATION IN SOUTH CENTRAL

INDEX (%) (100 = IDEAL REPRESENTATION)

13,230

4,125,690

0-16

36

n/a

17-21

753

257,456

91

22+

12,258

3,012,969

127

Not stated

183

AGE

GENDER Unspecified

27

Male

5,443

2,041,644

83

Female

7,761

2,084,045

116

White

10,780

3,556,479

71

Mixed

183

85,182

69

Asian or Asian British

527

277,046

56

Black or Black British

256

86,155

94

Other Ethnic Group

78

24,636

93

Not stated

1,346

Ethnicity

ACORN SOCIO-ECONOMIC CATEGORY Affluent Achievers [1]

3,860

1,335,655

90

Rising Prosperity [2]

1,487

498,475

93

Comfortable Communities [3]

3,652

1,034,315

110

Financially Stretched [4]

2,665

770,921

108

Urban Adversity [5]

1,295

442,416

91

Not Private Households [6]

205

43,907

146

Not available [NA]

66

Red: under-represented. Green: over-represented. Amber: within correct tolerance

181

Director’s Report

MEMBERSHIP AND ENGAGEMENT ACTIVITIES

Last year, for the first time, we invited GP surgeries across our four counties to pass on our request to complete the survey to their Patient Participation Groups (PPGs) and other contacts so they could tell us about their experience of the care they receive from us.

SCAS membership strategy will also continue to focus on meaningful, quality engagement with a representative group of the Trust’s members and regular, informative educational and health-related communication with all of our members.

Specific objectives and findings of the research: 1. Understand what membership activities our members have been involved with and what they find most beneficial about being a member 2. How members wish to get involved with their ambulance service 3. How members and service users rate the Trust’s emergency (999) and nonemergency services (111 and Patient Transport Service) and how these can be improved.

Members have been invited to all public Council meetings during the year, through Foundation Times, our quarterly membership newsletter, and meeting dates are also advertised on the website.

The newsletter contains invitations to get involved with the Trust, spotlight articles on different staff within the ambulance service to help raise awareness of what we do. We regularly feature our volunteers and encourage members to get involved and also have special features about our challenges and achievements.

We received nearly 500 responses and we aim to increase this figure next year. Below are examples of feedback from some of our responders.

In 2014/15 the Trust launched new membership and engagement initiatives and continued to undertake regular activities as follows: Membership Satisfaction and Patient Care Survey The second annual membership survey was undertaken last June. It was sent to all Foundation Trust public members who have supplied the Trust with an email address via Foundation Times.

The survey was also advertised on the SCAS website.

Furthermore the survey was posted to 867 members. These are members who have expressed an interest in taking part in surveys on their application form but do not have / have not supplied the Trust with an email address.

182

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

èè “Overall the service was excellent and, from my experience, there was nothing that could or should be improved” èè “Can’t think of anything. The ambulance people were careful, spending time in the ambulance examining the patient” èè “Better suspension” èè “The ambulance suspension system seemed non existent” èè “A new ambulance! The one used was noisy, hot and very shaky”

Q

PLEASE TELL US ONE THING THAT WOULD MOST IMPROVE YOUR EXPERIENCE OF 999

èè “For the ambulance to actually turn up within the 2 hours time we were told” èè “Waiting times need to be improved big time. And hospital departments need to be kept up to date, if transport is delayed. Waiting a long time can cause stress and worry” èè “I don’t use it any more, but I always had very nice drives”

Q

PLEASE TELL US ONE THING THAT WOULD MOST IMPROVE YOUR EXPERIENCE OF PATIENT TRANSPORT SERVICE

183

Director’s Report

èè “My experience was excellent” èè “Too many questions asked” èè “Tailor questions to specific needs – e.g. if the patient is speaking and responding to questions then you don’t need to ask basic life support questions” èè “Nothing. I have had to use 111 on several occasions for myself and others and have been helped effectively each time” èè “Not to be asked the same questions by nurse practitioner as those asked by call handler one minute earlier”

Q

PLEASE TELL US ONE THING THAT WOULD MOST IMPROVE YOUR EXPERIENCE OF 111

184

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PATIENT FORUMS (From Healthwatch Southampton website):

SCAS continued to work with our established Hampshire Patient Forum and Buckinghamshire and Milton Keynes Patient Forum throughout the year and members of both forums undertook the following activities:

14/05/2014 Many thanks to the team at South Central Ambulance Service (SCAS) for organising their Hampshire Patient Forum which Sam attended at in Winchester.

SCAS put on the agenda an issue raised by Healthwatch Southampton on the subject of ambulance queuing outside Emergency Departments.

èè Took part in the Trust’s Pain Management Consultation èè Assisted Thames Valley and Wessex Leadership Academy steering group with panels and workshops for November 2014 award ceremony

Queues have been known to form at busy periods and can affect the ability of ambulance crews being able to respond to new calls. Jonathan Dermott, Emergency Services Manager from Southampton and the South West spoke about the issue and said that crews were expected to wait no more than 30 minutes on arrival at hospital but at some periods, such as weekends, delays do occur. They have looked at these issues with Emergency Departments and come up with new ways of working and as a group we also discussed possible ways to improve upon this.

Ultimately, it may be only with increased capacity at Emergency Departments that ambulance queuing can be ended.

èè Gave their feedback about the AQI (Ambulance Quality Indicators) dashboard èè Attended visits at our Otterbourne control centre èè Made recommendation for dissemination of 111 service to elderly people èè Presented a personal experience of our Patient Transport Service as a Patient story at a Board meeting

The Trust also launched the Berkshire and the Oxfordshire Patient Forums in March and will shortly start working with their members on various projects.

Three of the patient forums are chaired by an existing public Governor for the Trust. The Hampshire Forum is chaired by a former Trust public Governor.

185

Directorâ&#x20AC;&#x2122;s Report

GOVERNORS VIDEO

PATIENT SURVEY ROADSHOWS

As part of the 2014 Governors election campaign the Trust produced a Governors video which explains the role of the Governor and how local people can make a difference and contribute to helping the patient experience.

SCAS regularly surveys patients and in November 2014 we launched a pilot scheme with an Emergency and NonEmergency Services Survey which members of the public can complete either on line on our website or at our roadshows in shopping centres across our four regions.

The video can be viewed on You Tube at https://youtu.be/MoZG3hcUjY8 and also on the Trustâ&#x20AC;&#x2122;s website at www.scas.nhs.uk/ft.

The link to the survey was sent to all relevant CCGs (Clinical Commissioning Groups), GP surgeries and Healthwatch groups.

The Trust has four new staff governors and one re-elected, and in 2015/16 we will focus on revitalising the Staff Member and Governor Group and launching new initiatives.

Two of the roadshows were held as part of the South Reading CCG Winter pressure Roadshow and the Talk before you Walk event with Aylesbury Vale CCG. There is no end date for this survey and the results are continually assessed and so far the Trust has received nearly 250 responses (as at 31 March 2015).

PUBLIC EVENTS SCAS has a duty to engage with its local communities and encourage local people to become members. The amount and quality of events which the Trust organises and/or attends continue to demonstrate our commitment and dedication in meeting our duty.

In 2014/15 the Trust attended and/or organised career fairs, community fetes, county shows, multicultural festivals and also gave talks at various organisations such as Patient Participation Groups and the University of Third Age.

NHS N&W Reading CCG @NWRCCG South Central Ambulance Service NHS Foundation Trust @SCAS999 regularly surveys patients and has launched a survey

186

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Aylesbury Vale CCG website

Oxfordshire CCG @OxonCCG @SCAS999 are doing a survey about Emergency & NonEmergency services. (111, 999 & the Patient Transport Service)

South Central Ambulance Service NHS Foundation Trust (SCAS) regularly surveys patients and has recently launched a quick online survey on its website.

The Trust takes your views and feeds them back to its staff for action and to the commissioners who employ its services.

Patients are at the heart of care within the NHS and the ambulance Trust wants to give patients and carers more information, choice and control over how their care is delivered and to strengthen the voice of the public. SCAS is listening to your views and it is making changes as a result which it will inform you about on its website.

West Hampshire CCG @WestHantsCCG Please take part in this survey launched by @SCAS999 - itâ&#x20AC;&#x2122;s about emergency and nonemergency services

MK Healthwatch Dec 2014 newsletter South Central Ambulance Service NHS Foundation Trust (SCAS) regularly surveys patients and has recently launched a quick online survey on its website. The Trust takes peopleâ&#x20AC;&#x2122;s views and feeds them back to its staff for action and to the commissioners who employ its services and would like to hear about your views and opinions.

187

Directorâ&#x20AC;&#x2122;s Report

DEALING WITH YOUNG CARERS PROJECT

YOU SAID WE DID

In July 2014 the Trust got involved with the Healthwatch Hampshire and the Winchester & District Young Carers Project when they heard that young carers had highlighted in one of their videos that ambulance staff were not thinking sufficiently about the most appropriate person to take in the ambulance with them to accompany the cared for person.

This had resulted in a young carer having to find someone else to take them to the hospital and then being left to find their mother.

NHS 111 GUIDELINES AND YOU SAID WE DID The Trust is continually seeking to improve the care we provide to patients and the welfare of our staff. So, whether things go well or not so well, we actively encourage feedback to help us develop better practices and processes.

SCAS was keen to improve relationships and ensure that their staff were made more aware of the potential needs of the group.

As a direct result of this work, we will be changing our training procedure to include information about young carers.

In spring 2015, following our NHS 111 Roadshows as part of 2013/2014 winter pressure campaign in shopping centres, colleges, universities and patient groups, we took some actions from feedback received at the events as listed on the right.

Furthermore the project scooped an award at the Patient Voice South Case Study Competition 2014.

The interview with Heather Knight, SCAS Senior Education Manager is available for the public to view at: http://youtu.be/pekOWTHWsuk.

From Healthwatch Hampshire newsletter - August 2014 SCAS improve their training to benefit young carers After viewing our recent film about the health and social care needs of Young Carers, South Central Ambulance Service (SCAS) contacted Healthwatch to talk about how they could improve their service to benefit Young Carers. They have agreed to review and improve their training across the service to include information about Young Carers and we will be working with them on a wider project to improve and develop services for Young Carers.

188

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

COMMUNICATION YOU SAID

YOU SAID

You felt that when you called NHS 111 many of the questions asked were delivered so quickly that you did not fully understand them first time around.

èè You were confused about what NHS 111 service can deliver and the amount of questions asked.

WE DID

WE DID

èè We compiled The Essential Guide to NHS 111 listing the 10 most frequently asked questions and published it on our website and also disseminated it to the CCGs (Clinical Commissioning Groups) and other organisations

èè We addressed this by including guidelines in the training programme for call takers, covering the following points: »» Questions to callers are asked clearly and with a brief explanation if necessary »» Instructions / advice are delivered clearly so that callers can understand and follow these more easily All takers are now regularly monitored on their mandatory call audits to ensure that they adhere to these guidelines.

CLINICAL CARE, QUALITY AND PATIENT SAFETY YOU SAID

WE DID

èè We felt that the care advice given at the end of the call was excessive and delivered too quickly to be fully understood.

èè Care advice is of vital importance to us and we addressed this by including feedback in the training and update sessions and all takers are now regularly monitored on their mandatory call audits.

189

Director’s Report

ANNUAL GOVERNANCE STATEMENT 2014/15 1. SCOPE OF RESPONSIBILITY

The system of internal control has been in place in SCAS for the year ended 31 March 2015 and up to the date of approval of the annual report and accounts.

As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of South Central Ambulance Service NHS Foundation Trust’s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me.

3. CAPACITY TO HANDLE RISK The Risk Management Strategy comprehensively sets out arrangements in respect of the accountability for risk management in SCAS. Leadership

I am also responsible for ensuring that South Central Ambulance Service NHS Foundation Trust is administered prudently and economically and that resources are applied efficiently and effectively.

èè as Chief Executive and Accounting Officer I have overall accountability for ensuring that the organisation has effective risk management systems in place. I have delegated specific areas of risk management activity to each of the Executive Directors; for example, as follows:

I also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum.

2. THE PURPOSE OF THE SYSTEM OF INTERNAL CONTROL

›› the Director of Patient Care has day-to-day responsibility for managing the strategic development and implementation of organisational risk management, clinical effectiveness and clinical governance. This includes acting as the designated lead for a range of responsibilities such as health and safety, security management, and infection prevention and control

The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness.

The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of South Central Ambulance Service NHS Foundation Trust (SCAS), to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically.

›› the Medical Director has responsibility for the management and development of clinical standards

190

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

›› the Director of Finance has responsibility for financial risk management and, in the role of Senior Information Risk Owner, for risks relating to information

èè the Audit Committee, also with delegated authority from the Board, receives the Board Assurance Framework and strategic risk register at every meeting, with the purpose of seeking assurance that effective risk management practice is in place

›› the Chief Operating Officer has responsibility for managing the strategic development and implementation of clinical and non-clinical risk management (operational risks) associated with the provision of emergency ambulance services, NHS111 and fleet management, as well as being the lead for emergency planning and business continuity activities

èè the Executive Team, underpinned by the work of its various subcommittees, receives and reviews updates from all directorates relating to risk management, as well as the Trust’s Board Assurance Framework and strategic risk register èè the Executive Team has also established a Risk, Assurance and Compliance Committee. This committee, comprising the Executive Directors of the Trust and the Company Secretary, carries out a deep-dive review of the Trust’s biggest risks and ensures that appropriate mechanisms are in place to provide assurance over the management of those risks

›› the Director of Strategy, Business Development, Communications and Engagement has responsibility for managing the risks associated with the provision of nonemergency ambulance services, including patient transport services èè the Board, with overall responsibility for governance, considers the risks faced by the Trust on a regular basis.

For example, it receives the Board Assurance Framework at each public Board meeting. èè the Quality and Safety Committee, with delegated authority from the Board, monitors and reviews the Trust’s clinical governance arrangements

191

Director’s Report

4A. THE RISK AND CONTROL FRAMEWORK STRATEGY

Training èè officers involved in leading the Trust’s risk management processes (e.g. Head of Risk and Security Management, Clinical and Non Clinical Risk Managers) are suitably qualified and experienced governance and risk management professionals. A wide range of training has been delivered to staff to enable them to manage identified clinical and non-clinical risks effectively.

The Trust has a comprehensive Risk Management Strategy which is reviewed annually, and the Audit Committee approved the most recent amendments in July 2014.

The key elements of our strategy are to: èè integrate risk management into the Trust’s culture and everyday management practice by clearly defining the Trust’s approach and commitment to risk management, by raising staff awareness, and building knowledge and skills

This training has been informed by a detailed training needs analysis based on external training requirements outlined by the NHSLA and CQC, in addition to training needs identified internally by the Trust. Our corporate induction training programme for new staff covers health and safety, awareness of risk, and incident reporting.

èè provide clearly documented responsibilities and structure for managing risk to ensure a coordinated, standard methodology is adopted by every directorate/ department èè encourage and support incident reporting in a ‘fair blame’ culture to ensure that the Chief Executive and Board are provided with evidence that risks are being appropriately identified, assessed, addressed and monitored

èè the Trust has a very positive culture of incident reporting. The team structure in place enables immediate raising of concerns with on duty team supervisors who are able to directly support the reporting of incidents and the actual investigation, and can apply actions to mitigate. Incidents are monitored and reviewed at different levels of the organisation, including by a Serious Incidents Requiring Investigation Review (SIRI) Group, to ensure trends and patterns are identified and responded to where appropriate.

èè adopt an integrated approach to risk management, whether the risk relates to clinical, organisational, health and safety or financial risk, through the processes and structures detailed in the Trust’s Risk Management Policy

192

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Appetite for risk

èè accept that whilst the provision of health care is not risk free, the Trust will aim to minimise the adverse effects of any risks through management of risk via the Quality and Safety Committee and Audit Committee both of which are sub committees of the Board

The Trust acknowledges that delivery of healthcare and, in particular, the provision of ambulance services, will always involve a degree of risk (potentially heightened during periods of demand and change management). However, the Trust is fully committed to taking all necessary actions to ensure that risk is both minimised and mitigated. We adopt a positive approach to risk management and are particularly cautious on matters affecting our reputation, or when pursuing new service developments.

Identification of risk A range of tools are used to identify and control risks, including: èè the monthly Integrated Performance Report, including SIRIs

Quality governance arrangements

èè review of adverse incidents and accident reports

The key elements of our quality governance arrangements are set out in the periodic self-assessments we undertake against the Monitor Quality Governance Framework, and report to the Board. We are either compliant (mostly) or partly compliant for all elements. Performance information is key to ensuring delivery of quality, and we have rigorous processes in place to ensure the quality of performance data. These include internal checking mechanisms, internal and external audit reviews, and a comprehensive review of the monthly Integrated Performance Report by the Executive Team prior to being presented to the Board.

èè quarterly reviews of claims and complaints èè workforce engagement and leadership walkarounds èè annual fire safety inspections èè review of performance against the NHSLA Risk Management Standards èè self-assessments against the Care Quality Commission essential standards of quality and safety The risks are identified through careful triangulation of the themes across the above reporting mechanisms recognising issues that effect patient safety, treatment and experience as the most reliable indicators.

193

Director’s Report

Key strategic risks

èè it has carried out a high-level review of the Trust’s corporate governance arrangements against the Monitor Code of Governance;

We have a range of key strategic risks, which we have identified and are proactively managing. The Board considers the Board Assurance Framework at every Board meeting in public, and at the final meeting of 2014/15 (in March 2015) the submitted BAF had three red risks and eleven rated as amber. The red rated risks fell into the following categories: performance against the national response time standards (and the impact of hospital handover delays and resourcing constraints), achievement of financial targets including cost improvement programmes, and the recruitment and retention of staff.

èè it assessed in detail the requirements of the Monitor Corporate Governance Statement declarations, presenting a self-assessment with supporting evidence to the Board in May 2014.

Involvement of public stakeholders Public stakeholders are involved in the management of risks which impact on them through the work of the governors, public meetings of the Board, and our attendance at Health Overview and Scrutiny Committee meetings.

Our engagement with our stakeholders produces an additional layer of scrutiny and challenge from broad representative areas of our population groups and therefore enables SCAS to remain grounded and responsive to the communities we serve.

Comprehensive action plans are in place for all of the risks reported in the BAF. NHS Foundation Trust licence condition 4 – FT Governance The Trust undertakes periodic reviews of its position against all of the conditions contained within its Monitor provider licence, and reports to the Board accordingly. No risks have been identified within 2014/15.

4B. COMPLIANCE WITH CQC REGISTRATION REQUIREMENTS

In terms of condition 4 – FT governance, the Trust has undertaken a number of steps during 2014/15 to identify any potential risks, including:

The Foundation Trust is fully compliant with the registration requirements of the Care Quality Commission (CQC). This was confirmed by a pilot inspection of the Trust undertaken by the CQC in September 2014.

èè it commissioned an external, independent assessment of the Board and the underlying Board governance arrangements;

194

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

4E. COMPLIANCE WITH CLIMATE CHANGE ADAPTATION REPORTING TO MEET THE REQUIREMENTS UNDER THE CLIMATE CHANGE ACT

A system to ensure continuing compliance with registration requirements is in place and mainstreamed within the Trust’s performance and governance arrangements.

4C. COMPLIANCE WITH NHS PENSION SCHEME REGULATIONS

The Foundation Trust has undertaken risk assessments and Carbon Reduction Delivery Plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act and the Adaptation Reporting requirements are complied with.

As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with.

This includes ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.

5. REVIEW OF ECONOMY, EFFICIENCY AND EFFECTIVENESS OF THE USE OF RESOURCES

4D. COMPLIANCE WITH EQUALITY, DIVERSITY AND HUMAN RIGHTS LEGISLATION

There are a number of key processes in place to ensure that resources are used economically, efficiently and effectively, which include:

Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with. Equality impact assessments are integrated into the core business of the Trust by ensuring that all policies have an equality impact assessment completed. In addition all papers presented to the Board highlight any relevant equality and diversity issues and implications.

èè the Board has regularly reviewed the economy, efficiency and effectiveness of resources through the regular performance management reports (the Integrated Performance Report, finance reports, and quality and safety reports) considered at each meeting

195

Director’s Report

èè savings targets are set annually in the form of cost improvement programmes. The Trust has a strong track record in terms of delivering annual savings targets, whilst ensuring that quality of service is in no way compromised

èè an annual programme of internal audits, monitored closely by the Audit Committee, allows further assurance to be given to the Board on the use of its resources.

6. INFORMATION GOVERNANCE

èè the Trust’s monthly Operational Performance Reviews are designed to review performance against key financial, operational, clinical and workforce targets as agreed at the start of the year. In addition, a programme of visits by directors across the service gives additional assurance on the management of the organisation

Information governance and data security risks are identified through the use of the NHS Connecting for Health Information Governance Toolkit. Risks are recorded in the risk register and managed via specific action plans which are subject to regular review by the Trust’s Information Governance Steering Group.

èè the Trust routinely carries out benchmarking reviews of its performance and efficiency levels with other NHS bodies, including those in the ambulance sector. It also benchmarks sickness and recruitment and retention rates.

The Trust has carried out a self assessment against the 2014/15 Information Governance Toolkit, achieving an overall score of 71%. This compares with a score of 82% in 2013/14, and indicates the work we need to undertake to strengthen our information governance arrangements.

èè the Board receives regular reports on the performance of the estate against a set of key performance indicators. These have been developed to report on criteria such as the physical condition, statutory compliance, functional stability, efficient utilisation and energy performance of the estate.

As reported in the 2013/14 Annual Governance Statement, the Trust identified a major data security breach in April 2014, involving the publication of staff personal data on the Trust’s website.

An independent investigation into the circumstances surrounding this took place, and the Trust also instructed its Internal Auditors to carry out a comprehensive review of its information governance processes. We are now in the process of implementing the recommendations made

by Internal Audit.

èè the Trust has in place governance and financial policies which include standing financial instructions, standing orders and a scheme of delegation. These policies prescribe the Trust’s policy for the effective procurement of goods and services within the Trust.

196

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

We liaised with the Information Commissioner’s Office over the data security breach, and they determined that no further action would be taken on the grounds that our response to the incident had been swift and robust.

èè appropriate processes have been used to develop and quality assure the Quality Report ensuring that it represents a balanced view of performance; this has included scrutiny by the Audit Committee and Quality and Safety Committee

7. ANNUAL QUALITY REPORT

èè the performance information reported in the Quality Report is reliable and accurate

The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial year. Monitor has issued guidance to NHS Foundation Trust Boards on the form and content of annual Quality Reports which incorporate the above legal requirements in the NHS Foundation Trust Annual Reporting Manual.

In preparing the Quality Report which is included within the Annual Report, the Trust’s Directors have taken steps to satisfy themselves that:

èè there are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm they are working effectively in practice èè the data underpinning the measures of performance reported in the Quality Report are robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review.

èè the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2014/15

8. REVIEW OF EFFECTIVENESS As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, clinical audit and the executive managers and clinical leads within the NHS Foundation Trust who have responsibility for the development and maintenance of the internal control framework.

èè the content of the Quality Report is not inconsistent with internal and external sources of information èè the officers accountable for the preparation of the Quality Report have the necessary skills and experience

197

Director’s Report

I have drawn on the content of the Quality Report attached to this Annual Report and other performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports.

I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the Audit Committee, and the Quality and Safety Committee, and a plan to address weaknesses and ensure continuous improvement of the system is in place.

èè reports to the Executive Management Committee from its relevant subcommittees, as well as the work of the Risk, Assurance and Compliance Committee

Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. My review during 2014/15 has also been informed by:

I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board and Audit Committee.

èè the monthly Integrated Performance Report, which covers clinical, operational, service development, financial and human resources èè staff satisfaction surveys èè Care Quality Commission reports èè the Quality Accounts and Annual Report

There have been four particular key sources of assurance for me in 2014/15: èè in September 2014, and subsequent weeks, the Care Quality Commission carried out a pilot inspection of the Trust using its new “A Fresh Start for the Regulation of Ambulance Services” approach. The CQCs final report was published in January 2015, and we are delighted with the outcomes with the regulator concluding that the Trust provides safe and effective services which are well-led and with a clear focus on patient care. No compliance actions were reported

èè internal and external audit reports èè the Annual Audit/Management Letter èè the Head of Internal Audit Opinion èè reports to the Board from the Audit Committee, and Quality and Safety Committee èè reviews of serious incidents requiring investigation and the associated learning from these

198

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

9. CONCLUSION

èè an independent assessment of the Board was undertaken in December 2014/January 2015, and this concluded that we have a strong Board albeit with some further areas for development. Of particular relevance to this Annual Governance Statement, the independent assessors concluded that the Board has a shared understanding of the major risks, and takes its governance responsibilities seriously

The data security breach referred to in section 6 (and also reported in the 2013/14 Annual Governance Statement) represented a significant control issue for the Trust, and robust action was taken in response to this (as confirmed by the Information Commissioner’s Office and our internal auditors). However, further action is being taken to further strengthen our general arrangements for information governance, and this is being monitored by the Audit Committee.

èè the Board has undertaken a comprehensive review of clinical assurance processes. Whilst this found no major concerns, the Board identified a number of areas where it wanted processes to either be introduced or refined; the majority of these have now been implemented and have helped strengthen the overall assurance arrangements

Aside from this particular issue, my review confirms that South Central Ambulance Service NHS Foundation Trust has a generally sound system of internal control that supports the achievement of its policies, aims and objectives.

èè we received an annual Head of Internal Audit Opinion for 2014/15 of “moderate assurance”, defined as “generally a sound system of internal control designed to achieve system objectives with some exceptions”.

Will Hancock Chief Executive 27 May 2015

199

Accounting Officerâ&#x20AC;&#x2122;s Statement of Responsibilities

200

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

6 ACCOUNTING OFFICER’S STATEMENT OF RESPONSIBILITIES

201

Accounting Officer’s Statement of Responsibilities

ACCOUNTING OFFICER’S STATEMENT OF RESPONSIBILITIES STATEMENT OF THE CHIEF EXECUTIVE’S RESPONSIBILITIES AS THE ACCOUNTING OFFICER OF THE SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST The NHS Act 2006 states that the Chief Executive is the accounting officer of the NHS Foundation Trust. The relevant responsibilities of the accounting officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by the Independent Regulator of NHS Foundation Trusts (“Monitor”).

In preparing the accounts, the Accounting Officer is required to comply with the requirements of the NHS Foundation Trust Annual Reporting Manual and in particular to: èè Observe the Accounts Direction issued by Monitor including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; èè Make judgements and estimates on a reasonable basis; èè State whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting Manual have been followed and disclose and explain any material departures in the financial statements; and èè ensure that the use of public funds complies with the relevant legislation, delegated authorities and guidance; and èè Prepare the financial statements on a going concern basis.

Under the NHS Act 2006, Monitor has directed South Central Ambulance Service NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction.

The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of South Central Ambulance Service NHS Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year.

202

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

The Accounting Officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS Foundation Trust which enable him to ensure that the accounts comply with requirements outlined in the above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS Foundation Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in Monitorâ&#x20AC;&#x2122;s NHS Foundation Trust Accounting Officer Memorandum.

Will Hancock Chief Executive 27 May 2015

203

Operational and Financial Review

204

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

7 OPERATIONAL AND FINANCIAL REVIEW

205

Operational and Financial Review

OPERATIONAL AND FINANCIAL REVIEW SUMMARY OF FINANCIAL PERFORMANCE EXCLUDING LMO ACTIVITIES

The Trust has met its financial duties in 2014/15 achieving a surplus of £2.547m.

Included within this figure is the net impact of the Trust’s activities in relation to the closure of the NHS Direct as SCAS was appointed to be the successor body for that organisation. The net impact of this activity was a gain of £2.497m therefore the surplus attributable to the operations of the Trust was £50k.

èè On Income and Expenditure the Trust reported a surplus of £50k for the year èè Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £8.3m represented 4.7% of turnover which is £3.1m below last year. This has been financed by lower dividend payments due to higher cash balances, the upward valuation of estate, where impairments previously taken to expenditure has been reversed into income, lower depreciation where accelerated depreciation was higher last year and the profit on disposal of assets.

This result has been achieved in the background of increasing operational pressures in front line ambulance services.

In addition the Trust has been able to increase its operating income base in the face of competition for its non emergency transport services.

The Trust maintained an overall 4 for the new continuity of service risk rating (where 4 is the highest rating). The Trust is forecasting to remain at a 4 for the new continuity of risk rating for the next two years which is reflective of a financially sound Trust.

èè Capital expenditure was £11.4m (£8.5m in 2013/14) which has allowed the Trust to fund a number of projects including new ambulances and an integrated platform for receipt and triaging of emergency and 111 calls.

206

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

2014/15 ACCOUNTS – ACCOUNTING FOR ABSORPTION

èè A year end cash balance of £27m which underpins the financial resilience of the Trust (£8.3m last year). The Trust received a capital loan of £7m in year primarily to fund future purchase of front line ambulances. The Trust’s cash position was boosted by an improvement in working capital of £2m at the year - end which has helped finance the increase in capital expenditure above.

The balance of cash is attributable to NHS Direct (£12.7m) which will finance the remaining closure liabilities

The Trust operated as the Legacy Management Office for NHS Direct as this body ceased to exist from 31 March 2014.

Since NHS Direct has not undertaken activities since this date, there is no impact on the operating activities of SCAS. The balance of net assets of NHS Direct attributable to SCAS as the LMO was £6.3m. In its role as LMO the Trust has incurred further additional costs which are reflected in operating costs (discontinued operations). This figure of £3.8m has been deducted from the gain from absorption to arrive at a net surplus of £2.5m which has exceptionally increased the surplus of SCAS for 2014/15.

èè It has been a financially challenging year with a £6.4 million cost improvement target set at the commencement of 2014/15 which the Trust achieved èè Total revenue income to meet pay and other day to day running costs reached £172.6m of which the majority was secured through various service level agreements with clinical care commissioning groups and hospital NHS trusts. èè The accounts were stated in accordance with International Financial Reporting Standards.

Total fixed assets (land, buildings and capital equipment) of the Trust were valued at £71.7m (£66m in 2013/14).

207

Operational and Financial Review

ANALYSIS OF INCOME The Trust reported income of £172.6 million for the year end 31 March 2015 (31 March 2014: £162.4 million). The increase of over 6.3% is mainly due to new income for Electronic Patient Record (ePR) and for the flu pandemic service.

The Trust principal source of income is from local NHS commissioning contracts for the provision of the emergency service. This income totalled £120.3 million (£118 million in 2014) which represented 70% of the Trust turnover (2013/14: 73%).

The Trust confirms that the NHS income it receives for the provision of healthcare exceeds the income that it receives for any other purpose in accordance with the requirements of the Health and Social Care Act 2012. The amount of income that the Trust received in this regard for 2014/15 was £162m representing 94% of total income.

£15.7m

111 call handling service

£12.4m Other

2014/15

£3.1m HART

TOTAL £172.6m

£21.1m

£120.3m Emergency Services

Patient Transport Services

£15.3m

111 call handling service

£7.4m Other

2013/14

£3.1m HART

£18.6m

TOTAL £162.4m

Patient Transport Services

£118.0m

Emergency Services

208

South Central Ambulance Service NHS Foundation Trust // Annual AnnualReport Reportand andAccounts Accounts2014/15 2014/15

ANALYSIS OF OPERATING EXPENDITURE Total operating expenditure for the Trust (excluding depreciation, amortisation and impairments) was £163.9 million for the year ended 31 March 2015 (31 March 2014: £150.5 million). The increase of 8.9% is mainly due to increased staff costs arising from the further development 111 call handling service and additional emergency front line staff recruited to replace use of private provider ambulance services.

Staff costs represent 63.4% of total expenditure (2013/14: 66.9%). The increase in other expenditure is due to an increase in use of front line ambulance private providers and an increase in the use of 111 service providers.

2014/15 £51.3m Other TOTAL £163.9m

£4.8m

£103.9m

Vehicle fuel

Staff costs

£3.9m

Clinical supplies & drugs expenditure

2013/14

£41.5m Other

£5.1m

TOTAL £150.5m

Vehicle fuel

£100.7m

£3.2m

Staff costs

Clinical supplies & drugs expenditure

209

Operational and Financial Review

CAPITAL INVESTMENT Investment in capital resources for 2014/15 was £11.3 million (2013/14: £8.5 million) which was above the initial capital plan and is line with resources generated internally within the Trust. The Trust was able to invest in front line ambulances, necessary infrastructure costs arising from the increase in non-emergency transport provision, a new IT platform for receipt and triaging of emergency and 111 calls and replacement of defibrillators.

£2.2m

Other

TOTAL £11.4m

£5.2m Fleet

£3.0m

2014/15

£1.0m

Information Technology

Estates

2013/14

£0.3m Other £1.4m Information Technology TOTAL £8.5m

£2.7m

£4.1m

Estates

Fleet

210

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

GOING CONCERN After making appropriate enquiries, the directors have a reasonable expectation that South Central Ambulance Service NHS Foundation trust has adequate resources to continue in operational existence in the foreseeable future. For his reason the accounts are prepared on a going concern basis.

DISCLOSURE OF INFORMATION TO THE AUDITORS As far as each of the directors is aware, there is no relevant audit information of which the auditors are unaware. Each director has taken all the steps a director ought to have taken to make themselves aware of any relevant audit information and to establish that the auditors are aware of such information.

COST ALLOCATION AND CHARGING South Central Ambulance Service NHS Foundation Trust has complied with the cost allocation and charging requirements set out in HM Treasury and Office of Public Sector information guidance.

SICKNESS ABSENCE The overall sickness rate for the Trust for 2014/15 was 5.9% (6.2% in 2013/14) which equated to 13.3 days lost per person (13.9 days lost in 2013/14).

211

Operational and Financial Review

REMUNERATION REPORT The Remuneration and Nominations Committee met 6 times during 2014/15, and in accordance with its terms of reference, considered and agreed the remuneration and terms of service of the Chief Executive and Executive Directors, being the only employees within the Trust currently covered by the Trustâ&#x20AC;&#x2122;s Remuneration Policy for Senior Trust Staff.

In 2014, the Committee again agreed that 5% of Executive salaries be available in 2015/16 for payment of non-consolidated bonuses where performance targets had been met in 2014/15.

During 2014/15 no decisions were made regarding the loss of office of Senior Trust staff resulting in severance payments.

In accordance with the policy, the Committee undertook a review of salaries informed by a benchmarking report, and agreed that salaries of 3 of the Executive team were no longer reflective of current market rates. With the backing of the full Non Executive membership of the Board, the Committee approved increases in salaries from 1 April 2014 for 3 Executive Directors. Following a review of portfolios it was also recommended that an Executive Directorâ&#x20AC;&#x2122;s salary be uplifted due to additional responsibility, and this was approved with effect from 1 June 2014.

Will Hancock Chief Executive 27 May 2015

In accordance with the policy, the Committee had agreed in 2013, that 5% of Executive salaries by available in 2014/15 for payment of non-consolidated bonuses where performance targets had been met in 2013/14. For consideration of a bonus to be paid, the Committee would first be assured that the Trust had met corporate targets, only then would the performance of individual directors be reviewed. Having undertaken this review, the Committee approved non-consolidated bonuses to be paid to 4 of the Executive Directors in July 2014.

212

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

213

Performance related bonuses in bands of £5,000 9

62.5-65

214 162.5 25.85

Highest paid Director's median band Total

Median Total Reumeration (£000) 6.3

95-100

John Black (Medical Director) 7

Ratio of highest paid director to median total

115-120 53.94

36.28

5-10

32.5-35

150-155

5.6

26.3

147.5

85 -90

100-105

49.47

39.25

50-55

Duncan Burke (Director of Communications and Public Engagement) 6

James Underhay (Director of Strategy and Business Development)

2.01

150-155

25-30

22.5-25

38.56

5.78

10-15 160-165 100 -105

30.08

90-95

John Nichols (Interim Chief Operating Officer) 5

5-10

37.5-40

135-140

16.15

11.11

120-125

Sue Byrne (Chief Operating Officer) 4

5-10

22.5-25

85-90

22.95

110-115

Charles Porter (Director of Finance)

Deborah Marrs (Interim Director of Patient Care) 3

22.46

110-115

Deirdre Thompson (Director of Patient Care) 2

Taxable benefits rounded to the nearest £100

27.65

5-10

5-10

Performance related bonuses in bands of £5,000 9

225-230 140 -145

97.5100

10-12.5

5-7.5

30-32.5

25-27.5

50-52.5

All pension related benefits (bands of £2,500)

21.88

200-205

60-65

30-35

115-120

135-140

200-205

of £5,000 8

150-155

0-5

15-20

Mike Hawker 1

2013/14 Total in bands

Mr William Hancock (Chief Executive)

10-15

10-15

15-20

10-15

0

15-20

15-20

20 - 25

Professor David Williams (Non - Executive Director)

Taxable benefits rounded to the nearest £100

15-20

5-10

All pension related benefits (bands of £2,500)

Keith Nuttall (Non - Executive Director)

of £5,000 8

10-15

Total in bands

Clare Carless (Non - Executive Director)

0

Ilona Blue (Non - Executive Director)

15-20

Alastair Mitchell - Baker (Non - Executive Director) 0-5

35-40

Trevor Jones (Chairman)

Salary (bands of £5,000) £000

Eddie Weiss (Non - Executive Director)

Salary (bands of £5,000) £000

NAME AND TITLE

2014/15

Operational and Financial Review

DIRECTORS SALARIES AND BENEFITS FOR THE YEAR ENDED 31 MARCH 2015

215 na

0-2.5 na

James Underhay (Director of Strategy and Business Development)

8.

7.

6.

5.

4.

3.

2.

1.

Notes.

Mike Hawker joined the Trust on 1 Jan 2014 Deirdre Thompson joined the Trust on 3 June 2013 Deborah Marrs was Interim Director of Patient Care until 2 June 2013 Sue Byrne joined the Trust on 8 July 2013.

John Nichols was interim Chief Operating Officer until 7 July 2013 Duncan Burke left the Trust on 23 October 2013.

Dr John Black is a recharge from the Oxford University Hospitals NHS Trust The total for the year includes salary, taxable benefits, performance related pay and derived increase in capital value of pension benefits at age 60.

Dr John Black (Medical Director) 7

na

0-2.5

Sue Byrne (Chief Operating Officer)

na

0 -2.5

5-7.5

2.5-5

Charles Porter (Director of Finance)

0 -2.5

Real increase in pension at age 60 (bands of £2,500)

Deirdre Thompson (Director of Patient Care)

Total accrued pension at age 60 at 31 March 2015 (bands of £5,000) na

5-10

0-5

10-15

30-35

45-50

na

na

na

35-40

95-100

130-135

£000

Lump sum at aged 60 related to accrued pension at 31 March 2015(bands of £5,000)

£000

na

120

37

200

552

710

£000

Cash Equivalent Transfer Value at 31 March 2015

5-7.5

£000

na

87

15

155

509

633

£000

Cash Equivalent Transfer Value at 31 March 2014

2.5-5

Real increase in pension lump sum at age 60 (bands of £2,500)

£000

na

31

22

40

30

60

£000

Real increase in Cash Equivalent Transfer Value 31 March 2015

Will Hancock (Chief Executive)

NAME AND TITLE

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

PENSIONS FOR THE YEAR ENDED 31 MARCH 2015

Operational and Financial Review

CASH EQUIVALENT TRANSFER VALUE

Government Actuary Department (“GAD”) factors for the calculation of Cash Equivalent Transfer Factors (“CETVs”) assume that benefits are indexed in line with CPI which is expected to be lower than RPI which was used previously and hence will tend to produce lower transfer values.

A Cash Equivalent Transfer Value (CETV) is the actuarially completed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme.

A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme.

The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.

They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost.

CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.

216

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

EXPENSES Details of number and value of expenses claimed by governors and directors are attached below.

2014/15 Total Number in Office

Total Number Receiving Expenses

2013/14 Aggregate Sum of Expenses paid (£00)

Total Number in Office

Total Number Receiving Expenses

Aggregate Sum of Expenses paid (£00)

Governors

26

17

58

30

20

45

Directors

14

12

195

17

12

192

OFF PAYROLL ENGAGEMENTS Details of the Trust’s Off Payroll Engagements are shown in the following tables.

Off-Payroll Engagements as at 31 March 2015 (greater than £220 / day) lasting longer than 6 months Total number of engagements as of 31 March 2015.

7

Number of engagements which have existed for less than 1 year at time of reporting.

1

Number of engagements which have existed for between 1 and 2 years at time of reporting.

2

Number of engagements which have existed between 4 years or more at time of reporting.

4

Declaration that all existing off-payroll engagements, outlined above, have at some point been subject to risk based assessment as to whether assurances needs to be sought that the individual is paying the right amount of tax and where necessary that assurance has been sought.

All persons identified and included in the above have advised on their taxation status and willingness to comply with any information requests in respect of such.

All have appointed accountancy services managing their accounts (which are not managed by the Trust).

217

Operational and Financial Review

Off-Payroll Engagements for engagements which reached six months in duration between 1 April 2014 and 31 March 2015 (greater than ÂŁ 220 / day) and that last for longer than 6 months Number of new engagements, or those that reached 6 months in duration, during the reporting period.

2

Number of engagements which include contractual clauses giving the Trust the right to request assurance in relation to income tax and National Insurance obligations.

2

Number for whom assurance has been requested.

2

Number for whom assurance has been requested and received.

2

There were no off-payroll engagements of Board members, and/or senior officials with significant financial responsibility between 1 April 2014 and 31 March 2015.

218

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

FOREWORD TO THE ACCOUNTS South Central Ambulance Service NHS Foundation Trust These accounts for the twelve months ended 31 March 2015 are prepared in accordance with paragraphs 24 and 25 of schedule 7 to the NHS Act 2006 and comply with the annual reporting guidance within the NHS Foundation Trust Annual Reporting Manual.

Will Hancock Chief Executive:

Date: 27 May 2015

219

Operational and Financial Review

STATEMENT OF COMPREHENSIVE INCOME Note

31 March 2015 £000

31 March 2014 £000

Operating income from continuing operations

4

172,649

162,410

Operating expenses of continuing operations

5

(171,276)

(158,881)

1,373

3,529

OPERATING SURPLUS FINANCE COSTS Finance income

10

41

41

Finance expense - financial liabilities

11

(87)

(83)

Finance expense - unwinding of discount on provisions

31

(17)

(56)

PDC Dividends payable

(1,260)

(1,914)

NET FINANCE COSTS

(1,323)

(2,012)

50

1,517

2,497

0

2,547

1,517

Gain on revaluation of property, plant and equipment

1,533

2,377

TOTAL COMPREHENSIVE INCOME FOR THE YEAR

4,080

3,894

SURPLUS FROM CONTINUING OPERATIONS Gain/ (loss) from absorption and discontinuance of operations SURPLUS/(DEFICIT) FOR THE YEAR

2

OTHER COMPREHENSIVE INCOME Items that will not be reclassified subsequently to income and expenditure

The notes on pages 224 to 269 form part of these accounts

220

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

STATEMENT OF FINANCIAL POSITION Note

31 March 2015 £000

31 March 2014 £000

3,324

2,332

Non-current assets Intangible assets

13

Property, plant and equipment

14

Total non-current assets

68,424

63,666

71,748

65,998

Current assets Inventories

22

946

1,043

Trade and other receivables

23

8,568

9,044

Non-current assets for sale and assets in disposal groups

19

2,950

3,565

Cash and cash equivalents

26

27,100

8,329

39,564

21,981

Total current assets Current liabilities Trade and other payables

27

(15,974)

(14,309)

Borrowings

28

(1,738)

(488)

Provisions

31

(6,234)

(2,129)

(23,946)

(16,926)

87,366

71,053

Total current liabilities Total assets less current liabilities Non-current liabilities Trade and other payables

27

(30)

(40)

Borrowings

28

(6,616)

(1,354)

Provisions

31

(9,476)

(2,495)

(16,122)

(3,889)

71,244

67,164

57,874

57,874

11,061

9,535

Other reserves

(350)

(350)

Income and expenditure reserve

2,659

105

71,244

67,164

Total non-current liabilities Total assets employed Financed by Public dividend capital Revaluation reserve

33

Total taxpayers’ and others’ equity

The financial statements on pages 220 to 223 were approved by the Board on 27 May 2015 and signed on its behalf by

Will Hancock Chief Executive:

Date: 27 May 2015 221

Operational and Financial Review

STATEMENT OF CHANGES IN TAXPAYERS EQUITY Total

Taxpayers’ Equity at 1 April 2014 Surplus for the year Transfers between reserves Revaluations - property, plant and equipment Impairments Other reserve movements Taxpayers' Equity at 31 March 2015

Taxpayers’ Equity at 1 April 2013 Surplus for the year Transfers between reserves Revaluations - property, plant and equipment Other reserve movements Taxpayers' Equity at 31 March 2014

Revaluation Reserve

Other reserves*

£000

Public Dividend Capital £000

£000

£000

Income and expenditure reserve £000

67,164

57,874

9,535

(350)

105

2,547

0

0

0

2,547

0

0

(7)

0

7

(1)

0

(1)

0

0

1,534

0

1,534

0

0

0

0

0

0

0

71,244

57,874

11,061

(350)

2,659

Total

Revaluation Reserve

Other reserves*

£000

Public Dividend Capital £000

£000

£000

Income and expenditure reserve £000

63,270

57,874

6,465

(350)

(719)

1,517

0

0

0

1,517

0

0

695

0

(695)

2,377

0

2,377

0

0

0

0

(2)

0

2

67,164

57,874

9,535

(350)

105

* Other reserves was a residual balance required in 2006 when the Trust was formed, from ambulance predecessor trusts, to balance opening net assets with taxpayer’s equity.

222

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

STATEMENT OF CASH FLOWS 31 March 2015 ÂŁ000

31 March 2014 ÂŁ000

Operating surplus / (deficit) from continuing operations

1,373

3,529

Depreciation and amortisation

7,297

7,699

Net (gain)/loss on revaluation of assets

(299)

170

(Profit)/Loss on asset disposal

(188)

(23)

730

(1,954)

Cash flows from operating activities

(Increase)/Decrease in Trade and Other Receivables (Increase)/Decrease in Inventories

97

(89)

309

2,246

1,163

(536)

10,482

11,042

Surplus from discounted operation

2,497

0

(Increase)/Decrease in Trade and other receivables discontinued operation

(106)

0

448

0

9,906

0

(12,745)

0

39

38

Increase/(Decrease) in Trade and Other Payables Increase/(Decrease) in Provisions NET CASH GENERATED FROM/(USED IN) CONTINUING OPERATIONS

Increase/(Decrease) in Trade and other payables discontinuation Increase/(Decrease) in Provisions discontinued operation Net cash generated from/(used in) discontinued operations Cash flows from investing activities Interest received Purchase of intangible assets

(1,800)

(179)

Purchase of Property, Plant and Equipment

(8,683)

(7,955)

954

72

(9,490)

(8,024)

Loans received from the Independent Trust Financing Facility

7,000

0

Loans repaid to the Department of Health

(488)

(987)

0

(20)

(57)

(82)

0

(1)

Sales of Property, Plant and Equipment Net cash generated from/(used in) investing activities Cash flows from financing activities

Capital element of finance lease rental payments Interest paid Interest element of finance lease PDC Dividend paid

(1,421)

(1,900)

5,034

(2,990)

18,771

28

Cash and Cash equivalents at 1st April

8,329

8,301

Cash and Cash equivalents at year end

27,100

8,329

Net cash generated from/(used in) financing activities Increase/(decrease) in cash and cash equivalents

223

Operational and Financial Review

NOTES TO THE ACCOUNTS 1. ACCOUNTING POLICIES

For this reason, they continue to adopt the going concern basis in preparing the accounts

Monitor has directed that the financial statements of NHS foundation trusts shall meet the accounting requirements of the NHS Foundation Trust Annual Reporting Manual which shall be agreed with HM Treasury. Consequently, the following financial statements have been prepared in accordance with the 2014/15 NHS Foundation Trust Annual Reporting Manual issued by Monitor. The accounting policies contained in that manual follow International Reporting Standards (IFRS) and HM Treasury’s Financial Reporting Manual to the extent that they are meaningful and appropriate to NHS foundation trusts. The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts.

Consolidation SCAS is a corporate trustee to the SCAS NHS Charity. SCAS has considered materiality of the current annual value of transaction and as a result has not consolidated the charitable fund results to the Trust accounts.

The Trust decided not to consolidate on the grounds of materiality. The SCAS Charity had total assets of £633k as at 31 March 2015 (31 March 2014: £578k).

During 2014/15 the Charity received income of £236k (2013/14: £134k) and incurred expenditure of £181k (2013/14: £68k).

1.2 ACQUISITIONS AND DISCONTINUED OPERATIONS

1.1 ACCOUNTING CONVENTION These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.

Activities are considered to be ‘acquired’ only if they are taken on from outside the public sector. Activities are considered to be ‘discontinued’ only if they cease entirely. This includes transfer from one public sector body to another where the transferring body has ceased operating.

Going Concern The Foundation Trust Accounts have been prepared on a ‘going concern’ basis. This means that the Trust expects to operate into the future and that the statement of financial position (assets and liabilities) reflects the ongoing nature of the Trust’s activities. The Trust Board of Directors have considered and declared that; ‘After making enquiries, the Board of Directors have a reasonable expectation that the Trust has adequate resources to continue in operational existence for the foreseeable future.

1.3 CRITICAL ACCOUNTING JUDGEMENTS AND KEY SOURCES OF ESTIMATION UNCERTAINTY In the application of the Foundation Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources.

224

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.

The NHS Pensions agency has provided information with regard to disclosure and calculation of ill health retirement liability

1.3.2 KEY SOURCES OF ESTIMATION UNCERTAINTY The following are the key assumptions concerning the future, and other key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year.

1.3.1 CRITICAL JUDGEMENTS IN APPLYING ACCOUNTING POLICIES

These valuations are judgemental and future events (such as a change in economic conditions) could cause these valuations to change. Non current assets relating to land and buildings had a carrying value of ÂŁ40.1m as at 31 March 2015 (31 March 2014 ÂŁ37.1m).

The following are the critical judgements, apart from those involving estimations (see below), that management has made in the process of applying the Foundation Trustâ&#x20AC;&#x2122;s accounting policies and that have the most significant effect on the amounts recognised in the financial statements.

The Trust has incurred and will continue to incur costs in respect of ongoing activities relating to the closure of NHSD and these have been recognised in the financial statements.

Indexation has not been applied to any Non Current assets, other than Land and Buildings, as no material changes were reflected in any relevant price indices.

There is a degree of uncertainty over the outstanding amounts as they relate to contracts in respect of NHSD. New contracts have been entered into for the retention of records particularly for those of a clinical nature.

The Trust has used the professional services of an independent valuer to provide an indicative amount of the annual increase/ decrease to be applied to the values of land and buildings carried forward from 1 April 2014. Indexation has been applied to Buildings at 9% and land at 2%.

The Trust continues to experience amendments to the amounts awarded on its existing provision for NHSD liabilities and the continuing uncertainty with regards to the future incidence of these cases has been recognised in the accounts.

Information provided by the NHS Litigation Authority has been used to determine provisions required for potential employer liability claims and disclosure of Clinical Negligence liability.

225

Operational and Financial Review

NOTES TO THE ACCOUNTS 1.4 INCOME

The cost of annual leave earned but not taken by employees at the end of the period is recognised in the financial statements to the extent that employees are permitted to carry forward leave into the following period.

Income in respect of services provided is recognised when, and to the extent that, performance occurs, and is measured at the fair value of the consideration receivable. The main source of revenue for the Trust is from commissioners for health care services.

Pension Costs Past and present employees are covered by the provisions of the NHS Pensions Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales.

It is not possible for the NHS Foundation Trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme.

Where income is received for a specific activity that is to be delivered in the following year, that income is deferred.

Income from sale of non-current assets is recognised only when all material conditions of sale have been met, and is measured as the sums due under the sale contract.

The Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim the cost of treating injured individuals to whom personal injury compensation has subsequently been paid e.g. by an insurer. The Trust recognises the income when it receives notification from the Department of Work and Pensionâ&#x20AC;&#x2122;s Compensation Recovery Unit that the individual has lodged a compensation claim. The income is measured at the agreed tariff for the treatments provided to the injured individual.

Employers pension cost contributions are charged to operating expenses as and when they become due.

Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill - health. The full amount of the liability for the additional costs is charged to the operating expenses at the time the Trust commits itself to the retirement, regardless of the method of payment.

1.6 EXPENDITURE ON OTHER GOODS AND SERVICES

1.5 EMPLOYEE BENEFITS Short-term employee benefits

Expenditure on goods and services is recognised when, and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment.

Salaries, wages and employment-related payments are recognised in the period in which the service is received from employees.

226

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

1.7 PROPERTY, PLANT AND EQUIPMENT

Valuation All property, plant and equipment are measured initially at cost, representing the cost directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management. All assets are measured subsequently at fair value.

Recognition

Property, plant and equipment is capitalised if: èè it is held for use in delivering services or for administrative purposes; èè it is probable that future economic benefits will flow to, or service potential will be supplied to, the foundation trust; èè it is expected to be used for more than one financial year; èè the cost of the item can be measured reliably; and èè the item has cost of at least £5,000; or èè Collectively, a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or èè Items form part of the initial equipping and setting-up cost of a new building, ward or unit, irrespective of their individual or collective cost.

Land and buildings used for the Trust’s services, or for administrative purposes, are stated in the Statement of Financial Position at their revalued amounts, being the fair value at the date of revaluation less any impairment.

Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows: èè Land and non-specialised buildings – market value for existing use èè Specialised buildings – depreciated replacement cost Subsequent expenditure Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset, when it is probable that an additional future economic benefit, or service potential deriving from the cost incurred to replace the component of such an item, will flow to the enterprise and the cost of the item can be determined reliably. Where a component of an asset is replaced, the cost of the replacement is capitalised if it meets the criteria for recognition above. The carrying amount of the part to be replaced is de-recognised.

Where a large asset, for example a building, includes a number of components with significantly different asset lives, the components are treated as separate assets and depreciated over their own useful economic lives. The Trust has assessed that adoption of component accounting would not materially affect the value of Trust assets and therefore it has not been applied.

227

Operational and Financial Review

NOTES TO THE ACCOUNTS Impairments

Other expenditure that does not generate future economic benefits or service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive Income in the period in which it is incurred.

In accordance with the Foundation Trust Annual Reporting Manual (FT ARM), impairments that arrise from a clear consumption of economic benefits or of service potential in the asset are charged to operating expenses. A compensating transfer is made from the revaluation reserve to the income and expenditure reserve of an amount equal to the lower of: (i) the impairment charged to operating expenses: (ii) the balance in the revaluation reserve attributable to that asset before the impairment.

Depreciation Items of property, plant and equipment are depreciated over their remaining useful economic lives in a manner consistent with the consumption of economic or service delivery benefits. Freehold land is considered to have an infinite life and is not depreciated.

An impairment that arises from a clear consumption of economic benefit or of service potential is reversed when, and to the extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating income to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised.

Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised.

Property, plant and equipment which has been reclassified as "held for sale" ceases to be depreciated upon the reclassification.

Assets in the course of construction are not depreciated until the asset is brought into use or reverts to the Trust respectively.

Revaluations, gains and losses Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that they reverse a revaluation decrease that has previously been recognised in operating expenses, in which case they are recognised in operating income.

Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, and thereafter are charged to operating expenses.

Other impairments are treated as revaluation losses. Reversals of "other impairments" are treated as revaluation gains.

Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of "other comprehensive income".

228

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

De-recognition

1.8 INTANGIBLE ASSETS

Assets intended for disposal are reclassified as "held for sale" once all of the following critera are met:

Recognition Intangible assets are non-monetary assets without physical substance, which are capable of sale separately from the rest of the Trust’s business or which arise from contractual or other legal rights. They are recognised only when it is probable that future economic benefits will flow to, or service potential be provided to, the Trust and where the cost of the asset can be measured reliably.

èè the asset is available for immediate sale in its present condition subject only to terms which are customary for such sales èè the sale must be highly probable i.e: ›› management are committed to a plan to sell the asset ›› an active programme has begun to find a buyer and complete the sale ›› the asset is being actively marketed at a reasonable price ›› the sale is expected to be completed within 12 months of the date of classification as "held for sale" ›› the actions needed to complete the plan indicate it is unlikely the plan will be dropped or significant changes made to it.

Software Software which is integral to the operation of hardware, eg an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software, which is not integral to the operation of hardware, eg application software, is capitalised as an intangible asset.

Measurement

Following reclassification, the assets are measured at the lower of their existing carrying amount and their value cost to sell. Depreciation ceases to be charged.

Assets are de-recognised when all material sale contract conditions have been met.

The amount initially recognised for internally-generated intangible assets is the sum of the expenditure incurred from the date when the criteria above are initially met. Where no internally-generated intangible asset can be recognised, the expenditure is recognised in the period in which it is incurred.

Property, plant and equipment which is to be scrapped or demolished does not qualify for recognition as "held for sale" and instead is retained as an operational asset and the asset's economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs.

Following initial recognition, intangible assets are carried at fair value by reference to an active market, or, where no active market exists, at amortised replacement cost (modern equivalent assets basis), indexed for relevant price increases, as a proxy for fair value. Internally-developed software is held at historic cost to reflect the opposing effects of increases in development costs and technological advances.

229

Operational and Financial Review

NOTES TO THE ACCOUNTS 1.9 DONATED, GOVERNMENT GRANT AND OTHER GRANT FUNDED ASSETS

The profit or loss arising on disposal of an asset is the difference between the sale proceeds and the carrying amount and is recognised in the Statement of Comprehensive Income. On disposal, the balance for the asset on the revaluation reserve is transferred to retained earnings.

For donated and government-granted assets, a transfer is made to or from the relevant reserve, to the profit/loss on disposal account so that no profit or loss is recognised in income or expenses. The remaining surplus or deficit in reserves is then transferred to retained earnings.

Donated non-current assets are capitalised at their fair value on receipt. The donation / grant is credited to income at the same time, unless the donor has imposed a condition that the future economic benefits embodied in the grant are to be consumed in a manner specified by the donor, in which case the donation/grant is deferred with liabilities and is carried forward to future financial years to the extent that the condition has not yet been met.

Property, plant and equipment that is to be scrapped or demolished does not qualify for recognition as held for sale. Instead, it is retained as an operational asset and its economic life is adjusted. The asset is de-recognised when it is scrapped or demolished.

The donated and grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment.

1.10 NON-CURRENT ASSETS HELD FOR SALE

1.11 LEASES Finance leases

Non-current assets are classified as held for sale if their carrying amount will be recovered principally through a sale transaction rather than through continuing use. This condition is regarded as met when the sale is highly probable, the asset is available for immediate sale in its present condition and management is committed to the sale, which is expected to qualify for recognition as a completed sale within one year from the date of classification. Noncurrent assets held for sale are measured at the lower of their previous carrying amount and fair value less costs to sell.

Fair value is open market value including alternative uses.

Where substantially all risks and rewards of ownership of a lease are borne by the NHS foundation trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease.

The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted for as an item of property, plant and equipment.

230

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

The annual rental is split between the repayment of the liability and the finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to Finance Costs in the Statement of Comprehensive Income. The lease liability, is de-recognised, when the liability is discharged, cancelled, or expires.

Cash equivalents are investments that mature in 3 months or less from the date of acquisition and that are readily convertible to known amounts of cash with insignificant risk of change in value.

1.14 PROVISIONS The NHS Foundation Trust recognises where it has a present legal or constructive obligation as a result of a past event, for which it is probable that there will be a future outflow of cash or other resources: and a reliable estimate can be made of the amount. The amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk adjusted cash flows are discounted using the appropriate rates as recommended by HM Treasury.

Operating leases Other leases are regarded as operating leases and the rentals are charged to operating expenses on a straight-line basis over the term of the lease. Operating lease incentives received are added to the lease rentals and charged to operating expenses over the life of the lease.

Leases of land and buildings Where a lease is for land and buildings, the land component is separated from the building component and the classification for each is assessed separately.

When some or all of the economic benefits required to settle a provision are expected to be recovered from a third party, the receivable is recognised as an asset if it is virtually certain that reimbursements will be received and the amount of the receivable can be measured reliably.

1.12 INVENTORIES Inventories are valued at the lower of cost and net realisable value. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.

Present obligations arising under onerous contracts are recognised and measured as a provision. An onerous contract is considered to exist where the Trust has a contract under which the unavoidable costs of meeting the obligations under the contract exceed the economic benefits expected to be received under it.

1.13 CASH AND CASH EQUIVALENTS Cash, is cash in hand, and deposits with any financial institution repayable without penalty on notice of not more than 24 hours.

231

Operational and Financial Review

NOTES TO THE ACCOUNTS 1.16 NON-CLINICAL RISK POOLING

A restructuring provision is recognised when the foundation trust has developed a detailed formal plan for the restructuring and has raised a valid expectation in those affected that it will carry out the restructuring by starting to implement the plan or announcing its main features to those affected by it.

The Trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and, in return, receives assistance with the costs of claims arising. The annual membership contributions, and any excesses payable in respect of particular claims are charged to operating expenses as and when they become due.

The measurement of a restructuring provision includes only the direct expenditures arising from the restructuring, which are those amounts that are both necessarily entailed by the restructuring and not associated with ongoing activities of the entity.

1.17 CONTINGENCIES 1.15 CLINICAL NEGLIGENCE COSTS

A contingent liability is a possible obligation that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Trust, or a present obligation that is not recognised because it is not probable that a payment will be required to settle the obligation or the amount of the obligation cannot be measured sufficiently reliably. A contingent liability is disclosed unless the possibility of a payment is remote.

The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the Trust pays an annual contribution to the NHSLA which in return settles all clinical negligence claims. The contribution is charged to expenditure.

Although the NHSLA is administratively responsible for all clinical negligence cases the legal liability remains with the Trust.

The total value of clinical negligence provisions carried by the NHSLA on behalf of the Foundation Trust is disclosed at note 31.3.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed by the occurrence or non-occurrence of one or more uncertain future events not wholly within the control of the Trust. A contingent asset is disclosed where an inflow of economic benefits is probable.

Where the time value of money is material, contingencies are disclosed at their present value.

232

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

1.18 FINANCIAL INSTRUMENTS AND FINANCIAL LIABILITIES

All of the Trust’s financial assets are classified as loans and receivables.

Recognition

Loans and receivables

Financial assets and financial liabilities which arise from contracts for the purchase or sale of non - financial items (such as goods and services), which are entered into in accordance with the Trust’s normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs i.e, when receipt or delivery of the goods or services is made.

Loans and receivables are non-derivative financial assets with fixed or determinable payments which are not quoted in an active market. They are included in current assets.

Derecognition

Loans and receivables are recognised initially at fair value, net of transaction costs, and are subsequently measured at amortised costs, using the effective interest method. The effective interest rate is the rate that exactly discounts estimated future cash receipts through the expected life of the financial asset, to the initial fair value of the financial asset.

The Foundation Trust’s loans and receivables comprise cash and cash equivalents, NHS debtors, accrued income and other debtors.

All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or the Trust has transferred substantially all of the risks and rewards of ownership.

Financial liabilities are de-recognised when the obligation is discharged, cancelled or expired.

Classification and measurement

Interest on loans and receivables is calculated using the effective interest method and credited to the Statement of Comprehensive income.

Financial assets are classified as loans and receivables. Financial liabilities are classified as other financial liabilities.

Impairment of financial assets At the Statement of Financial Position date, the Trust assesses whether any financial assets, other than those held at ‘fair value through profit and loss’ are impaired. Financial assets are impaired and impairment losses recognised if there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.

Financial assets and financial liabilities Financial assets are classified into the following categories: financial assets at fair value through profit and loss; held to maturity investments; available for sale financial assets, and loans and receivables.

The classification depends on the nature and purpose of the financial assets and is determined at the time of initial recognition.

233

Operational and Financial Review

NOTES TO THE ACCOUNTS Other financial liabilities

For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the asset’s carrying amount and the present value of the revised future cash flows discounted at the asset’s original effective interest rate. The loss is recognised in expenditure and the carrying amount of the asset is reduced directly.

If, in a subsequent period, the amount of the impairment loss decreases and the decrease can be related objectively to an event occurring after the impairment was recognised, the previously recognised impairment loss is reversed through expenditure to the extent that the carrying amount of the receivable at the date of the impairment is reversed does not exceed what the amortised cost would have been had the impairment not been recognised.

After initial recognition, all other financial liabilities are measured at amortised cost using the effective interest method, except for loans from Department of Health, which are carried at historic cost.

The effective interest rate is the rate that exactly discounts estimated future cash payments through the life of the asset, to the net carrying amount of the financial liability. Interest is recognised using the effective interest method.

1.20 CORPORATION TAX SCAS has determined that it has no corporation tax liability as the Trust's profit generated from non-operation income falls below the threshold of £50k.

1.19 FINANCIAL LIABILITIES

1.21 VALUE ADDED TAX

Financial liabilities are recognised in the Statement of Financial Position when the Trust becomes party to the contractual provisions of the financial instrument or, in the case of trade payables, when the goods or services have been received.

Financial liabilities are de-recognised when the liability has been discharged, that is, the liability has been paid or has expired.

Most of the activities of the Trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets. Where output tax is charged, or input VAT is recoverable, the amounts are stated net of VAT.

Loans from the Department of Health are recognised at historical cost. Otherwise, financial liabilities are initially recognised at fair value.

1.22 FOREIGN CURRENCIES The Trust’s functional currency and presentational currency is sterling.

Transactions denominated in a foreign currency are translated into sterling at the exchange rate ruling on the dates of the transactions.

234

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

At the end of the reporting period, monetary items denominated in foreign currencies are retranslated at the spot exchange rate on 31 March 2015.

Resulting exchange gains and losses for either of these are recognised in the Trustâ&#x20AC;&#x2122;s surplus/deficit in the period in which they arise.

Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets (including lottery funded assets), (ii) average daily cash balances held with the Government Banking Services (GBS) and National Loans Fund (NLF) deposits, excluding cash balances held in GBS accounts that relate to a short term working capital facility and any PDC dividend balance receivable or payable.

In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average relevant net assets as set out in the preaudit version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result the audit of the annual accounts.

1.23 THIRD PARTY ASSETS Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the Trust has no beneficial interest in them.

However they are disclosed as a separate note to the accounts in accordance with the requirements of HM Treasuryâ&#x20AC;&#x2122;s FReM.

1.24 PUBLIC DIVIDEND CAPITAL (PDC) AND PDC DIVIDEND

1.25 LOSSES AND SPECIAL PAYMENTS

Public Dividend Capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS trust. HM Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32.

Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the Health Service or past legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled.

A charge, reflecting the cost of capital utilised by the NHS Foundation Trust is payable as public dividend capital dividend.

The charge is calculated at the rate set

by HM Treasury (currently 3.5%) on the average relevant net assets of the NHS Foundation Trust during the financial year.

Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).

235

Operational and Financial Review

NOTES TO THE ACCOUNTS 1.26 ACCOUNTING STANDARDS THAT HAVE BEEN ISSUED BUT HAVE NOT YET BEEN ADOPTED

Since the date of transfer, SCAS management have provided a further £3.8 million relating to the NHS Direct business, which represents management's best estimate of future liabilities of the residual NHS Direct business. As NHS Direct is a discontinued operation, these costs have been shown together on the face of the Statement of Comprehensive Income as Gain/(loss) from absorption and a discontinuance of operations.

At the date of authorisation of these financial statements, the following Standards and Interpretations which have not been applied in these financial statements were in issue but not yet effective.

None of them are expected to impact upon the Trust’s financial statements: èè IFRS 13 Fair Value Measurement èè IFRS 15 Revenue from contracts with customers èè IFRS 9 Financial Instruments èè IAS 36 Recoverable amount disclosures èè Annual Improvements 2012 èè Annual Improvements 2013 èè IAS 19 (amendment) - employer contributions to defined benefit pension schemes èè IFRIC 21 Levies

2 TRANSFER BY ABSORPTION On 1 April 2015, SCAS took on the residual business of NHS Direct as its successor body, in order to manage and pay any residual liabilities, as well as the agreement to store and manage historical clinical and call data. In accordance with the FT Annual Reporting Manual, this transaction has been accounted for as a machinery of government change.

Accordingly, the residual assets and liabilities of NHS Direct (including cash of £36.0 million, debtors of £3.0 million and creditors and provision of £32.7 million) were transferred to SCAS, resulting in a gain from absorption of £6.3 million.

236

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

3 OPERATING SEGMENTS Each segment is reported separately in the monthly Board report. Emergency Services include the 999 service, 111 call handling, Education and Training and the Hazardous Area Response Team. Non-Emergency Services include Patient Transport Services (PTS), Logistic Services and Commercial Training Income.

Direct costs include employee and non employee costs (staff costs, drugs, medical equipment, vehicle costs etc). The Trust only reports contribution before overheads by service line reporting to the Trust Board at Public Board meetings.

2014/15 Emergency Services

Non-Emergency Services

Total

£000

£000

£000

147,770

24,879

172,649

(117,413)

(22,799)

(140,212)

30,357

2,080

32,437

Income Direct Costs Contribution Operational Activities Total Overheads

(23,766)

Depreciation and amortisation

(7,298)

Total Costs Before Dividends and Interest

(31,064)

Operating Surplus

1,373

2013/14 Emergency Services

Non-Emergency Services

Total

£000

£000

£000

140,440

21,970

162,410

(108,676)

(19,179)

(127,855)

31,764

2,791

34,555

Income Direct Costs Contribution Operational Activities Total Overheads

(23,327)

Depreciation and amortisation

(7,699)

Total Costs Before Dividends and Interest

(31,026)

Operating Surplus

3,529

237

Operational and Financial Review

NOTES TO THE ACCOUNTS 4 OPERATING INCOME FROM CONTINUING OPERATIONS 4.1 INCOME BY CLASSIFICATION 2014/15 £000

2013/14 £000

A&E Income

124,244

121,593

111 Income

15,697

15,284

PTS Income

21,064

18,595

1,009

902

Education, training and research

2,079

2,104

Non-patient care services to other bodies

2,657

2,621

Other revenue

5,899

1,311

172,649

162,410

Income from activities

Other Income Other operating income

4.2 PRIVATE PATIENT INCOME

Other revenue includes £3,695k for funding implementation of Electronic Patient Record (ePR) (2013/14: nil), £397k commercial training (2013/14: £361k), £285k radio mast income (2013/14: £301k), £786k income covering costs incurred in the management of NHSD LMO (2013/14: nil) and £358k reversal of impairments previously charged in the accounts (2013/14: £483k).

The Trust had no Private Patient income in 2014/15 (2013/14: nil).

4.3 OPERATING LEASE INCOME There is no operating lease income in 2014/15 (2013/14: nil).

238

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

4.4 OPERATING INCOME BY TYPE 2014/15 £000

2013/14 £000

1,771

2,130

153,353

150,022

Public Health England

3,644

0

Foundation trusts

1,645

2,860

NHS trusts Clinical Commissioning Groups

Local authorities

90

97

0

307

Injury costs recovery

556

506

Other

955

452

10,635

6,036

172,649

162,410

Department of Health Non-NHS:

Other operating income

4.5 INCOME GENERATION ACTIVITIES

Injury cost recovery income is subject to a provision for impairment of receivables of 100% for claims in excess of three years, 50% for claims between two and three years, 25% for claims between one and two years and 15% of all other claims, to reflect expected rates of collection.

The Trust undertakes income generation activities. No income generating activity exceeded £1m (2013/14: nil)

£136.0m of income received relates to Commissioner Requested Services (£133.2m in 2013/14).

All other income relates to NonCommissioner Requested Services.

239

Operational and Financial Review

NOTES TO THE ACCOUNTS 5 OPERATING EXPENSES

2014/15 £000

2013/14 £000

Employee Expenses - executive directors

828

794

Trust chair and non executive directors

217

101

102,855

99,829

334

282

3,618

2,920

921

903

3,807

3,645

Transport *

28,257

24,010

Premises **

9,766

5,540

44

56

Rentals under operating leases

4,327

4,801

Depreciation

6,489

6,637

Amortisation

808

1,062

Audit fee - statutory services

49

42

Audit fee - other assurance services

11

11

8

79

Clinical negligence premiums

487

513

Legal Costs

283

264

Consultancy services

240

732

Training, courses and conferences

653

595

Insurance

1,349

1,295

Other contracted services ***

4,714

2,985

61

0

0

353

59

300

1,091

1,132

171,276

158,881

Employee Expenses - Staff Supplies and services - drugs Supplies and services - clinical (excluding drugs costs) Supplies and services - general Establishment

Increase / (decrease) in provision for impairment of receivables

Non-audit fee - other non-audit services

Loss on disposal of property plant and equipment Impairment of property plant and equipment Impairment of assets held for sale Other ****

* Includes expenditure on running cost of vehicles and purchase of healthcare from non-NHS bodies ** Includes premises and IT related expenditure *** Other contracted services includes £3,676k arising from the National Pandemic Flu Service. **** Other includes £616k for additional injury benefit provision.

240

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

5.1 LIMITATION ON AUDITORS LIABILITY The Trust’s contract with its auditors for 2014/15, as set out in the engagement letter, limited the auditor’s liability to £1,000,000. (2013/14: £1,000,000)

6.1 EMPLOYEE EXPENSES 2014/15 Total

Salaries and wages Social security costs

2014/15 Other

£000

2014/15 Permanently Employed £000

81,898

81,898

0

£000

6,167

6,167

0

10,034

10,034

0

5,584

0

5,584

103,683

98,099

5,584

2013/14 Total

2013/14 Other

£000

2013/14 Permanently employed £000

Salaries and wages

79,305

79,305

0

Social security costs

6,024

6,024

0

Employers contributions to NHS Pensions

9,930

9,930

0

Agency/contract staff

5,364

0

5,364

100,623

95,259

5,364

Employers contributions to NHS Pensions Agency/contract staff Total gross staff costs

Total gross staff costs

241

£000

Operational and Financial Review

NOTES TO THE ACCOUNTS 6.2 AVERAGE NUMBER OF EMPLOYEES (WTE BASIS) 2014/15 Total

2014/15 Permanently Employed

2014/15 Other

1,369

1,369

0

Administration and estates including Emergency and 111 Control staff

839

713

126

Healthcare assistants and other support staff

441

441

0

86

86

0

2,735

2,609

126

2013/14 Total

2013/14 Permanently employed

2013/14 Other

1,350

1,350

0

Administration and estates including Emergency and 111 Control staff

775

673

102

Healthcare assistants and other support staff

441

441

0

98

98

0

2,664

2,562

102

Ambulance staff

Nursing, midwifery and health visiting staff Total gross staff costs

Ambulance staff

Nursing, midwifery and health visiting staff Total gross staff costs

6.3 REMUNERATION AND OTHER BENEFITS RECEIVED BY DIRECTORS 2014/15 £000

2013/14 £000

Salaries and wages

670

646

Social security costs

73

68

Employers contribution to NHS Pensions

85

80

828

794

Total

In the year ended 31 March 2015, 5 directors (31 March 2014: 6) accrued benefits under a defined benefit pension scheme.

During the year to 31 March 2015, the highest paid director for the Trust was the Chief Executive who was paid a salary between £160k and £165k and benefits in kind of £2.8k.

242

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

6.4 EARLY RETIREMENTS DUE TO ILL HEALTH There were three early retirements due to ill health in the reporting period with a value of £155k (2013/14: seven cases at £329k).

6.5 ANALYSIS OF TERMINATION BENEFITS 2014/15

2014/15

Number of compulsory redundancies Number

Cost of compulsory redundancies £000

<£10,000

2

5

£10,001 - £25,000

1

18

Total

3

23

2013/14 Number of compulsory redundancies Number

2013/14 Cost of compulsory redundancies £000

<£10,000

29

115

£10,001 - £25,000

13

213

£25,001 - £50,000

4

107

£50,001 - £100,000

4

359

£100,001 - £150,000

1

133

51

927

Exit package cost band (including any special payment element)

Exit package cost band (including any special payment element)

Total

243

Operational and Financial Review

NOTES TO THE ACCOUNTS 6.6 PENSION COSTS

However, formal actuarial valuations for unfunded public service schemes have been suspended by HM Treasury on value for money grounds while consideration is given to recent changes to public service pensions, and while future scheme terms are developed as part of the reforms to public service pension provision in 2015.

Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.

The Scheme Regulations were changed to allow contribution rates to be set by the Secretary of State of Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as appropriate. Employers pay contributions at 14% of pensionable pay and most employees had, up to April 2008 paid 6%, with manual staff paying 5%.

Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004 and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his valuation report recommended that employer contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings.

The scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these is as below: a) Full actuarial (funding) valuation The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates.

On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the schemeâ&#x20AC;&#x2122;s liabilities.

The last formal actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2004. Consequently, a formal actuarial valuation would have been due for the year ending 31 March 2008.

244

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

b) Accounting valuation

Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service.

A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. Actuarial assessments undertaken in intervening years between formal valuations using updated membership data are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2013, is based on the valuation data as at March 2012, updated to 31 March 2013 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.

With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”.

Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011/12 the Consumer Price Index (CPI) will be used to replace the Retail Prices Index (RPI).

The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.

Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity.

A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable.

c) Scheme provisions The NHS Pension Scheme provided defined benefits, which are summarised below.

This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained: The Scheme is a “final salary” scheme.

For early retirements, other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability is charged to the Statement of Comprehensive Income at the time the Trust commits itself to the retirement, regardless of the method of payment.

245

Operational and Financial Review

NOTES TO THE ACCOUNTS Members can purchase additional service in the NHS Scheme and contribute to money purchase AVCâ&#x20AC;&#x2122;s run by the Schemeâ&#x20AC;&#x2122;s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers. d) National Employment Savings Trust (NEST) The Pensions Act 2008 introduced new duties on employers in providing access to a workplace pension for all of its employees. The NHS Pension Scheme is not available to all employees and the Trust has provided access to a scheme for these employees which is operated by the National Employment Savings Trust (NEST). NEST is a defined contribution scheme where a minimum contribution is paid by the employer. South Central Ambulance NHS Foundation Trust currently contribute 1% of qualifying earnings to the scheme and employees contribute 1% of pensionable pay.

Nest levies a contribution charge of 1.8% and an annual management charge of 0.3% which is paid from the employer contributions. There are no separate employer charges levied by NEST and the Trust is not required to enter into a contract to utilise NEST qualifying pension schemes.

246

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

7.1 ANALYSIS OF OPERATING LEASE EXPENDITURE 2014/15 Total £000

2013/14 Total £000

4,327

4,801

Minimum lease payments Total 2014/15 £000

Land 2014/15 £000

Buildings 2014/15 £000

Other 2014/15 £000

not later than one year

3,161

0

1,305

1,856

later than one year and not later than five years

8,714

0

5,117

3,597

later than five years

11,542

0

11,542

0

Total

23,417

0

17,964

5,453

Total 2013/14 £000

Land 2013/14 £000

Buildings 2013/14 £000

Other 2013/14 £000

not later than one year

2,479

0

1,326

1,153

later than one year and not later than five years

6,895

0

5,161

1,734

later than five years

12,755

0

12,755

0

Total

22,129

0

19,242

2,887

Future minimum lease payments due:

Future minimum lease payments due:

The Trust leases property, vehicles and equipment under operating leases.

7.2 THE LATE PAYMENT OF COMMERCIAL DEBTS (INTEREST AT ACT 1998) No interest payments were made by the Trust in the reporting period

8 DISCONTINUED OPERATIONS Cost arising from the transfer of discontinued operations

2014/15 Total £000

2013/14 Total £000

3,820

0

The Trust is the appointed successor body to NHSD which ceased providing services on 31 March 2014.

9 CORPORATION TAX

The Trust has determined that it has no corporation tax liability as it has no private income from non operational areas.

247

Operational and Financial Review

NOTES TO THE ACCOUNTS 10 FINANCE INCOME 2014/15 £000

2013/14 £000

41

41

2014/15 £000

2013/14 £000

87

82

0

1

87

83

Interest on bank accounts

11 FINANCE COSTS Interest expense: Loans from the Department of Health Finance leases Total

12 IMPAIRMENT OF ASSETS 2014/15 £000 Net Impairments

2014/15 £000 Impairments

2014/15 £000 Reversals

0

0

0

Changes in market price

(299)

59

(358)

Total impairments charged to operating surplus

(299)

59

(358)

Impairments charged to operating surplus: Abandonment of assets in course of construction

There were net reversal impairments in 2014/15 of (£299k). Of this total (£358k) were reversals of amounts previously charged to revenue expenditure and have now been reversed.

2013/14 £000 Net Impairments

2013/14 £000 Impairments

2013/14 £000 Reversals

60

60

0

Changes in market price

110

593

(483)

Total impairments charged to operating surplus

170

653

(483)

Impairments charged to operating surplus: Abandonment of assets in course of construction

There were net reversal impairments in 2013/14 of £170k. Of this total (£483k) were reversals of amounts previously charged to revenue expenditure and have now been reversed.

248

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

13.1 INTANGIBLE ASSETS - 2014/15 Total £000

Software licences (purchased) £000

Valuation/Gross Cost at 1 April 2014

5,155

4,382

773

Additions - purchased

1,800

7

1,793

Reclassifications

0

330

(330)

Disposals

0

0

0

Valuation/Gross Cost at 31 March 2015

6,955

4,719

2,236

Amortisation at 1 April 2014

2,823

2,823

0

808

808

0

Provided during the year

Intangible Assets Under Construction £000

0

0

0

3,631

3,631

0

Total £000

Software licences (purchased) £000

Intangible Assets Under Construction £000

3,324

1,088

2,236

NBV - Finance leases at 31 March 2015

0

0

0

NBV - Donated and government grant funded at 31 March 2015

0

0

0

3,324

1,088

2,236

Disposals Amortisation at 31 March 2015

Net book value NBV - Purchased at 31 March 2015

NBV total at 31 March 2015

Note. There is no revaluation reserve held for intangible assets.

249

Operational and Financial Review

NOTES TO THE ACCOUNTS 13.2 INTANGIBLE ASSETS - 2013/14 Total

Valuation/Gross Cost at 1 April 2013

£000

Software licences (purchased) £000

Intangible Assets Under Construction £000

4,477

3,642

835

Additions - purchased

179

179

0

Reclassifications

661

723

(62)

Disposals

(162)

(162)

0

Valuation/Gross Cost at 31 March 2014

5,155

4,382

773

Amortisation at 1 April 2013

1,923

1,923

0

Provided during the year

1,062

1,062

0

Disposals

(162)

(162)

0

Amortisation at 31 March 2014

2,823

2,823

0

Reclassifications relate to movements in year between assets in the course of construction within PPE and intangible assets - see note 13.1 Total £000

Software licences (purchased) £000

Intangible Assets Under Construction £000

2,332

1,559

773

NBV - Finance leases at 31 March 2014

0

0

0

NBV - Donated and government grant funded at 31 March 2014

0

0

0

2,332

1,559

773

Net book value NBV - Purchased at 31 March 2014

NBV total at 31 March 2014 (restated

Note. There is no revaluation reserve held for intangible assets.

250

251

(126) 0

(118)

(923)

Transfers to / from assets held for sale

Disposals

0 0 0

38

1

(10)

(821)

Reversal of impairments

Accumulated depreciation at 31 March 2015

Disposals

Transfers to / from assets held for sale

0

0

6,489

Provided during the year

47,506

0

41,809

Accumulated depreciation at 1 April 2014

Revaluations

0

115,930

Valuation/Gross cost at 31 March 2015

9,203

0

0

Revaluations

Reversal of impairments 0

0

(20) 238

0

9,566

0

9,091

105,475

1,950

£000

£000

Reclassifications

Impairments

Additions - purchased

Valuation/Gross cost at 1 April 2014

Land

Total

4,553

0

(10)

0

38

1,307

3,218

35,466

0

8

0

2,569

1,698

(20)

111

31,100

£000

Buildings excluding dwellings

7

0

0

1

0

6

0

161

0

0

0

0

14

0

0

147

£000

Dwellings

0

0

0

0

0

0

0

7,494

0

0

0

(3,855)

0

0

7,398

3,951

Assets under construction & payments on account £000

14.1 PROPERTY, PLANT AND EQUIPMENT 2014/15

7,591

(20)

0

0

0

747

6,864

12,111

(20)

0

0

219

0

0

1,998

9,914

£000

Plant and machinery

27,405

(773)

0

0

0

3,602

24,576

40,676

(875)

0

0

621

0

0

25

40,905

£000

7,149

(28)

0

0

0

767

6,410

9,413

(28)

0

0

368

0

0

33

9,040

£000

Transport Information equipment technology

801

0

0

0

0

60

741

1,406

0

0

0

78

0

0

1

1,327

£000

Furniture & fittings

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

NBV total at 31 March 2015

Donated

Finance Leased

Owned

8,299 0 904

66,615

0

1,809 9,203

£000

£000

68,424

Land

Total

30,913

905

0

30,008

£000

Buildings excluding dwellings

154

0

0

154

£000

Dwellings

7,494

0

0

7,494

Assets under construction & payments on account £000

14.1 PROPERTY, PLANT AND EQUIPMENT 2014/15

4,520

0

0

4,520

£000

Plant and machinery

13,271

0

0

13,271

£000

2,264

0

0

2,264

£000

Transport Information equipment technology

605

0

0

605

£000

Furniture & fittings

Operational and Financial Review

NOTES TO THE ACCOUNTS

252

319 0 25 0

0

0 0 0

(353)

483

(661)

189

(2,257)

105,475

39,568

6,637

(2,188)

(2,208)

41,809

Impairments

Disposals

Valuation/Gross cost at 31 March 2014

Accumulated depreciation at 1 April 2013 as previously stated

Provided during the year

Revaluations

Disposals

Accumulated depreciation at 31 March 2014

Revaluations

Reclassifications

253 0

9,091

0 (203)

8,335

Additions - purchased

Reversal of impairments

8,950

£000

£000

99,739

Valuation/Gross cost at 1 April 2013

Land

Total

3,218

(209)

(2,169)

1,268

4,328

31,100

(209)

154

960

164

(90)

145

29,976

£000

Buildings excluding dwellings

0

0

(19)

5

14

147

0

10

0

0

0

0

137

£000

Dwellings

0

0

0

0

0

3,951

0

0

(3,386)

0

(60)

4,480

2,917

Assets under construction & payments on account £000

14.2 PROPERTY, PLANT AND EQUIPMENT 2013/14

6,864

(93)

0

724

6,233

9,914

(93)

0

131

0

0

520

9,356

£000

Plant and machinery

24,576

(1,726)

0

3,575

22,727

40,905

(1,764)

0

177

0

0

3,089

39,403

£000

6,410

(6)

0

957

5,459

9,040

(6)

0

1,113

0

0

105

7,828

£000

Transport Information equipment technology

741

(174)

0

108

807

1,327

(185)

0

344

0

0

(4)

1,172

£000

Furniture & fittings

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

NBV total at 31 March 2014

Donated

Finance Leased

Owned

8,225 0 866

61,956

0

1,710 9,091

£000

£000

63,666

Land

Total

27,882

844

0

27,038

£000

Buildings excluding dwellings

147

0

0

147

£000

Dwellings

3,951

0

0

3,951

Assets under construction & payments on account £000

14.2 PROPERTY, PLANT AND EQUIPMENT 2013/14

3,050

0

0

3,050

£000

Plant and machinery

16,329

0

0

16,329

£000

2,630

0

0

2,630

£000

Transport Information equipment technology

586

0

0

586

£000

Furniture & fittings

Operational and Financial Review

NOTES TO THE ACCOUNTS

254

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

15 INTANGIBLE ASSETS ACQUIRED BY GOVERNMENT GRANT The Trust had no intangible assets acquired by government grant.

16.1 ECONOMIC LIFE OF INTANGIBLE ASSETS Min Life Years

Max Life Years

3

5

Min Life Years

Max Life Years

Property excluding dwellings

20

70

Dwellings

20

70

5

15

Intangible assets purchased Software

16.2 ECONOMIC LIFE OF PROPERTY, PLANT AND EQUIPMENT Tangible assets purchased

Plant & Machinery Transport Equipment

5

10

Information Technology

5

5

Furniture & Fittings

5

15

17 INVESTMENTS The Trust held no investments at 31 March 2015 (31 March 2014: nil).

18 INVESTMENTS IN ASSOCIATE OPERATIONS The Trust had no investments in associate or jointly controlled operations (2013/14: nil).

255

Operational and Financial Review

NOTES TO THE ACCOUNTS 19.1 NON-CURRENT ASSETS FOR SALE AND ASSETS IN DISPOSAL GROUPS - 2014/15 Total

NBV of non-current assets for sale and assets in disposal groups at 1 April 2014 Plus assets classified as available for sale in the year Less assets sold in year Less Impairment of assets held for sale NBV of non-current assets for sale and assets in disposal groups at 31 March 2015

£000

Property, plant & equipment £000

3,565

3,565

108

108

(664)

(664)

(59)

(59)

2,950

2,950

The balance for assets held for sale as at 31 March 2015 is the total open market value for Trust property that has been declared as available for sale for sites at Battle and Fareham. Totton, that was declared as available for sale in 2013/14, has now been re-classified as a non-current asset and valued on a modern equivalent asset basis.

19.2 NON-CURRENT ASSETS FOR SALE AND ASSETS IN DISPOSAL GROUPS - 2013/14 Total £000

Property, plant & equipment £000

NBV of non-current assets for sale and assets in disposal groups at 1 April 2013

3,865

3,865

Less Impairment of assets held for sale

(300)

(300)

NBV of non-current assets for sale and assets in disposal groups at 31 March 2014

3,565

3,565

256

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

19.3 LIABILITIES IN DISPOSAL GROUPS The Trust held no liabilities in disposal groups as at 31 March 2015 (31 March 2014: nil)

20 OTHER ASSETS The Trust held no other assets as at 31 March 2015 (31 March 2014: nil)

21 OTHER FINANCIAL ASSETS The Trust held no other financial assets as at 31 March 2015 (31 March 2014: nil)

22.1 INVENTORIES 2014/15 £000

2013/14 £000

Consumables

814

861

Fuel

132

182

Carrying Value as at 31 March

946

1,043

22.2 INVENTORIES RECOGNISED IN EXPENSES There were no inventories recognised in expenses during the reported period.

257

Operational and Financial Review

NOTES TO THE ACCOUNTS 23 TRADE RECEIVABLES AND OTHER RECEIVABLES 31 March 2015 £000

31 March 2014 £000

NHS Receivables - Revenue

2,116

1,965

Provision for impaired receivables

(600)

(556)

Prepayments (Non-PFI)

2,881

2,685

Accrued income

2,948

3,538

5

3

PDC Dividend Receivable

147

0

VAT receivable

212

582

Other receivables - Revenue

859

827

8,568

9,044

Current

Interest Receivable

Total Current Trade And Other Receivables The Trust had no non-current trade or other receivables.

The majority of trade receivables are due from clinical commissioning groups, as commissioners for NHS patient care services. As clinical commissioning goups are funded by Government to commission NHS patient care services, no credit scoring of them is considered necessary.

24.1 PROVISION FOR IMPAIRMENT OF RECEIVABLES

At 1 April (restated) Increase in provision Amounts utilised At 31 March

31 March 2015 £000

31 March 2014 £000

556

500

44

56

0

0

600

556

The provision relates to £373k Injury cost recovery (2013/14: £344k), £165k trade receivables (2013/14: £128k) and £91k overpaid salaries (2013/14: £84k).

258

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

24.2 ANALYSIS OF IMPAIRED RECEIVABLES

31 March 31 March 31 March 2015 2015 2014 Trade Other Trade Receivables Receivables Receivables £000 £000 £000

31 March 2014 Other Receivables £000

Ageing of impaired receivables 0 - 30 days

0

0

0

0

30-60 Days

0

0

0

0

60-90 days

0

0

0

0

90- 180 days (was "In three to six months")

0

373

0

344

over 180 days (was "Over six months")

0

227

0

212

Total

0

600

0

556

0 - 30 days

287

77

571

41

30-60 Days

112

2

169

12

60-90 days

Ageing of non-impaired receivables past their due date

90

0

107

0

90- 180 days (was "In three to six months")

0

2

0

2

over 180 days (was "Over six months")

0

32

0

18

489

113

847

73

Total

25 FINANCE LEASE RECEIVABLES The Trust had no finance lease receivables as at 31 March 2015 (31 March 2014: nil).

26 CASH AND CASH EQUIVALENTS

2014/15 £000

2013/14 £000

8,329

8,301

36,004

0

(17,233)

28

27,100

8,329

9

37

Cash with the Government Banking Service

27,091

8,292

Cash and cash equivalents

27,100

8,329

At 1 April Transfers by absorption Net change in year At 31 March Broken down into: Cash at commercial banks and in hand

The Trust held no third party assets as at 31 March 2015 (31 March 2014: nil).

259

Operational and Financial Review

NOTES TO THE ACCOUNTS 27.1 TRADE AND OTHER PAYABLES

31 March 2015 Total £000

31 March 2014 Total £000

302

167

Amounts due to other related parties - revenue

1,346

1,307

Other trade payables - capital

1,803

920

Other trade payables - revenue

1,115

1,641

Social Security costs

1,067

975

Other taxes payable

927

863

53

105

9,361

8,317

0

14

15,974

14,309

30

40

0

0

30

40

Current NHS payables - revenue

Other payables Accruals PDC dividend payable Total current trade and other payables Non-current Other payables Accruals Total non-current trade and other payables

Amounts due to related parties represents £1,346k outstanding pensions contributions as at 31 March 2015 (31 March 2014: £1,307k).

There were no early retirement payments in the above.

27.2 BETTER PAYMENT PRACTICE CODE

March 2015 Number

March 2015 £000

March 2014 Number

March 2014 £000

Measure of compliance Non-NHS Payables Total Non-NHS Trade Invoices Paid in the Year

40,986

79,440

40,999

60,835

Total Non-NHS Trade Invoices Paid Within Target

36,187

77,471

36,330

57,268

Percentage of Non-NHS Trade Invoices Paid Within Target

88.3%

97.5%

88.6%

94.1%

Total NHS Trade Invoices Paid in the Year

516

1,969

556

2,771

Total NHS Trade Invoices Paid Within Target

437

1,875

502

2,708

84.7%

95.2%

90.3%

97.7%

NHS Payables

Percentage of NHS Trade Invoices Paid Within Target

The Better Payment Practice Code requires the Trust to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

260

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

28 BORROWINGS 31 March 2015 £000

31 March 2014 £000

Current Loans from Independent Trust Financing Facility

1,400

0

338

488

0

0

1,738

488

Loans from Independent Trust Financing Facility

5,600

0

Loans from Department of Health

1,016

1,354

Obligations under finance leases

0

0

Total non-current borrowings

6,616

1,354

Loans from Department of Health Obligations under finance leases Total current borrowings Non-current

The Trust has one capital loan of £3,551k (payable over 10 years) taken out in 2008/09 and a further loan of £7,000k (payable over 5 years) taken out in 2014/15. The final instalment of principal loan of £1,500k taken out in 2009/10 was paid during 2014/15.

29 OTHER LIABILITIES The Trust had no other liabilities as at 31 March 2015 (31 March 2014: nil)

30 OTHER FINANCIAL LIABILITIES

The Trust had no other financial liabilities as at 31 March 2015 (31 March 2014: nil)

261

Operational and Financial Review

NOTES TO THE ACCOUNTS 31.1 PROVISIONS FOR LIABILITIES AND CHARGES Current

Non-current

31 March 2015 £000

31 March 2014 £000

31 March 2015 £000

31 March 2014 £000

Pensions relating to other staff

219

153

4,352

2,115

Other legal claims

252

190

166

192

60

116

0

0

400

0

0

0

Other*

5,303

1,670

4,658

188

Total

6,234

2,129

9,476

2,495

Restructurings Redundancy

* The other provisions include £1,676k for agency related costs, £5,784k ongoing costs arising from management of closure activities of NHSD including the retention of clinical records, £785k staff related costs, £249k property dilapidations, £107k for lease car related costs, £606k provision for credit notes and £714k supplier disputes.

262

(932)

Reversed unused

263 5,973

later than five years 15,710

3,503

later than one year and not later than five years

Total

6,234

15,710

not later than one year

Expected timing of cashflows:

At 31 March 2015

17

(447)

Utilised during the year - cash

Unwinding of discount

8,735

Arising during the year

0

3,713

Transfer by Absorption

Change in the discount rate

4,624

At 1 April 2014

£000

Total

4,871

3,807

845

219

4,871

17

0

(205)

1,977

0

814

2,268

Pensions other staff £000

418

0

166

252

418

0

0

(26)

62

0

0

382

Other legal claims £000

60

0

0

60

60

0

(33)

(23)

0

0

0

116

£000

Re-structurings

31.2 PROVISIONS FOR LIABILITIES AND CHARGES ANALYSIS

400

0

0

400

400

0

0

0

400

0

0

0

£000

Redundancies

9,961

2,166

2,492

5,303

9,961

0

(899)

(193)

6,296

0

2,899

1,858

£000

Other*

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Operational and Financial Review

NOTES TO THE ACCOUNTS 31.3 CLINICAL NEGLIGENCE LIABILITIES

Total £000

Amount included in provisions of the NHSLA at 31 March 2015 in respect of clinical negligence liabilities of South Central Ambulance Service NHS Foundation Trust

4,208

Amount included in provisions of the NHSLA at 31 March 2014 in respect of clinical negligence liabilities of South Central Ambulance Service NHS Foundation Trust

5,189

32 CONTINGENT LIABILITIES / ASSETS 31 March 2015 £000

31 March 2014 £000

(101)

(54)

0

0

Other

(559)

(427)

Gross value of contingent liabilities

(660)

(481)

Amounts recoverable against liabilities

0

0

Net value of contingent liabilities*

(660)

(481)

0

0

Value of contingent liabilities NHS Litigation Authority Legal Claims Equal pay

Net value of contingent assets

* Additional liability on legal claims and agency related issues at 100% probability.

33 REVALUATION RESERVE 31 March 2015 £000

31 March 2014 £000

Revaluation reserve at 1 April

9,535

6,465

Impairments / Reversal of Impairments

1,534

0

Revaluations

(1)

2,377

Transfers to other reserves *

(7)

695

0

(2)

11,061

9,535

Asset disposals Revaluation reserve at 31 March

* Adjustment for 2013/14 relates to the reversal of negative land revaluation reserves that arose during the Trust’s conversion to IFRS in 2009/10.

264

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

34 RELATED PARTY TRANSACTIONS During the year none of the Board Members or members of the key management staff or parties related to them has undertaken any material transactions with South Central Ambulance Service NHS Foundation Trust. The Department of Health is regarded as a related party. During the year South Central Ambulance Service NHS Foundation Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entries are listed below: Note 34.1 Note 34.2 Payments to related party £000 Health Education England

Receipts from Amounts owed related party to related party £000 £000

Amounts due from related party £000

10

2,082

0

61

NHS England

0

4,280

0

586

Public Health England

0

3,644

0

0

Oxford Health NHS Foundation Trust

13

1,472

0

45

Berkshire Healthcare NHS Foundation Trust

74

1,788

57

6

Buckinghamshire Healthcare NHS Trust

0

1,529

0

46

NHS Oxfordshire CCG

0

26,081

0

629

NHS West Hampshire CCG

0

19,727

0

301

29

7,870

0

145

NHS Chiltern CCG

0

12,194

0

244

NHS Southampton CCG

0

10,200

0

161

NHS Milton Keynes CCG

0

8,957

0

30

NHS Fareham & Gosport CCG

0

8,893

0

447

NHS Portsmouth CCG

0

8,351

0

45

NHS South Eastern Hampshire CCG

0

7,706

0

186

NHS Slough CCG

0

6,093

0

60

NHS North Hampshire CCG

0

6,097

0

101

NHS South Reading CCG

0

5,357

0

26

NHS Windsor, Ascot & Maidenhead CCG

0

4,734

0

103

NHS Wokingham CCG

0

4,860

0

19

NHS Bracknell & Ascot CCG

0

4,715

0

40

NHS Newbury & District CCG

0

4,129

0

137

0

4,179

0

22

3,796

0

0

0

NHS Aylesbury Vale CCG

NHS North & West Reading CCG British Telecom*

* Other related parties arising from Ministers and other Senior Department of Health officials.

During the period South Central Ambulance NHS Foundation Trust had charitable funds of £0.6m as at 31 March 2015 (2014 £0.6m) 265

Operational and Financial Review

NOTES TO THE ACCOUNTS 35.1 CONTRACTUAL CAPITAL COMMITMENTS 31 March 2015 £000

31 March 2014 £000

Property, Plant and Equipment

106

148

Intangible assets

200

193

Total

306

341

35.2 OTHER FINANCIAL COMMITMENTS

Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The Foundation Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Trust in undertaking its activities.

The Trust has no other commitments under non-cancellable contracts as at 31 March 2015 (31 March 2014: nil).

36 FINANCE LEASE OBLIGATIONS The Trust has no finance lease obligations as at 31 March 2015 (31 March 2014: nil).

The Foundation Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Foundation Trust’s standing financial instructions and policies agreed by the Board of Directors.

Foundation Trust treasury activity is subject to review by the Trust’s internal auditors.

37 EVENTS AFTER THE REPORTING PERIOD There were no events after the reporting period.

Currency risk The Foundation Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Foundation Trust has no overseas operations. The Foundation Trust therefore has low exposure to currency rate fluctuations.

38 FINANCIAL INSTRUMENTS Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the Foundation Trust has with clinical commissioning groups and the way those clinical commissioning groups are financed, the Foundation Trust is not exposed to the degree of financial risk faced by business entities.

266

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

Interest rate risk The Foundation Trust’s borrowings are from government, the borrowings are for 1-10 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Foundation Trust therefore has low exposure to interest rate fluctuations.

Credit risk Because the majority of the Foundation Trust’s income comes from contracts with other public sector bodies, the Foundation Trust has low exposure to credit risk.

The maximum exposures as at 31 March 2015 are in receivables from customers, as disclosed in the trade and other receivables note. The Trust’s procurment process is robust and the Trust restricts prepayments to suppliers.

Liquidity risk The Foundation Trust’s operating costs are incurred under contracts with clinical commissioning groups, which are financed from resources voted annually

by Parliament. The Foundation Trust is not exposed to significant liquidity risks.

38.1 FINANCIAL ASSETS BY CATEGORY 31 March 2015 £000

31 March 2014 £000

5,007

5,666

Cash and cash equivalents at bank and in hand

27,100

8,329

Total

32,107

13,995

31 March 2015 £000

31 March 2014 £000

8,354

1,842

15,172

14,284

7,003

841

30,529

16,967

Trade and other receivables excluding non financial assets

38.2 FINANCIAL ASSETS BY CATEGORY

Liabilities as per SoFP; Borrowings excluding Finance lease and PFI liabilities Trade and other payables excluding non financial assets Provisions under contract Total

267

Operational and Financial Review

NOTES TO THE ACCOUNTS 38.3 FAIR VALUES OF FINANCIAL ASSETS AT 31 MARCH 2015 The Trust has no non-current financial assets at 31 March 2015 (31 March 2014: nil).

38.4 FAIR VALUES OF FINANCIAL LIABILITIES AT 31 MARCH 2015 Book value £000

Fair value £000

Provisions under contract

4,533

4,533

Loans

6,616

6,616

Total

11,149

11,149

31 March 2015 £000

31 March 2014 £000

19,380

15,422

In more than one year but not more than two years

3,780

376

In more than two years but not more than five years

5,203

1,111

In more than five years

2,166

58

30,529

16,967

Current assets are assumed to have a fair value equal to net book value.

39 MATURITY OF FINANCIAL LIABILITIES

In one year or less

Total

268

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

40 LOSSES AND SPECIAL PAYMENTS 2014/15 Total number of cases Number

2013/14

Total value of cases £000

Total number Total value of of cases cases Number £000

Losses Loss incurred due to change in requirements Overpayment of salaries

1

60 0

1

4

0 0

0

Damage to equipment

75

272

79

206

Total Losses

76

276

80

266

7

7

0

0

Bad Debts and abandoned claims

Special Payments Extra statutory payments

269

Operational and Financial Review

INDEPENDENT AUDITOR’S REPORT TO THE COUNCIL OF GOVERNORS OF SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST OPINIONS AND CONCLUSIONS ARISING FROM OUR AUDIT

The risk: The main source of income for the Trust is the provision of healthcare services to the public under contracts with NHS commissioners and other NHS bodies, which make up (92.9%) of income. The Trust participates in the national Agreement of Balances (AoB) exercise which is designed by the Department of Health and mandated

by Monitor for the purpose of ensuring that intra-NHS balances are eliminated on the consolidation of the Department’s Consolidated Resource Account. The AoB exercise identifies mismatches between receivable and payable balances recognised by the Trust and its counter parties at 31 March 2015.

1. Our opinion on the financial statements is unmodified We have audited the financial statements of South Central Ambulance Service NHS Foundation Trust (FT) for the year ended 31 March 2015 set out on pages 219 to 269.

In our opinion: èè the financial statements give a true and fair view of the state of the Trust’s affairs as at 31 March 2015 and of the Trust’s income and expenditure for the year then ended; and èè the financial statements have been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2014/15.

Mis-matches can occur for a number of reasons, but the most significant arise where the Trust and commissioners have not concluded the reconciliations of activity levels completed within the last quarter of the financial year, which have not yet been invoiced, or there is not final agreement over proposed contract penalties as activity data for the period has not been finally validated. Commissioners are often under pressure to spend the resources available to them in any financial year.

There is a risk that amounts billed to the commissioning bodies and recognised as income may be in respect of activity that either does not exist or has been delivered after the date of transfer.

2. Our assessment of risks of material misstatement In arriving at our audit opinion above on the financial statements the risks of material misstatement that had the greatest effect on our audit were as follows: NHS Income Recognition - £160.4 million

We do not consider NHS income to be at high risk of significant misstatement, or to be subject to a significant level of judgement.

Refer to page 164 (Audit Committee Report), page 226 (accounting policy) and page 238-239 (financial disclosures).

270

South Central Ambulance Service NHS Foundation Trust / Annual Report and Accounts 2014/15

However, due to its materiality in the context of the financial statements as a whole NHS income is considered to be one of the areas which had the greatest effect on our overall audit strategy and allocation of resources in planning and completing our audit.

èè Carrying out testing of invoices raised around the financial year-end to determine whether income had been recognised in the appropriate period.

We also considered the adequacy of the Trusts disclosures in respect of income, particularly in relation to any key judgments made and estimates used in recognising income.

Our response: In this area our audit procedures included, among others: èè Reconciling the income recorded in the financial statements to signed contracts with material commissioners and reviewing material variations agreed throughout the year to supporting invoices, supported by explanations from the Trust; èè Carrying out testing of invoices for material income from other NHS organisations to determine whether income was recognised in accordance with the amounts billed to corresponding parties; èè Assessing whether the Trust was in formal dispute or arbitration in relation to any material income balances and examining the supporting correspondence, including - if appropriate - any legal advice, for consistency with the treatment of these balances within the financial statements; èè Inspecting third party confirmations from commissioners and other NHS organisations, including the results of the Agreement of Balances (AoB) exercise and comparing the values disclosed within their financial statements to the values recorded in the Trusts financial statements through the national Agreement of Balances exercise;

3. Our application of materiality and an overview of the scope of our audit The materiality for the financial statements was set at £3.3 million, determined with reference to a benchmark of income from operations (of which it represents 2%).

We consider income from operations to be more stable than a surplus-related benchmark. èè We report to the Audit Committee any corrected and uncorrected identified misstatements exceeding £0.165 million, in addition to other identified misstatements that warrant reporting on qualitative grounds. èè Our audit of the Trust was undertaken to the materiality level specified above and was all performed at the Trust’s head office.

271

INDEPENDENT AUDITOR’S REPORT TO THE COUNCIL OF GOVERNORS OF SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST 4. Our opinion on other matters prescribed by the Audit Code for NHS Foundation Trusts is unmodified

In particular, we are required to report to you if: èè we have identified material inconsistencies between the knowledge we acquired during our audit and the directors’ statement that they consider that the annual report and accounts taken as a whole is fair, balanced and understandable and provides the information necessary for patients, regulators and other stakeholders to assess the Trust’s performance, business model and strategy; or èè The Audit Committee Report does not appropriately address matters communicated by us to the Audit Committee.

In our opinion: èè the part of the Directors’ Remuneration Report to be audited has been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2014/15; and èè the information given in the Strategic Report and the Directors’ Report for the financial year for which the financial statements are prepared is consistent with the financial statements.

5 We have nothing to report in respect of the matters on which we are required to report by exception

Under the Audit Code for NHS Foundation Trusts we are required to report to you if in our opinion:

Under ISAs (UK&I) we are required to report to you if, based on the knowledge we acquired during our audit, we have identified other information in the annual report that contains a material inconsistency with either that knowledge or the financial statements, a material misstatement of fact, or that is otherwise misleading.

èè the Annual Governance Statement does not reflect the disclosure requirements set out in the NHS Foundation Trust Annual Reporting Manual 2014/15, is misleading or is not consistent with our knowledge of the Trust and other information of which we are aware from our audit of the financial statements. èè the Trust has not made proper arrangement for securing economy, efficiency and effectiveness in its use of resources We have nothing to report in respect of the above responsibilities.

272

Certificate of audit completion We certify that we have completed the audit of the accounts of South Central Ambulance Service NHS Foundation Trust in accordance with the requirements of Chapter 5 of Part 2 of the National Health Service Act 2006 and the Audit Code for NHS Foundation Trusts issued by Monitor.

Respective responsibilities of the accounting officer and auditor As described more fully in the Statement of Accounting Officerâ&#x20AC;&#x2122;s Responsibilities on page 202 the accounting officer is responsible for the preparation of financial statements which give a true and fair view.

Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the UK Ethical Standards for Auditors.

Scope of an audit of financial statements performed in accordance with ISAs (UK and Ireland) A description of the scope of an audit of financial statements is provided on our website at www.kpmg.com/uk/ auditscopeother2014. This report is made subject to important explanations regarding our responsibilities, as published on that website, which are incorporated into this report as if set out in full and should be read to provide an understanding of the purpose of this report, the work we have undertaken and the basis of our opinions.

The purpose of our audit work and to whom we owe our responsibilities This report is made solely to the Council of Governors of the Trust, as a body, in accordance with Schedule 10 of the National Health Service Act 2006. Our audit work has been undertaken so that we might state to the Council of Governors of the Trust, as a body, those matters we are required to state to them in an auditorâ&#x20AC;&#x2122;s report and for no other purpose.

To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors of the Trust, as a body, for our audit work, for this report or for the opinions we have formed.

Jonathan Brown for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 100 Temple Street Bristol BS1 6AG 29 May 2015

GLOSSARY A and E AACP ACP ACS Agenda for change AMPDS ATP BASICS BMJ CAD CARS CBRN CCG CEO CF CFR CNST CPD CPI CPR CQC CQUIN CSD DH E and D ECP ECT EOC EoLC ePRF FFT Frem FT GBS GPS HALO HART HCP HOSC

IAS IFRS

Accident and Emergency Ambulance Anticipatory Care Plan Anticipatory Care Plan Acute Coronary Syndrome National pay system implemented in 2004 for NHS staff Advanced Medical Priority Dispatch System Adenosine Triophosphate Testing British Association for Immediate Care British Medical Journal Computer aided dispatch system Clinical Audit Record System Chemical, Biological, Radiological, Nuclear Clinical Commissioning Group Chief Executive Officer Clinical Fellow Community First Responder Clinical Negligence Scheme for trusts Continuous Professional Development Clinical Performance Indicator Cardiopulmonary resuscitation Care Quality Commission Commissioning for Quality and Improvement Clinical Support Desk Department of Health Equality and Diversity Emergency Care Practitioner Emergency Call Taker Emergency Operations Centre End of Life Care Electronic Patient Report Form Friends and Family Test Financial Reporting Manual Foundation Trust Government Banking Service Global Positioning System Hospital Ambulance Liaison Officer Hazardous Area Response Team Health Care Provider Health Overview and Scrutiny Committee

JRCALC KPMG LD LMO MINAP NBV NHSLA PALS PBL PCI PCT PCR PDC PERG PFI PRF PPCI PTS RAG RCN ROSC SCAS SCIE SID SIRI SLA SOP STEIS STEMI TARN TUB uDNACPR UKcip

274

International Accounting Standards International Financial Reporting Standards Joint Royal Colleges Ambulance Liaison Committee Trustâ&#x20AC;&#x2122;s appointed external auditors Learning Disability Legacy Management Office Myocardial Ischaemia National Audit Project Net Book Value NHS Litigation Authority Patient Advice and Liaison Service Prudential Borrowing Limit Primary angioplasty Primary Care Trust Patient Clinical Record Public Dividend Capital Patient Experience Review Group Public Finance Initiative Patient Report From Primary Percutaneous Coronary Intervention Patient Transport Services Red, Amber, Green Royal College of Nursing Return of spontaneous circulation South Central Ambulance Service Social Care Institute for Excellence Serious Incident Desk Serious Incidents Requiring Investigation Service Level Agreement Standard Operating Procedure Strategic Executive Information System ST elevation Myocardial Infarction (Heart Attack) Trauma Audit and Research Network Trauma Unit Bypass Unified Do Not Attempt CardioPulmonary Resuscitation United Kingdom Climates Impacts Programme

Operational and Financial Review

PRODUCED BY South Central Ambulance Service NHS Foundation Trust 7 & 8 Talisman Business Centre Talisman Road Bicester Oxfordshire OX26 6HR Tel 01869 365000 Fax 01869 322814

De si

gn

>B

en

He

nn

ess

y

www.scas.nhs.uk

276