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BOARD OF DIRECTORS MEETING MEETING TO BE HELD IN PUBLIC

DATE: Wednesday 24 September 2014

TIME: 09.45am – 12.30pm VENUE: Oculus Room, The Gateway Office and Conference

Centre, Aylesbury Vale District Council, Gatehouse Road, Aylesbury, Buckinghamshire, HP19 8FF

***

VOTING BOARD MEMBERS:

Trevor Jones Chairman

Alastair Mitchell-Baker Non Executive Director / Deputy Chairman Ilona Blue Non Executive Director Claire Carless Non Executive Director Mike Hawker

Keith Nuttall Non Executive Director Non Executive Director

Professor David Williams

Non Executive Director

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 IN ATTENDANCE: Sharon Walters Director of Human Resources Steve Garside Company Secretary APOLOGIES:

AGENDA Board of Directors Meeting – Meeting to be Held in Public Date: Wednesday 24 September 2014 Time: 09.45am – 12.30pm Venue: Oculus Room, The Gateway Office and Conference Centre, Aylesbury,

HP19 8FF ______________________________________________________________

Time (est)

1 Chairman’s Welcome and Apologies for Absence Trevor Jones – Chairman

Note 09.45

09.47

09.48

09.50

Verbal

2 Declaration of Directors’ Interests Trevor Jones – Chairman

Note Verbal

3 Minutes from the 30 July 2014 Meeting Trevor Jones – Chairman

Approve

Paper

4 Matters arising from the 30 July 2014 Meeting Trevor Jones – Chairman

Note Paper

5 Chairman’s Report Trevor Jones - Chairman

Note 09.55 Verbal

6 Chief Executive’s Report Will Hancock - Chief Executive

Note 10.05 Paper

QUALITY AND PATIENT SAFETY

7 Patient Story Case Study Deirdre Thompson – Director of Patient Care

Note 10.25 Verbal

8

Quality & Patient Safety Report Deirdre Thompson – Director of Patient Care

Note

10.45

Paper

FINANCIAL AND INTEGRATED SERVICE PERFORMANCE 9 Operational Performance Progress Report

Sue Byrne – Chief Operating Officer Note 11.00 Paper

10 Integrated Performance Report Charles Porter - Director of Finance, with support from Director leads

Note

11.15 Paper

11 Finance and Estates Report Charles Porter – Director of Finance

Note 11.35 Paper

STRATEGY No items for this particular meeting.

WORKFORCE STRATEGY AND DEVELOPMENT 12 Staff Attitude Survey Update Report

Sharon Walters – Director of Human Resources

Note 11.55 Paper

REGULATORY, COMPLIANCE & CORPORATE GOVERNANCE 13 Board Assurance Framework

Deirdre Thompson – Director of Patient Care Note 12.10 Paper

BOARD SUB-COMMITTEE CHAIR REPORTS 14 Report from the Quality and Safety Committee

Keith Nuttall – Quality and Safety Committee Chair Note 12.15 Paper

ANY OTHER BUSINESS (Should only normally include any matters previously notified to the Chairman at least 48 hours prior to the date of the meeting) 15 Any Other Business

Trevor Jones – Chairman

Note 12.20 Verbal

16 Questions from governors, Trust members, and members of the public Trevor Jones – Chairman

Note 12.22 Verbal

17 Date and Time of Next Meeting held in Public: 10.00am, 24th November 2014, Shaw House, Newbury

Confirm 12.30 Verbal

RESOLUTION TO EXCLUDE MEMBERS OF THE PUBLIC & CLOSE PUBLIC SESSION OF THE MEETING

18 To resolve that the representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity of which would be prejudicial to the public interest Section 1 (2) of the Public Bodies (Admissions to Meetings Act 1960) refers.

Verbal

Unapproved minutes – 30 July 2014 Page 1 of 6 Author: SG

ITEM 3 - UNAPPROVED MINUTES FROM THE 30 JULY 2014 BOARD MEETING IN PUBLIC

Unconfirmed minutes of the public meeting of the South Central Ambulance Service NHS Foundation Trust Board of Directors held on 30 July 2014 at Hilton Newbury Centre Hotel, Newbury Present Trevor Jones (Chairman); Ilona Blue (NED); Keith Nuttall (NED); Professor David Williams (NED); Will Hancock (Chief Executive); John Black (Medical Director); Sue Byrne (Chief Operating Officer); Deirdre Thompson (Director of Patient Care); Charles Porter (Director of Finance); James Underhay (Director of Strategy, Business Development, Communications and Engagement) In attendance Steve Garside (Company Secretary); Sharon Walters (Director of Human Resources); John Nichols (Director of 111) Apologies Alastair Mitchell-Baker (NED); Claire Carless (NED); Mike Hawker (NED) _________________________________________________________________________ 14/021 - Chairman’s Welcome and Apologies for Absence The Chairman welcomed all to the meeting, including the eight governors in attendance. He expressed his thanks both personally, and on behalf of the Board, to John Nichols who was attending his last SCAS Board meeting. Apologies were noted from Alastair Mitchell-Baker, Claire Carless and Mike Hawker. 14/022 - Declaration of Directors’ Interests No new interests were declared. 14/023 - Minutes of the Board meeting held in public on 28 May 2014 The minutes were approved without amendment. 14/024 - Matters arising from the Board meeting held in public on 28 May 2014 Steve Garside highlighted the one action from the last meeting which remained outstanding, explaining the plans to hold a workshop in October to look at workforce issues, including recruitment and retention. The Chairman advised that he did not consider action 3 (business case for purchase of DCA vehicles) to have been completed. He highlighted that he wished to see a comparison of vehicles purchased against the plan that was approved by the Board a couple of years ago, and then to understand what future purchases were required factoring in the Trust’s replacement policy. Action 14/024 Charles Porter and Sue Byrne to circulate a comparison showing vehicles purchased against the plan last approved by the Board, with details of the Trust’s future vehicle purchase plan (taking into account the approach to replacement).

14/025 - Chairman’s Report The Chairman highlighted his recent stakeholder engagement activity, including meetings with Chairs of those NHS organisations who had recently gone through the new Care Quality Commission inspection regime.


14/026 - Chief Executive’s Report The Chief Executive highlighted a number of key points from his report, including recent leadership development initiatives for staff, the mental health concordat action plan, and red 2 performance. Professor Williams stated that the failure to achieve red 2 performance in quarter 1 was disappointing and asked what had contributed to this. Sue Byrne provided an overview of the issues, including the surge in demand above planned levels, and the national shortage of paramedics. In particular, the Trust was now looking to pre-book private provider resource as, during quarter 1, this had not been done. The Board discussed demand management, noting that an academic study was to take place to look in greater detail at this. It was agreed that, more locally, the Trust needed to ensure that future commissioning contracts were more robust in terms of planning for greater levels of resilience. Keith Nuttall asked about long waits and Sue Byrne highlighted the various actions that were being taken, and which were already starting to be successful in NHS111. Deirdre Thompson added that every instance of a long wait was assessed to see whether this had resulted in patient harm, and this process could involve seeking direct feedback from the patient. The Board considered hear and treat performance, which was ahead of plan, and Sue Byrne advised that the introduction of NHS Pathways in the South has had a beneficial effect. Steve Garside tabled a paper and asked the Board to consider and approve three amendments to the Constitution which had already received governor approval. These changes, which were linked to the forthcoming governor election process, were approved, and the Board also supported a further proposed amendment which would clarify that an employee opting out of becoming a staff member could not then become a public member. Finally, the Board noted the latest equality and diversity report. Sharon Walters agreed to clarify the position in terms of the analysis of the workforce by sexual orientation as the breakdown did not add up to 100%. Action 14/026 Sharon Walters to clarify the workforce by sexual orientation data in the equality and diversity workforce report.

QUALITY AND PATIENT SAFETY

14/027 - Quality and Patient Safety Report The Board extensively discussed a range of quality and patient safety issues: • Deirdre Thompson highlighted the improving performance on both stroke and STEMI

against their respective trajectories, and advised that the Trust would continue to monitor closely.

• Sharon Walters advised that the Trust had reviewed its processes in response to the

Jimmy Savile enquiry and, whilst these were considered to be robust, further national learning was due to be released later in the year and this would need to be considered

• Deirdre Thompson gave an update on two additional SIRIs to those included in the

report, one relating to the death of a child and the other to a delayed response

• the Trust was performing well (third) on the national clinical performance indicator for single limb fracture, and was also third best nationally with a non-conveyance rate of 41%


• the Non Executive Directors asked for some further enhancements to the report in order for them to gain a greater understanding of issues and trends:

Action 14/027a Deirdre Thompson to ensure the following refinements to the next Quality and Patient Safety Board report:

o section 19 - the chart showing the total number of SIRIs to be extended to include a longer reporting period (e.g. a number of quarters)

o section 19 – the SIRIs relating to delayed responses to clarify whether these are

SCAS response only or may involve one of the Trust’s partner (e.g. private provider)

o section 20 - a breakdown of the NHS111 reported incidents to be provided o section 11 - actual performance to be shown for each month as well as the

trajectory in respect of the STEMI care bundle o section 21 – the number of RIDDOR incidents to be compared with other

ambulance trusts o section 31 – the 25 day complaints performance indicator to include actual data

only (i.e. remove the line for future months) o Appendix 1a/b – the variance between the total safeguarding referrals in the

North compared with the South to be explored and explained o Appendix 2 – the SIRI Group Summary Upward Report to include a ‘status’

column • in relation to RIDDOR incidents, Sue Byrne explained that these had been reviewed in

great detail by the Health and Safety Committee, including considering recurring themes. Whilst the Trust was keen to adopt an open reporting culture, her own view was that the number of incidents was high. She highlighted that risk assessment and investigation skills needed to be improved across the organisation. The Board asked Sue Byrne to consider the effectiveness of manual handling training as this was an area where incidents were occurring

• the Chairman noted the SIRI Review Group Upward Report, and the concern that had

been raised regarding call taker resilience in the EOC at times of high demand. He asked for further details, including the effectiveness of the action plan, to be provided at the next meeting

Action 14/027b Sue Byrne to provide an update on EOC call taker resilience at the next Board meeting.

• the Board noted the 2013/14 ambulance survey of hear and treat callers, and the

positive results for SCAS 14/028 – Quality and Patient Safety Assurance Review The Chairman provided an overview of the paper, which provided a status update on the Board assurance review. Ilona Blue noted that the paper reported that arrangements for leadership engagement walkarounds had been strengthened and asked what the position was in relation to action plans, as staff members on a recent EOC visit had questioned whether the comments they made were robustly addressed. Deirdre Thompson stated that this was a relatively new process and the Trust needed to become slicker in terms of reporting the outcomes of


leadership walkarounds to the Quality and Safety Committee. Ilona Blue responded that it was important for feedback to be given both to the staff making comments but also the NEDs receiving them. Action 14/028 Deirdre Thompson to ensure that a process is in place for feedback to be provided to both staff and Board members on matters that are raised during leadership walkarounds.

14/029 – Infection Prevention and Control, Safeguarding and Medicines Management The Board discussed each of the three 2013/14 Annual Reports. In terms of safeguarding, Ilona Blue asked whether obtaining feedback from local authorities on safeguarding referrals was included in the priorities for 2014/15. Deirdre Thompson explained that SCAS’ attendance at the various Safeguarding Board meetings helped provide an insight into the appropriateness of SCAS referrals but she would ensure this continued to be a priority area for the Trust. In terms of infection prevention and control, Professor David Williams asked how SCAS was addressing the challenge of hand hygiene. Deirdre Thompson outlined the work of Make Ready including the various provisions which are held on vehicles, and the use of water bottles. In terms of medicines management, James Underhay asked whether external audit was used to review the Trust’s arrangements. Deirdre Thompson responded that all of the audit scrutiny was from the in-house clinical audit team. Keith Nuttall noted that one of the workstreams for 2014/15 was to implement patient charging for the supply of PGD medicines. It was agreed that the actual implementation of such a proposed policy should be approved by the Board first. Action 14/029 The Board to approve implementation of any future proposed policy which charges patients for the supply of PGD medicines.

The Board APPROVED formal publication of the three Annual Reports. FINANCIAL AND INTEGRATED SERVICE PERFORMANCE

14/030 - Integrated Performance Report (IPR) The Board considered the three red rated elements in the IPR that had not already been discussed; complaints, cost improvement programmes, and HR (sickness and attrition). A number of issues were discussed: • complaints – the Board noted that the target had been amended by taking the prior-year

outturn and adjusting for the budgeted growth in activity. Staff attitude related complaints were discussed and Sue Byrne explained that each one was scrutinised in detail, with pressure of work not appearing to be a contributory factor

• cost improvement programmes (CIP) – these were marginally behind plan, with some

new schemes needed to cover the expected shortfall on the unsocial hours sickness payments CIP

• human resources – Sharon Walters discussed attrition, including recruitment and

retention initiatives for paramedics. Ilona Blue asked whether the Trust had looked at leavers in terms of trends for time in post. Sharon Walter explained that the quickest turnover was in NHS111, but that there was no particular trend for paramedics


As an aside, Charles Porter asked whether, in relation to NHS111, an excess of actual calls over the planned volume should be treated as green. It was agreed that he and Sue Byrne would consider this off-line. Action 14/030 Charles Porter and Sue Byrne to revisit the approach to setting, and RAG rating, a target for NHS111 call volumes.

14/031 - Finance and Estates Report The Board considered the month 3 financial position, Charles Porter explaining that cost improvement programmes (CIPs) were the main concern at this stage. He added that he remained confident the planned year-end position would be achieved both in terms of CIPs and income and expenditure. The Chief Executive highlighted the reference to “Mangar Elk” in the capital expenditure statement. John Nichols explained that this was non-standard kit (lifting cushion) which was generally found in response cars. Sue Byrne agreed that she would ascertain whether any of the other ambulance services used any alternative form of equipment. Action 14/031 Sue Byrne to investigate what alternatives are used to the Mangar Elk lifting cushions.

Charles Porter stated that the three main financial challenges, in addition to CIPs, were 999 and 111 performance (the financial implications) and the start-up costs for the new Hampshire PTS contract. STRATEGY 14/032 - Strategic Plan 2014-2019 Summary The Board noted the summary version of the 2014-2019 strategic plan, and James Underhay explained that it had been very well received by key stakeholders, including the Trust’s governors. REGULATORY, COMPLIANCE AND CORPORATE GOVERNANCE

14/033 - Monitor 2014/15 Quarter 1 Return The Board discussed the proposed quarter 1 return to Monitor, with Charles Porter advising that flagging a potential risk to red 2 and red 19 performance in quarter 2 was entirely consistent with the plan the Trust submitted at the start of the year. The Board APPROVED the proposed submission, subject to referring to the data security breach. On this matter, Charles Porter explained that the internal audit review had concluded that SCAS had made a robust response to the breach and that he had just been advised that the Information Commissioners Office would not be taking any further action. 14/034 - Board Development Update The Chairman provided an overview of the paper and updated on the latest position in terms of the approach and indicative timescales. The Board agreed in principle to the direction of travel outlined, and asked the Chairman to proceed with the board development work, with a firm proposal from the Thames Valley and Wessex Leadership Academy to be presented to the Board once available. Charles Porter declared that he had an interest insofar as being a member of the Thames Valley and Wessex Leadership Academy Board. He would therefore play no part in the commissioning of the Leadership Academy’s services. Action 14/034 The Chairman to circulate a firm proposal for Board development.


14/035 - Board Assurance Framework (BAF) The Board noted that the key risks in the BAF had already been discussed. In view of the update from Charles Porter on the data security breach, it was agreed that the nature and scoring of this risk should now be revisited. Action 14/035 Deirdre Thompson and Charles Porter to review the data security breach risk in light of the latest information (no further action by the ICO).

BOARD SUB-COMMITTEE CHAIR REPORTS

14/036 - Report from the Audit Committee, including progress with investigation into IG SIRI Ilona Blue provided an update from the Audit Committee meetings held on 28 May and 10 July, including in relation to Internal Audit’s review of the data security breach. 14/037 - Report from the Quality and Safety Committee Keith Nuttall highlighted the positive assurance the Quality and Safety Committee had received in respect of estates and fire safety management, and added that three quality related Trust policies had been ratified. The Board considered some proposed revisions to the Quality and Safety Committee terms of reference, and these were approved as presented, subject to: • monitoring whether the committee can effectively deliver its business in four meetings

per annum (as opposed to the previous six) • re-wording section 4.3 so that it is clear the quoracy requirements relate only to the

members (NEDs) of the committee (and not the Medical Director or Director of Patient Care)

Action 14/037 Deirdre Thompson to amend section 4.3 of the terms of reference for the Quality and Safety Committee such that it is clear that the quoracy requirements only apply to the members of the Committee (the three NEDs), but that either the Director of Patient Care or Medical Director needs to be present.

ANY OTHER BUSINESS

14/038 - Any Other Business No other items of business were discussed. 14/039 - Pre-notified questions from governors, Trust members, and members of the public No questions had been received for this particular meeting. 14/040 - Date and time of next meeting The next public meeting of the South Central Ambulance Service NHS Foundation Trust Board of Directors will be held on Wednesday 24 September 2014 at The Gateway in Aylesbury. 14/041 - Resolution by the Chairman To resolve that the representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1 (2) of the Public Bodies (Admissions to Meetings) Act 1060 refers).

SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST Agenda Item 4

TRUST BOARD MEETING IN PUBLIC 24 SEPTEMBER 2014

MATTERS ARISING FROM PREVIOUS BOARD MEETING IN PUBLIC (JULY 2014)

Public Board 24 September 2014 Page 1 of 4 Author: SG

No. Minute ref.

Agenda Item Action Resp Target Due Date

Comments/Outcome

1. 14/024 Matters arising Charles Porter and Sue Byrne to circulate a comparison showing vehicles purchased against the plan last approved by the board with details of the Trust’s future vehicle purchase plan (taking into account the approach to replacement).

SB/CP ASAP Action completed Circulated 16.9.2014.

2. 14/026 Chief Executive’s Report Sharon Walters to clarify the workforce by sexual orientation.

SW ASAP Action completed The breakdown is 71% heterosexual, 4% LGB, and 25% not disclosed.

3. 14/027a Quality and Patient Safety

Deirdre Thompson to ensure the following refinements to the next Quality and Patient Safety Board report: • section 19 - the chart showing the total number of

SIRIs to be extended to include a longer reporting period (e.g. a number of quarters)

• section 19 – the SIRIs relating to delayed responses to clarify whether these are SCAS response only or may involve one of the Trust’s partner (e.g. private provider)

• section 20 - a breakdown of the NHS111 reported incidents to be provided

• section 11 - actual performance to be shown for each month as well as the trajectory in respect of the STEMI care bundle

• section 21 – the number of RIDDOR incidents to be compared with other ambulance trusts

• section 31 – the 25 day complaints performance indicator to include actual data only (i.e. remove the line for future months)

• Appendix 1a/b – the variance between the total safeguarding referrals in the North compared with the South to be explored and explained

• Appendix 2 – the SIRI Group Summary Upward Report to include a ‘status’ column

DT 24/09/14 Action completed Refinements have been made to this month’s Quality and Patient Safety Report.





4. 14/027b Quality and Patient

Safety Sue Byrne to provide an update on EOC call taker resilience at the next Board meeting

SB 24/09/14 Action completed EOC have reviewed demand requirements until the end of the financial year and identified their headcount. A recruitment plan has been developed accordingly which will put EOC at full establishment during October although they will not be fully operational until the end of October. In the meantime the introduction of a virtual call centre functionality should improve productivity throughout October which then provide us with a small buffer going into peak winter months.

5. 14/028 Quality and Patient Safety Assurance Review

Deirdre Thompson to ensure that a process is in place for feedback to be provided to both staff and Board members on matters that are raised during leadership walkarounds.

DT ASAP Action ongoing The templates completed by Board members following leadership walkarounds are shared with Area Managers/Team Leaders, and reported through to the Quality and Safety Committee. Themes will then be reported through to the Board.





6. 14/029 Infection Prevention and

Control, Safeguarding and Medicines Mgt.

The Board to approve implementation of any future proposed policy which charges patients for the supply of PGD medicines.

The Board

As required

Action in hand Board approval will be sought should a proposal be made to charges patients for the supply of PGD medicines.

7. 14/030 Integrated Performance Report

Charles Porter and Sue Byrne to revisit the approach to setting, and RAG rating, a target for NHS111 call volumes.

CP/SB ASAP Action completed It has been agreed that call volumes will not be RAG rated.

8. 14/031 Finance and Estates Report

Sue Byrne to investigate what alternatives are used to the Mangar Elk lifting cushions.

SB ASAP Action completed The Mangar Elk is regarded as the best piece of equipment of its type available at the moment. SCAS is in the process of reviewing the risk assessment for the equipment because it can, where appropriate, be used by one person. The Trust currently has on order 130 further units so that it will be available for use on all front line vehicles.

9. 14/032 Regulatory, Compliance and Corporate Governance

The Chairman to circulate a firm proposal for Board development.

TJ ASAP Action in hand An update to be provided as part of the Chairman’s Report.

10. 14/033 Board Assurance Framework

Deirdre Thompson and Charles Porter to review the data security breach in light of the latest information (no further action by the ICO).

DT/CP ASAP Action completed This risk has been considered by the Executive Team as part of their overall review of the risk register and BAF.





11. 14/035 Board sub-committee

chair reports Deirdre Thompson to amend section 4.3 of the terms of reference for the Quality and Safety Committee such that it is clear that the quoracy requirements only apply to the members of the Committee (the three NEDs), but that either the Director of Patient Care or Medical Director needs to be present.

DT ASAP Action completed Terms of reference amended.

JB John Black CP Charles Porter JU James Underhay SB Sue Byrne DT Deirdre Thompson CC Claire Carless SG Steve Garside SW Sharon Walters

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ITEM 6

BOARD OF DIRECTORS PUBLIC MEETING 24 SEPTEMBER 2014

CHIEF EXECUTIVE’S REPORT

PURPOSE 1 The purpose of my report is to keep the Board abreast of key issues affecting

the Trust. TRAGIC NEW FOREST INCIDENT, 26 APRIL 2013 2 Board members will be aware that both Hampshire Constabulary and SCAS

have been carrying out investigations into the circumstances surrounding the tragic incident in the New Forest on 26 April last year.

3 As reported previously, the male driver of the car involved in the collision with

the ambulance vehicle was found not guilty on the charge of causing the deaths of staff member Gill Randall and patient Francis Ironside by careless driving.

4 Our own investigation has been carried out by an external, independent

Senior Investigating Officer, and the final report is due to be published imminently.

5 This was an extremely rare but tragic event and the organisation rightly set

out to respond in a thorough and open manner. 6 Our thoughts and sympathies remain with the families and all those affected

by this tragic incident. RESPONSE TIMES, PERFORMANCE STANDARDS, RESILIENCE & EFFICIENCY Operational, clinical and financial performance 2014/15 Quarter 2 to date 7 As can be seen from the Integrated Performance Report, performance on 999

was good throughout the month of August, with the Trust successfully delivering all three key national response time standards. However, levels of demand are proving to be extremely challenging and we are actively working to ensure we make the best use of our available resources. I will update on the latest quarter 2 position at the Board meeting.

8 I am delighted to report that performance on NHS111 has been very good

throughout August, with SCAS achieving the key targets across all of the contracts we are providing, despite considerable growth in demand.

9 In terms of finance, we achieved a small surplus for the month and are

retaining our forecast outturn of £0.5m, although there are some additional risks linked to achieving the required standards of operational performance.

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10 Performance on the eight national clinical indicators has been good in August; we successfully achieved six of these, but further improvement is particularly required on the STEMI care bundle indicator.

11 Further details in relation to the above can be found in the Quality and Patient

Safety Report, the Finance Report, and the Integrated Performance Report. CLINICAL OUTCOMES, PATIENT SAFETY AND PATIENT EXPERIENCE Care Quality Commission (CQC) inspection 12 The Care Quality Commission pilot inspection of SCAS, under the new A

Fresh Start for the Regulation of Ambulance Services approach, took place during the week commencing 8 September 2014.

13 I delivered my opening presentation to the full team of CQC inspectors on 9

September and this was followed by a comprehensive range of interviews and focus group meetings with Directors, staff and governors. Additionally, the inspection team have been visiting resources centres and other SCAS locations, and participating in crew ride-outs.

14 Initial verbal feedback has been highly positive, particularly in terms of our

staff and the commitment and care they show towards patients. We are currently in a period where the CQC can undertake further, unannounced visits and a final report is not due for a further six to eight weeks.

15 The CQC have advised that they will not be issuing an inspection rating for

this pilot. Transition to NHS Pathways 16 An Executive Gateway Project Review of the implementation of NHS

Pathways in the South was undertaken in July. As a result we have made a number of adjustments to our roll-out plans for the North, including in respect of training and resources. We therefore now expect to have full transition completed by the end of this month.

Electronic patient reporting system (ePR) 17 The pilot for ePR has now been completed, and fifteen vehicles across

Bletchley and Milton Keynes are live with the system. Staff have responded positively to the system and full support has been given via the project team, operations and the 24/7 helpdesk. Training is almost completed in Hampshire and the project is working with the operations team to confirm roll out dates. We remain on track to achieve full roll-out by April 2015.

PORTFOLIO OF COMMERCIALLY VIABLE NON EMERGENCY CONTRACTS NHS111 18 We are currently providing NHS111 services in Oxfordshire, Hampshire,

Berkshire, Buckinghamshire, and Bedfordshire and Luton. As mentioned earlier in my report, performance on the key quality and safety measures remains good, but we are looking at increasing our resources ahead of the winter period.

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Patient Transport Services (PTS) 19 As noted previously, we were delighted to be successful in our bid to provide

PTS in Hampshire from October 2014. This is for both lots of the contract: the call handling, co-ordination and management; and the actual provision of PTS. The contract runs for five years and although we have been providing some PTS in the area, this is a much extended contracted which consolidates all of the existing PTS service provision currently delivered by multiple providers into a single contract. Our mobilisation arrangements are being finalised and we are well on-track to commence the new service from next month.

LEADERSHIP, STAFF ENGAGEMENT AND WORKFORCE Student Paramedic Recruitment 20 In July, SCAS launched a new initiative to offer both internal staff and external

applicants the opportunity to train to become a paramedic. The 18 month programme is aimed internally at Technicians and Emergency Care Assistants and lasts for 18 months. It has been developed collaboratively with Oxford Brookes University in response to the increasing demand for paramedics and to increase the opportunity for career progression to staff.

21 The first applicants began their internal training in August, and will be

seconded to Oxford Brookes in January 2015. The programme will be offered again in January and September 2016 with 30 places available on each programme, the balance of places being for SCAS staff. This programme is in addition to the secondment opportunities already offered for September 2014 at Oxford Brookes and Portsmouth University.

Unsocial Hour’s Allowance Payments During Periods of Sickness Absence – National Agreement 22 A national meeting with trade union officials was held on 30 July to discuss

the potential and viability of the ambulance service moving from Annex E to Section 2a as an agreed methodology for Unsocial Hours Payments, in the same way as the rest of the NHS.

23 These discussions were helpful in that the national officials restated their

position that they could not agree any changes unless they received a mandate from their members, but agreed that this may be progressed through Trusts holding local non-prejudicial talks to gauge local opinion.

24 SCAS has therefore begun these discussions with local staff side

representatives through the joint partnership meeting (JCC). Outcomes from these meetings and other local meetings will be collected and discussed by the National Steering Group.

Potential industrial action 25 Following the government’s decision not to award a pay uplift to staff on

Agenda for Change contracts, NHS unions announced that they would consider their response. Unison, Unite, and GMB have now informed us that they are balloting their members on the possibility of taking Industrial action with regard to this issue.

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26 Union members are being asked to respond to 2 questions:

• Are they prepared to take part in strike action? • Are they prepared to take part in industrial action short of strike action?

27 The Unison ballot closes on 18 September, Unite on 26 September and GMB on 1 October. We are reviewing our contingency plans and communication plans in readiness should the ballot be in favour of industrial action and have begun discussions with our local union representatives through the joint partnership meeting, (JCC). Discussions will continue to ensure patients are not put at risk should the outcome of the ballot be for any industrial action.

Annual Staff Recognition Awards (‘AMBIES’) 28 Our 2014 annual staff recognition awards evening is taking place on the

evening of Friday 28 November 2014 as, once again, we look to recognise and celebrate the achievements of our staff. The award categories are:

• A&E person of the year • Commercial Services person of the year • EOC person of the year • 111 person of the year • Support person of the year • Volunteer of the year • Team of the year • Educator of the year • Governors Ambassador award • CEO’s commendation for outstanding service to the trust • Chairman’s special award

29 Nominations closed at the end of August and we have received a record

number of entries (over 150) with a spread across all the categories and the organisation.

GOVERNANCE, VALUE FOR MONEY AND FINANCIAL STANDING Monitor Continuity of Services ratings 30 We submitted our quarter 1 return to Monitor at the end of July, and our

provisional risk ratings have been confirmed as follows: • Continuity of services (financial sustainability) = 4/4 • Governance = Green

Information Governance Serious Incident Requiring Investigation (IG SIRI) 31 As reported previously, an IG SIRI was declared in April relating to a personal

data security breach. This involved the publication of staff personal data on the Trust’s public website. We commissioned an independent review by BDO (our Internal Auditors) and this confirmed that there was some learning for the Trust. It also highlighted some positive aspects to our IG arrangements, and reported that our response to the incident had been swift and robust. The

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Information Commissioners Office has advised that it does not intend to take any further action following our response to them.

PARTNERSHIPS AND STAKEHOLDER RELATIONSHIPS 32 We are currently engaged in a number of partnerships that are helping to

improve the services being provided to patients in the South Central region. These include:

• since completing a six month pilot in May 2014, the ‘24hr Labour Line’ at

the Emergency Operations Centre (EOC) in Southern House gives women in Hampshire telephone access to a midwife 24 hours a day when they go into labour. The joint venture between SCAS and Hampshire Hospitals NHS Foundation Trust has to date been a great success with over 1,600 calls taken in the first 8 weeks of operation.

• from November, we will be working collaboratively with Royal Berkshire

NHS Foundation Trust on a six week pilot study (‘Project Nucleus’) considering telehealth admission avoidance, alternative care pathways and social prescribing in the frail, elderly patient group. It will use telemedicine between SCAS crews in the home of the patient, linked with a senior Secondary / Out of Hours Urgent Care decision maker to facilitate admission avoidance / engagement with alternative care pathways.

Stakeholder engagement 33 In terms of major stakeholder engagement since the July meeting, the

Chairman, Medical Director and myself hosted a recent visit from the Chairman and Chief Executive of Oxfordshire Clinical Commissioning Group where our discussions included demand for services.

34 We have been holding engagement events for members who aspire to

become governors, with public and staff governor elections due to be held in November/December.

Media coverage 35 In terms of major media coverage since the July meeting, we have released a

number of press releases during times of service pressure (e.g. bank holiday weekends) to advise the public on how to appropriately use and access NHS services. This closely aligns to our #Summersafe campaign which has received attention in publications and radio and TV stations across our region. This campaign saw SCAS cascade messages via the press and Twitter which focused on key health messages during the summer period (e.g. water and heat safety).

36 We were delighted to showcase our new mobile simulation vehicle, the

“Simbulance”, for the first time with it being launched at Hampshire’s CarFest. Thousands of visitors to the show took the opportunity to take a look at this new valuable resource.

Will Hancock, Chief Executive, September 2014

BOARD MEETING IN PUBLIC 24 SEPTEMBER 2014

Agenda Item: 8

Details of the paper

Title

Quality and Patient Safety Report

Responsible Director

Deirdre Thompson, Director of Quality and Patient Care

Recommendation (eg. note, approve, endorse)

The Trust Board is asked to receive and note the report

Links to SCAS Business & Risks

Strategic theme to which the paper relates (please mark in bold)

To deliver clinical excellence by improving clinical outcomes

To achieve operational excellence

To deliver effective stakeholder relationships

To deliver sound governance, VFM & financial standing

To deliver leadership, staff engagement & a learning culture

To develop the portfolio of commercially viable non emergency commercial contracts

Please provide details of the risks associated with the subject of this paper

All clinical risks are detailed in the Trust Corporate Risk Register and Integrated Performance Report that link to the quality work streams. Key issues and risks that are outlined in the paper are BAF risks: 1.2, 1.3, and 1.5

Implications

Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards, competition law etc) All quality related work streams aid and enhance compliance with the CQC essential standards. Information provided in this paper provides evidence of compliance.

Financial implications / impact (e.g. CIPs, FRR, year-end outturn) There are no direct financial implications.

Council of Governor implications / impact (e.g. links to governors statutory role)

Quality and Patient Safety work streams are shared with commissioners through the Quality Schedule in the contract and stakeholders through regular updates and meetings and performance shared through the Integrated Performance Report.

Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

Links to all elements of NHS constitution of patient and staff rights.

Other

Previous considerations by the Board

Quality and safety report is presented at every board meeting and quality accounts were presented to the Council of Governors.

Audit Committee July 2014 review of BAF and Risk Register

Quality and Safety Committee June 2014 Background papers / supporting information

Berwick (2013) A promise to learn – a commitment to act. Improving the safety of patients in England. National Advisory Group on the Safety of patients in England. London.

Care Quality Commission Guidance about compliance: Essential Standards of Quality & Safety

Care Quality Commission (2012) Guidance about compliance: Judgement Framework

Department of Health (2012/13) The NHS Outcomes Framework

Monitor (2013) Quality Governance. How does a board know that its organisation is working effectively to improve patient care.

Monitor (2013) The NHS Foundation Trust Annual Reporting Manual 2013/14

National Quality Board (NQB) (2012) Quality in the new health System

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QUALITY AND PATIENT SAFETY REPORT

PURPOSE

1. This report provides the Board with information, updates and assurances on progress with work streams to maintain clinical excellence and high standards of care for our patients.

2. Details and information on the delivery of performance can be found in the

Integrated Performance Report.

3. Following on from an initial executive summary highlighting the key issues and updates, the report follows on with updates for the three dimensions of quality: • Patient Safety • Clinical Excellence • Patient Experience

4. The report outlines figures, narrative and actions taken in regard to risks

identified through incidents and work streams and in the corporate r isk reg is ter and Board Assurance Framework (BAF).

EXECUTIVE SUMMARY, KEY ISSUES AND UPDATES

A) Stroke trajectory (“FAST means Fast”) – BAF Risk 1.2 April May June July Aug Sept Oct Nov Dec Jan Feb March

48% 50% 52% 53% 54% 56% 57% 58% 59% 60% 61% 63% 55.2% 55.9% 55.1% 60.3% 59.3% B) STEMI trajectory

C) Evidence of learning from complaints, claims, incidents and coroners rulings

5. SCAS recognises the importance of learning from all feedback, claims, incidents, errors and coroner’s rulings and can demonstrate a number of initiatives and strategies for sharing learning individually and organisationally as described in an aggregated learning report presented at the August 2014 Quality and Safety Committee. See link below:

April May June July Aug Sept Oct Nov Dec Jan Feb March 69% 70% 71% 72% 73% 74% 75% 76% 77% 78% 79% 80% 72.8% 71.3% 72.64% 64.8% 67.3%

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http://www.southcentralambulance.nhs.uk/_assets/board/meeting%20agenda%20and%20papers/2014-15/learning%20from%20incidents%20and%20coroners%20reviews.pdf 6. The report demonstrates learning and actions taken from incidents, claims,

complaints and coroners rulings in a triangulated way. As well as evidencing the learning strategies shared and used, the report will mature into developing themes

Some of the learning strategies SCAS deploys include (although not exclusively):

• face to face training • Elearning modules • individual performance reviews and 1to1’s • reflective practice • clinical supervision with mentors • policy review • email reminders • Clinical Directives • Clinical memos • SCAScade learning tool to all staff • Staff Matters articles

7. Going forward SCAS will continue to develop systems that support the learning

processes, end to end reporting and compliance to improve patient safety and outcomes within the organisation.

D) Annual Report Patient and Public Experience 2013/14

8. An annual report on SCAS Patient and Public Experience 2013/14 was presented to the Quality and Safety Committee in August 2014. The report highlighted workstreams throughout 2013/14 to enhance patient experience and how we learn and act on all types of feedback. See link below:

http://www.scas.nhs.uk/_assets/board/meeting%20agenda%20and%20papers/2014-15/annual%20report%20-%20complaints%202013-14.pdf 9. The report demonstrated the range of feedback mechanisms and how SCAS

utilises that to inform learning organisationally and locally. SCAS introduced the DATIX complaints module for recording complaints and concerns and introduced the early implementation of the Friends and Family test in 2013/14.

10. The report also outlined the activity around the patient survey plan including

our participation in the National Ambulance Hear and Treat Survey as well as our low number of contacts with the Parliamentary Health Service Ombudsman.

http://www.southcentralambulance.nhs.uk/_assets/board/meeting%20agenda%20and%20papers/2014-15/learning%20from%20incidents%20and%20coroners%20reviews.pdf



http://www.scas.nhs.uk/_assets/board/meeting%20agenda%20and%20papers/2014-15/annual%20report%20-%20complaints%202013-14.pdf

http://www.scas.nhs.uk/_assets/board/meeting%20agenda%20and%20papers/2014-15/annual%20report%20-%20complaints%202013-14.pdf

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PATIENT SAFETY

A) Safeguarding Activity YTD (children and adults)

11. SCAS has had a difference in the referral rates between the North and South

regions consistently for several years. This was unexplained and despite several attempts to understand the differences, such as audit of quality, no reason could be found. The data was then reviewed based against population for each of the CCG which illustrates the position.

12. This shows that in fact the south has more referrals per 1,000 populations than the north however it is within a steady range with the exception of Southampton and Portsmouth which are significant spikes.

13. SCAS has been working closely with the Chief Quality Officer for Fareham and

Gosport and South East Hampshire CCG’s to complete the actions resulting from recommendations following a peer review that SCAS had as part of a national peer review program and also some concerns that had been raised by CCG’s. A meeting was arranged to review progress on the 6th August 2014 and the Chief Quality Officer has now signed off the actions and sufficient assurance has been gained for the special measures to be withdrawn and for the CQRM to continue to monitor safeguarding as business as usual.

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B) Serious Incidents Requiring Investigation (SIRI)

14. Since the last report to the Board, SCAS has reported two SIRIs in July and one in September 2014. The details of these are below.

Incident Date

SIRI Number Status

15/5/2014 2014/22452 Open Child Death Grade 1 5 year old girl collapsed as she left school with her Mother. Crew found her unconscious and with no palpable pulse. Crew initiated basic life support and provided cardio pulmonary resuscitation, but decided against providing defibrillation for ventricular fibrillation. Patient conveyed to Hospital by Ambulance and at the Hospital they continued the resuscitation but patient later declared dead.

19/5/2014 2014/24273 Open Ambulance Delay Grade 1 The patient was a 45 year old female domestic abuse victim with mental health and drug abuse problems. She was found having taken an overdose by her ex-partner who called '999'. The call was graded as a social domestic problem and given a low priority. The CSD did not intervene until 2 hours after the call. A DCU arrived some 2 hours after the call and found the patient in cardiac arrest, from which she did not recover.

8/09/2014 2014/29620 Open Grade 1 SCAS double crewed ambulance – Ambulance Technician and an ECA responded to a 999 call to a 64 year old male adult. The incident had come through to the ambulance service as a “Fall/head injury”. The ambulance responded and was with the patient within 5 minutes of the call having been received. The patients’ previous medical history revealed that he had suffered a myocardial infarction approximately 5 weeks previously. It is reported that the patient had requested to be transported to hospital as he (patient) felt he was not coping at home. The patient was a known diabetic patient and was also having renal dialysis – of which he was due to have treatment that afternoon. The crew remained with the patient for just under an hour, treating some abrasions sustained in the fall – which the patient stated was from a ‘slip’ and not any other cause. ECG was completed which showed cardiac changes – this information was not acted on and the patient was left at home. GP Triage / ECP visit or Vulnerable Adults forms were not attempted /completed. At 11:12, the same day, SCAS received a second call to the same address. It was found that the patient was in cardiac arrest. The patient died.

15. Since the last report, SCAS has closed down three SIRIs, for further details

please see table below. Total number of SIRIs between September 2013 and August 2014

16. The total number of SIRIs reported by SCAS between September 2013 to August 2014 was 18. However, one of these was downgraded from being a

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SIRI. Therefore, there were 17 SIRIs in this period. Of these, 10 have been closed and seven remain open.

C) Incidents reported in July and August (Quarter 2) 2014/15

Incidents reported in July and August of Quarter 2, 2014/15 Category July 2014 August

2014 Total

111 20 0 20 Bully and Harassment 2 5 7 Clinical 34 66 100 Control of Infection 8 8 16 Equipment 22 17 39 Estates 5 3 8 Feature Request 10 17 27 Fire 1 0 1 Ill Health 3 1 4 Information Governance 3 1 4 Inter-Agency: Clinical 55 55 110 Inter-Agency: Non-Clinical 4 7 11 Medication 25 24 49 Mental Health 2 0 2 Office Information Technology 2 1 3 Operational 27 28 55 Operational Radio & ICT 3 2 5 Patient Abuse/Aggression (by staff/third party)

0 1 1

Patient Self-Harm 1 1 2 Personal Accident 71 48 119 Physical Assault 5 9 14 Security 4 9 13 Staff Abuse/Aggression (by patient/third party)

11 20 31

Vehicle 29 13 42 Welfare 3 9 12 Total 350 345 696

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Total number of Incidents reported between September 2013 and August 2014

17. The total number of incidents reported between the 1/9/13 and the 31/8/14 was 4,102. For further details of these incidents, please see the chart below.

D) Further review into the top three sub-categories of 111 incidents reported in Quarter 1 of 2014/15

18. Of the 121 incidents reported and categorised as 111 incidents in Quarter 1, the top three sub-categories were:

• Ambulance Crew Feedback (56) • Operational Issue (25) • Clinical (18)

111 – Ambulance Crew Feedback (56)

19. Most of the incidents in the sub-category of Ambulance Crew Feedback involve staff reporting that the 111 Call takers had inappropriately requested an ambulance resource, often on blue lights, to patients who did not require this type of response.

20. However, in 10 of the incidents investigated it was also identified that the

response of 111 in requesting an ambulance resource had been appropriate. 111 - Operational Issue (25)

21. Most of the incidents in the subcategory were miscellaneous and consisted of:

• Seven incidents about calls building up in 111 resulting in patients waiting longer to be dealt with.

• Two incidents involved discussions about the geographic area the patient was in and who should be providing patient care.

• Two incidents were about the opening times of surgeries/health centres and the resulting delay in providing care to patients.

• The remaining incidents were miscellaneous and consisted of a phone number not being taken correctly resulting in a delay in contacting the patient;

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the telephone/ICAD system ‘freezing’ resulting in the ICAD system having to be restarted for each user; a GP Surgery not taking a call form 111.

111 - Clinical

22. Most of the incidents in this sub-category were miscellaneous and consisted of:

• Two incidents involved 111 classing the calls as non-emergency response when an emergency response was required.

• Conversely, there was one incident where 111 classed it as an emergency response when an emergency response was not required.

• Delay in clinicians calling patients in a period of high demand with some staff being off on sick leave.

• Calls being passed between 111 and one of the OOH service resulting in a delay in responding to patient.

• 111 Call Hander did not pass a call requiring a clinical response to a clinician • 111 Clinician did not follow correct procedure resulting in a delay to providing

care and treatment to a patient.. • GP surgery did not pick up calls from 111 or patient.

E) RIDDOR incidents reported in Quarter 2 of 2014/15

23. There were 9 incidents reported to the Health and Safety Executive (HSE) in July and there were 6 incidents reported in August. Therefore, the total number of incidents for the two months is 15. When comparing the number of incidents reported for the same period last year, it can be seen that there were 4 incidents in total reported to the HSE in July and August 2013. This is a direct result of ensuring that the process for reporting these incidents is robust, with a focus going forward on learning to reduce these types of incidents. For further details, please see the table below.

Total number of incidents reported to the HSE in Quarters 1 and 2 of 2013/14 and 2014/15 Month and Quarter Number of

incidents reported to HSE 2013/14

Number of incidents reported to the HSE 2014/15

Quarter 1 April 5 10 May 0 5 June 2 5 Quarter 1 Total 7 20 Quarter 2 July 3 9 August 1 6 September 8 0 Quarter 2 Total 12 15

Details of RIDDOR incidents reported in July and August of 2014

24. In quarter 2 of 2014/15, there were 15 incidents reported to the Health and Safety Executive (HSE) in accordance with the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1995.

25. These incidents consisted of patient handling, manual handling, road traffic

collisions and miscellaneous incidents.

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26. All incidents involved staff sustaining injuries resulting in them either being off

work for over seven days (not including the day of injury) or being unable to carry out their full range of duties for over seven days.

27. Six of these incidents were patient handling incidents and consisted of:

• One incident involved a staff member sustaining musculoskeletal injuries

when carrying a patient over a long distance on a scoop stretcher over rough terrain.

• One incident involved a staff member sustaining musculoskeletal injuries when assisting in the lift of a 16 stone patient up steps on a carry chair. No other practical route/means for lift was possible.

• One incident involved a staff member sustaining musculoskeletal injuries assisting a patient up from the floor to their bed.

• One incident involved a staff member sustaining musculoskeletal injuries when assisting in the lift of a 20+ stone patient on a Southampton sling.

• One incident involved a staff member sustaining musculoskeletal injuries when preventing a large patient from falling from their bed.

• One incident involved a staff member sustaining injuries when assisting in the extraction of a fitting patient from a vehicle in restricted surroundings.

28. Three incidents were manual handling incidents and consisted of

• A staff member sustaining musculoskeletal injuries when lifting a response bag up from the floor to the ambulance.

• Two incidents involved staff members sustaining musculoskeletal injuries when lifting boxes.

29. Four incidents were miscellaneous and consisted of:

• Two incidents involved two individuals trapping their fingers when closing vehicle doors

• One incident involved a staff member sustaining ligament injuries when accidently caught by a patient’s arm.

• One incident involved a staff member sustaining a needlestick injury when a patient, having a hypoglycemic episode, lashed out with their leg and caused the staff member to jab themselves with a needle/syringe combination that they were disposing of into a sharps bin.

30. Two incidents involved staff members sustaining injuries following road traffic

collisions and consisted of:

a. Staff member sustained injury to their neck when their stationary vehicle was struck from behind by a third party.

b. Staff member sustained right shoulder injuries when a vehicle pulled into the side of the ambulance while on blue lights.

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CLINICAL EFFECTIVENESS

Actions Taken

31. The Risk Team and the Training Department have reviewed these incidents and the Training Team is using information about the causes of incidents to inform future manual handling training.

32. The Area Managers whose staff have been involved in these incidents are

invited to present the details of the investigation, the actions taken to prevent recurrence and the learning from the incident to the Health, Safety and Risk Group.

RIDDOR Incidents reported between September 2013 and August 2014

33. The total number of RIDDOR incidents reported to the HSE between September 2013 and October 2014 was 110.

A) Clinical Outcome Measures

34. The table below shows the performance ACQI’s for all of the English ambulance Trusts for the full year 2013/14. SCAS has performed in the upper quartile for 5 out of the 8 indicators, North East matching the performance and only London achieving greater with 6 out of 8. SCAS has achieved the greatest number of 1st positions.

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Ambulance Clinical Quality Indicators 2013/14 Year End Upper Quartile Rating

Clinical Quality

Indicator Units East

Midlands East of

England Great

Western Isle of Wight London North

East North West

South Central

South East

Coast South

Western West

Midlands Yorkshire

STEMI - Care % 76.8 84.6 - 78.5 74.6 85.9 85.3 68.0 78.3 89.6 75.7 82.8

Stroke - Care % 97.3 96.0 - 97.8 95.0 98.5 99.4 98.4 92.3 97.4 94.3 96.6

STEMI - 60 % - - - - - - - - - - - - STEMI - 150 % 94.2 88.6 - 71.4 92.5 89.2 88.9 89.9 92.3 81.4 89.0 86.5

Stroke - 60 % 60.8 52.9 - 65.3 65.8 75.5 75.3 42.6 65.1 55.6 58.7 64.1

ROSC % 16.2 21.6 - 19.7 31.1 24.6 28.3 37.8 30.9 24.6 23.3 23.6 ROSC - Utstein % 33.7 42.3 - 53.6 58.4 60.3 45.9 43.1 51.0 45.6 36.7 47.8

Cardiac - STD % 5.5 6.5 - 6.8 9.3 6.7 8.6 19.4 7.5 10.2 7.4 10.3

Cardiac - STD Utstein

% 19.2 19.6 - 21.4 30.3 31.3 22.3 37.5 20.2 29.1 21.6 32.5

Rag key 1st 2nd 3rd 4th If highlighted represents within upper quartile

35. Of the three indicators that SCAS are not in the upper quartile two, STEMI

Care Bundle and Stroke 60 have had significant focus and are starting to show improvements following an Operations Directorate campaign to make crews aware of the time critical element of getting patients to the HASU in 60 minutes. Progress on the STEMI analgesia administration has been slower but focus and training has been applied. The third indicator is the ROSC Utstein comparator where SCAS has achieved 8th and is in the middle of the performance range, however in April SCAS recorded 57.5%. This indicator has low monthly numbers making the figures rise and fall significantly with only 154 cases for the entire year.

36. The Clinical Directorate are following several work streams to improve

performance and enhance clinical care; • New Patient Group Directions • Introducing intravenous paracetamol for children • Extending use of tranexamic acid to children • Medicines resources to answer questions – including ‘Ask Ed’ video • E-learning for new PGDs developed • Developing phone advice for End of Life patients to enable administration of

their own medicines • We work closely with our Private Provider’s to ensure that they are aware of

our procedures, with a focus on clearing more quickly at hospital and starting their shifts in the right place

• Clinical supervision with our staff which makes them more confident to make non-conveyance decisions thereby reducing demand on hospitals and improving the patient experience

PATIENT EXPERIENCE

A) Parliamentary and Health Service Ombudsman (PHSO) 2014 – 2015

37. PHSO has now changed the process for complaints referred to them to ensure

that a robust review is made of all unresolved concerns. Previously a request for a file would be made for review and then later confirmation provided

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whether a case would be investigated or not. Changes mean that all referrals must now be fully investigated following a formal request for a file; these changes have therefore provided a significant increase in cases identified as being investigated for this year against 2013-2014.

SCAS PE Ref Service Area Current Position PE 1323 SEH 999 Waiting decision PE 1070 NW 999 Waiting decision BEC 014 NW 999 Waiting decision PE 1454 PTS MK Closed – upheld and actions for SCAS

identified as follows: - apology to complaint for delay in

responding and management of complaint by investigating officer;

- production of new SOP for discharge of patients from hospital units by PTS and confirmation when complete to complainant and PHSO;

- professional training in the investigation of complaints for operational managers of the PTS department and confirmation when complete to complainant and PHSO;

EOCC 022 EOC N Waiting decision HS-189255 NHSD Legacy Closed – not upheld

38. There are 2 outstanding Ombudsman cases in the NHS Direct legacy

handover B) The Friends and Family test (FFT)

39. On the 25 May 2012, the Prime Minister announced the introduction of the ‘Friends and Family Test’ to improve patient care and identify the best performing hospitals in England. The introduction of the test was based on recommendations from the Nursing and Care Quality Forum who also made a number of other proposals after consulting frontline nurses, care staff and patients. The Friends and Family test (FFT) was introduced to acute trusts in 2013/14 with monthly reporting to Unify. For ambulance trusts there is currently an early implementation CQUIN scheme which SCAS signed up to.

40. On 21st July 2014 NHS England wrote to CEO’s (Publications Gateway ref:

01946) and published updated guidance on FFT based on a review to date. The following guidance for ambulance services was issued:

1. Ambulance services are required to ask the FFT to all 999 patients not

conveyed and all users of PTS. 2. (NOT required to ask hear and treat or conveyed patients)

41. SCAS currently collects FFT information from:

• All PTS patients (postcards) • FT members • 111 Satisfaction surveys • CSD surveys • Direct real time feedback through a new survey approach called WIGFY

(Was it good for you?)

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• Other adhoc surveys as per annual plan • Staff

42. SCAS are currently considering a number of options to meet the requirements

including text messaging, postcards, social media and the website. The National Patient Experience Group for Ambulance services are working together to attempt to standardize approaches in order that benchmarking is possible in relation particularly to reach groups such as children, those with mental health problems and dementia patients.

C) WIGFY – real time face to face feedback.

43. Gathering real time feedback from patients using the 999 ambulance service is a challenge. Our Quality Account priority 3c was to gain real time face to face feedback in A&E departments from patients who used the 999 service and ask the FFT question. A template for recording these interactions has been developed called WIGFY – ‘Was it good for you?’ The surveys began in quarter 2 and to date and have received positive feedback from patients. All of those surveyed so far would be extremely likely to recommend SCAS to friends and family. All patients reported feeling safe and well cared for and appreciated being asked.

44. Further comments included: “I was kept well informed”; “I had a quick

response”; “caring staff”.

45. This will be relatively low in numbers of surveys but rich in qualitative data going forward.

D) Patient Experience data - Month 4 2014 – 2015

Total Numbers for Trust

July 2014 – 2015

July 2013 - 2014

v 2013-2014

Complaints

48

28

+ 71%

Concerns/Comments

69

95

- 27%

Compliments

108

67

+ 61%

Total PE Issues

225

130

+ 73%

PE Issues / themes by Service COMPLAINTS E&U Ops EOC 111 PTS TOTAL Clinical Care 8 0 2 0 10 Staff Attitude 7 0 2 0 9 Delay/Non Attendance 2 10 1 11 24 Patient Care 0 0 0 3 3 Driving Standards 0 0 0 0 0 Communications 0 0 0 2 2

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Safeguarding 0 0 0 0 0 Other 0 0 0 0 0 TOTAL 17 10 5 16 48

CONCERNS/COMMENTS E&U Ops EOC 111 PTS TOTAL Clinical Care 11 0 3 0 14 Staff Attitude 11 0 2 3 16 Delay/Non Attendance 1 11 2 9 23 Patient Care 1 0 0 0 1 Driving Standards 5 0 0 3 8 Communications 2 0 2 0 4 Safeguarding 0 0 0 0 0 Other 3 0 0 0 3 TOTAL 34 11 9 15 69 COMPLIMENTS E&U Ops EOC 111 PTS TOTAL Care and Kindness 64 0 2 1 67 Professionalism 34 3 3 1 41 Positive Attitude 0 0 0 0 0 TOTAL 98 3 5 2 108 Trends in Complaint Category 2014 – 2015

0

5

10

15

20

25

30

Mon

th 1

Mon

th 2

Mon

th 3

Mon

th 4

Mon

th 5

Mon

th 6

Mon

th 7

Mon

th 8

Mon

th 9

Mon

th 1

0

Mon

th 1

1

Mon

th 1

2

Cl inical Care

Staff Attitude

Delay/Non Attendance

Patient Care

Driving Standards

Communications

Safeguarding

Other

Action/Outcome – relates to June 2014 111 Additional training and support provided to call handler, whose performance will

be monitored by manager. Call handler will receive feedback and performance will be monitored through regular audits.

EOC Clinician completed a reflective practice of call which could have been handled in more empathetic manner. Audit noted clinician’s manner was abrupt. Clinician been advised of manner they came across and will review call.

Ops Member of staff will be debriefed on this incident and his manager will offer advice and guidance for future practice in the form of a formal action plan to ensure

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adherence to the standards of care expected from him. Driver has been suspended from driving RRVs for 3 months. Paramedic to reflect on his actions and how his tone could be perceived as being rude. Internal investigation by ESM which could lead to disciplinary action. Both members of staff to undergo some clinically supervised shifts with a Clinical Mentor.

PTS Member of staff has been given a verbal warning and been reminded of SCAS policy. Will be given a formal warning if any recurrence.

RECOMMENDATIONS TO THE BOARD

D) The Trust Board is asked to receive and note the report.

Deirdre Thompson, Director of Patient Care, September 2014

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Appendix 1-Safeguarding referrals July and August 2014 Adults North Total 571 South Total 244 Physical Abuse 122 Sexual Abuse 16 Emotional / Psychological Abuse 142 Financial / Material Abuse 89 Neglect & Acts of Omission 693 Discriminatory Abuse 13

Children’s North Total 197 South Total 83 Physical Abuse 59 Sexual Abuse 14 Emotional / Psychological Abuse 68 Financial / Material Abuse 5 Neglect & Acts of Omission 209 Discriminatory Abuse 0

Appendix 2 - Summary Upward Report from the SIRI Review Group held on 6th August 2014 Summary Upward Report

Upward reporting from the SIRI (Serious Incidents Requiring Investigation) review Group to the Quality and Safety Committee Issues identified by the SIRI review group held on 6Th August 2014 Topic Issue Action Taken/Person

responsible/Timeframe Items with issues not achieved/ compliant

1. None to escalate this meeting

Areas of concern/risk

2. Process for CCG’s to close SIRI’s on STEIS

Thames Valley commissioners have proposed a different structure to the current procedure for lead commissioners at Fareham and Gosport CCG to close SIRI’s. SCAS have responded formally as TV wish to conduct their own SIRI closure meetings. This poses a risk in delaying closure and a risk to SCAS reputation if SIRI’s are delayed as open on STEIS.

Thames Valley CSU to write formally to SHIP commissioners and agree a process. (by end August 2014) SCAS await further clarity regarding who and how the CCG's for SHIP and TV intend to formally sign off the 999 SIRI's that are recommended by our SIRI review group for closure.

3. MOD reporting incidents onto STEIS

If a serving member of the armed forces is a patient involved in a SIRI the MOD are not able to load the incident onto STEIS.

Southern CSU and SCAS continue to work with partners to ensure incidents are reported. SCAS to attend further meetings in the South CCG’s to ensure incidents are reported and investigated. The group await an update from the CCG regarding how these incidents will be managed in the future notwithstanding that the MOD are not able to log incidents on STEIS.

Items for awareness / assurance

4. SIRI regarding a child death in Berkshire – learning lessons quickly.

The group have discussed the investigation to date of a young child who died after a cardiac event. The child was attended by 2 land crews and Helimed 24. There has been immediate actions taken to ensure the child’s mother has been involved through a face to face meeting, staff involved are supported and lessons learned. The full report will be completed in September 2014.

Resus council guidelines on defibrillation where VF is present to be reissued to staff. The case has been discussed for shared learning purposes at the joint AA Clinical Governance meeting. Reflective practice is being undertaken by all involved. SCAS are working with the child’s family to lobby for AED’s in schools.

5. Safeguarding Serious Case Reviews/Domestic Homicide reviews.

SCR’s are a routine agenda item on the SIRI review group agenda. SCAS currently has 10 reviews ongoing of which 5 cases require an IMR (Independent Management Review). Any actions will be reported to the group and monitored through the Patient Safety Group. All reports regarding these reviews have a vigorous, stepped, quality assurance process applied of internal review.

Safeguarding lead is working through the development of an anonymised report for the meetings in future (October 1st 2014) and with the Head of Risk to enable safeguarding cases/concerns to be stored on Datix.

Best Practice / excellence

6. Turning recommendations into SMART actions which can be audited, collated and monitored.

Currently SCAS SIRI reports provide a lessons learned through recommendations template. Actions therefore needed to clear with accountability and responsibility visible. The group agreed an action plan template to be used in every report with all actions being monitored through the Patient Safety Group.

Immediate use of action plan template.

Agenda Item: 9



Title Operational Performance Progress Report

Responsible Director Sue Byrne, COO

Recommendation (eg. note, approve, endorse) To note the content










Maintenance of essential standards of care for patients Failure to deliver financial plans and strategic aims SCAS contractual arrangements with commissioners of its services

Implications Regulatory and legal implications / impact (e.g. Monitor provider licence and continuity of services risk ratings, CQC essential standards, competition law etc)

Contractual penalties as a result of failure at contractual levels Monitor and CQC monitored standards

Financial implications / impact (e.g. CIPs, FRR, year-end outturn)

Delivery of Trust budget Financial penalties from commissioners CIP’s programme

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc)

Operational performance issues are discussed at each Council of Governors meeting.


Other Previous considerations by the Board

Operational performance covered at every meeting as part of the IPR

Background papers / supporting information N/A

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OPERATIONAL PERFORMANCE PROGRESS REPORT

PURPOSE

1 The purpose of the paper is to provide oversight of the key opportunities and issues affecting SCAS operations. It will outline the possible impact of the issues and summarise the actions that the operational team are taking.

EXECUTIVE SUMMARY

2 This report aims to give a brief overview of operational performance year to date across the operational directorate including EOC and 111 highlighting challenges, project work and where appropriate improvement plans. The report gives some insight into the challenging environment in which it seeks to achieve all operational targets.

KEY ISSUES Activity and Demand

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3 Demand is significantly higher year on year and above the long term forecast.

Our short term forecast has been more accurate but we have been unable to resource to meet that demand. As can be seen the pattern is completely different to that of the prior year where demand significantly decreased following the winter period. This year the demand reached winter peak levels. This has impacted our ability to deliver our targets in all areas, in particular red 2 which contains the biggest proportion of red incidents.

As of w/e 7th September the position was as detailed below:- Red 1 Red 2 Red 19 Q1 78.84 74.17 95.88 Q2 75.87 74.52 95.75

4 The key learning from this is that we need to secure private providers early

even in our forecasted quieter times to attain the levels of resourcing and dependability that we achieved over the winter period.

Implementation of NHS Pathways (NHSP) 5 The implementation of NHSP into EOC has been taking place during the first

half of the year. The project was specifically designed so that we could phase it in gradually, believing that one of the likely outcomes would be an increase in red demand. The project proposal suggested that we would retain the growth to less than 10% and this has been achieved throughout by managing the rollout and pausing further rollout until issues were understood and under control.

6 Red calls however have increased from an average of 27% to 35%, although

initially that impact was greater although not across the whole of SCAS. Our call profile therefore has significantly changed with many more calls requiring

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an eight minute response. Continued work is being undertaken to improve our performance but it can be seen that this continues to reduce.

7 However at the same time our hear and treat rates have increased from 4%

to 5.6% in August. Whilst see and treat has declined slightly but remains at 42.2 vs target for the year of 42%.

Indirect Resources 8 A reorganisation of the IDR team has taken place in the first few months of

the year. Creating a national lead and team for delivery of services and a development lead and team for development which encompasses Public access defibrillators, community engagement and training and public access defibrillators.

9 Our analysis has identified significant opportunities to grow our CFR schemes

and 42 potential areas have been highlighted for development. 8 of these schemes have already been started and 36 new CFRs have been trained.

10 Work continues with our Fire Service colleagues to grow co-responding

teams and we are currently running two pilots (Oxford, Buckinghamshire) to further support our Thames Valley performance.

11 However it is worth noting that although we are now deploying CFRs more

than ever before unique contribution is down from prior year levels. There are two primary reasons: • NHSP has increased despatch lengths, although this has improved over

the implementation. This was highlighted as one of the concerns from the original paper but it was felt that this could be kept under control. There has undoubtedly been some impact and the team have been working dynamically to correct performance, enhance and adjust process. The main impact of this change however has been felt within IDR resources unique contribution where slower despatching on instances which are not quickly identified as requiring 8 minute responses meant that IDR weren’t reaching patients in time.

• Fire Co-responder teams in Hampshire have in recent years provided a

significant amount of responding in the Hampshire area. This has declined by 20%. We have been investigating this and working with the fire service to improve.

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Rural Performance

12 Comparative Urban and Rural performances are reviewed with CCG’s each month and SCAS has noted that there is a strong desire to deliver a more equitable service across the whole of our area whilst recognising that an equal service is probably not affordable. Whilst there is no obvious improvement in results and rural performance lags behind urban performance, and during a period where we have been experiencing high demand you would not necessarily expect to see an improvement.

13 However what can be seen is that responses for urban, semi urban and rural

locations have stabilised and SCAS is now producing a more reliable result. This should provide a firm basis on which we can seek to build performance so that there is less disparity. We will seek to improve this further with the expansion of CFR schemes in rural areas and to continue with our very successful campaign to place more defibrillators in villages and train the community to use them. However, without significant investment by commissioners in resources it will not be possible to give complete equality.

111/EOC 14 Both services have experienced significant increase in year on year demand.

111 and has struggled since April to achieve the call answer target at 95% of calls answered in 60 seconds. During April average performance was 83%. However in each successive month performance was improved. A performance plan had been in place and a number of improvement notices were received from commissioners. During August the target level was achieved, a month earlier than the trajectory.

15 The team are now well placed to start working on quality issues using some

new tools that have been developed by our Performance Improvement Team to identify outliers in performance based on real data. It is anticipated that we will be able to utilise these tools to improve individual and team performance whilst build a sense of team and a supportive environment.

16 EOC have had similar challenges and have had to recruit and train new staff

both to cope with increased demand and staff turnover which has impacted Northern EOC more than Southern EOC. A number of measures had been taken to rectify the issues including recruitment and training and a decision to route more of our calls to SEOC. It is anticipated that this will be fully resolved during October.

17 As yet there are still a number of challenges in EOC including continue work

on NHSP implementation, fixing allocation times to they return to their previous levels and ensuring timely despatch of CFR’s.

18 In order to ensure that both services remain on track detailed recruitment and

training plans have been drawn up to take us to the end of the financial year. This plan aims to keep our recruitment and training ahead of demand ensuring that we have sufficient resilience during the winter months.

19 During October we plan to rollout out a move to virtualised call centres across

SCAS. This will mean that when a patient calls they are routed automatically and quickly to the next available call handler. This should enable us to gain better utilisation of call handlers and clinicians in time for the winter months.

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Winter Resilience 20 Winter planning and securing of winter funding has started early this year. We

believe that SCAS will be successful in securing additional funding for schemes such as HALO’s (Hospital Ambulance Liaison Officer), clinicians in 111 to focus on further reducing our 111 transfer rate, early bird GPs and additional frontline resources. Bids will be confirmed at the end of September

CONCLUSIONS 21 The first six months of this year have been very demanding with levels of

demand not previously experienced at this time of the year. This has led to challenging situations right across the operations directorate. However there are positives by putting in placed action plan Operations is getting us back on track and delivering at the required levels. These high levels of demand have also been managed through a period of significant system change which has been managed almost seamlessly and at a much faster pace than our fellow trusts. The challenge remains to deliver the second quarter.

RECOMMENDATIONS TO THE BOARD 22 The Board are asked to consider and note the update report. Sue Byrne Chief Operating Officer September 2014

Agenda Item: 10



Title Integrated Performance Report (IPR)


Will Hancock (workforce and Monitor), Charles Porter (finance), John Black (clinical performance), Sue Byrne (national standards / operational performance and NHS111), and Deirdre Thompson (safety, risk management, patient experience and QIPP quality impact)


To note the latest IPR, which is based largely on performance at to the end of August 2014 (month 5)










The report provides a Red-Amber-Green (RAG) rating of performance against each element, and then an assessment of the level of risk around future delivery relating to each.

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) There are specific sections in the IPR regarding our performance against the Monitor Risk Assessment Framework risk ratings. Performance against the indicators that relate to the CQC essential standards are also included.


The report includes three specific sections on finance; Monitor financial ratings, general finance performance, and QIPP cost improvement delivery.


Each Integrated Performance Report is shared with the Council of Governors


There are specific indicators in the IPR which relate directly to patients and staff; for example, under the elements for patient experience and human resources.

Other Previous considerations by the Board Performance is considered on a monthly basis

Background papers / supporting information N/A

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INTEGRATED PERFORMANCE REPORT (IPR)

PURPOSE

1 The purpose of the paper is to present details of the performance of the Trust for August 2014 (month 5 of 2014/15).

EXECUTIVE SUMMARY 2 Seven of the twelve areas of performance are currently rated as either ‘green’

or ‘amber’ (three and four respectively), with five rated as ‘red’. KEY ISSUES Month 5 performance 3 Three areas are currently rated as ‘green’; the two Monitor elements of

performance (governance and finance), and NHS111. 4 Four areas are rated as ‘amber’; clinical performance, operational

performance, finance and the quality element of cost improvement programmes.

5 Five areas are rated as ‘red’; national standards, safety and risk

management, patient experience, the financial element of cost improvement programmes, and human resources.

CONCLUSIONS

6 Month 5 performance was affected by the high levels of activity (and associated acuity) during the period. However, the Trust achieved all three key national response time standards for the month, and improved on call answer times. Performance on NHS111 has been very good.

7 Action plans are in place to address all areas where performance is below

target. RECOMMENDATIONS TO THE BOARD 8 The Board are asked to note and comment on the report. Charles Porter (Director of Finance) Steve Garside (Company Secretary) September 2014

Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest

(Key indicators are: national standards, financial risk rating, overall FRR, SIRI's and Never Events).

RAGVs. last month R A G

Lead Director Assessment of Risk

Monitor - financial rating G n/a n/a n/a G

Monitor - governance rating G n/a n/a n/a G

Clinical Performance A 10% 24% 67% A

National Standards R 33% 0% 67% Sue Byrne R

Operational performance A 21% 29% 50% Sue Byrne A

Safety and risk management R 31% 0% 69% Deirdre Thompson R

Patient Experience R 53% 7% 40% Deirdre Thompson R

111 G 6% 11% 83% Sue Byrne G

Finance A 15% 0% 85% Charles Porter A

QIPP's (cost improvements) R 37% 7% 57% Charles Porter R

QIPP's (quality impact) A 0% 58% 43% Deirdre Thompson A

Human Resources R 56% 22% 22% Will Hancock R

Overall Commentary:

National Standards

Complaints continue to be adverse to target cumulatively although they dropped by 25% compared to July.

Safety & risk management and HR KPI's which are red-rated in the month are reported on further below.

Integrated Performance ReportReport Period: August 2014

Will Hancock

Will Hancock

John Black

Demand remained higher than plan although growth has slowed a little over the last two months - year on year growth in Q1 was 8.5% and is 5.4% for Q2 so far. This continues to put pressure on services. Against this back-drop we have performed well: Red performance is higher than the national targets and call answering times have improved on the previous month.

Overall August has seen standards improving in particular with Red response times. There are still challenges in particular with high demand and acuity which seem to be a continuing theme this year and action plans are in place to address any gaps we have in service. Meanwhile the service to our sickest patients remains on track and long waits are significantly improved year on y ear.

Red -rated areas are further commented on below:

We have performed on plan or ahead of plan for 6 of the 8 national clinical indicators and on a year to date basis are behind for STEMI care only (3% lower than plan).

34,000

36,000

38,000

40,000

42,000

44,000

46,000 Activity (999 incidents)

2014-15 actual

2014-15 plan

2013-14 actual

Activity levels were 5% higher than last August (7% year to

date)

0

500

1,000

1,500

2,000

2,500Hospital handover delays

2014-15 actual

2014-15 plan

2013-14 actual

Delays have fallen by 55% since April 2013 but are

starting to return to prior year levels now

81.6%

77.8%

76.9%

75.4%

76.6%

75.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0%

82.0%

84.0%

86.0%Red 1 Performance

2014-15 actual

2014-15 plan

2013-14 actual

This improved further this month and is well above the

national target.

77.3%

73.8%

71.7%

73.8%

75.7%

75.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0%

82.0%


2014-15 actual

2014-15 plan

2013-14 actual

Significant improvement this month

0

500

1,000

1,500

2,000

2,500Hospital handover delays

2014-15 actual

2014-15 plan

2013-14 actual

Handover to hospital staff delays better than plan in August and 5%

above plan cumulatively

81.6%

77.8%

76.9%

75.4%

76.6%

75.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0%

82.0%

84.0%


2014-15 actual

2014-15 plan

2013-14 actual

Above target

77.3%

73.8%

71.7%

73.8%

75.7%

75.0%

70.0%

72.0%

74.0%

76.0%

78.0%

80.0%

82.0%


2014-15 actual

2014-15 plan

2013-14 actual

Improving performance over the last 2 months and above the national target for

August 2014

96.5% 95.7%

95.5% 93.9% 95.9%

95.0%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%


2014-15 actual

2014-15 plan

2013-14 actual

Continuing improved performance in September and the Q2 targets has been

achieved

89.0% 88.6%

85.7%

81.7%

85.3%

95.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%Call answer time (95% percentile)

2014-15 actual

2014-15 plan

2013-14 actual

Deterioration month on month due to staffing levels

- call answering still good

3000.00%

8000.00%

13000.00%

18000.00%

23000.00%

28000.00%

33000.00%

38000.00%

43000.00%

48000.00% Long waits Red 8

2014-15 actual 2014-15 planThe level has dropped in the month (18%)

3.0%

4.3%

4.2%

5.7%

4.2% 3.83%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

10.00% Long waits Greens

2014-15 actual

2014-15 plan

Adverse to plan as priority is focused on higher clinical acuity incidents

3000.00%

8000.00%

13000.00%

18000.00%

23000.00%

28000.00%

33000.00%

38000.00%

43000.00%

48000.00% Long waits Red 19

2014-15 actual 2014-15 plan

The level has improved by 23% from last month

96.5%

95.7%

95.5% 95.7% 95.9%

95.0%

90.0%

91.0%

92.0%

93.0%

94.0%

95.0%

96.0%

97.0%

98.0%

99.0%


2014-15 actual

2014-15 plan

2013-14 actualAbove target for the month

89.0% 88.6%

85.7%

81.7%

85.3%

95.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

100.0% Call answer time (95% percentile)

2014-15 actual

2014-15 plan

2013-14 actual

Behind plan for the month but significantly

improved in August

0.3%

0.5% 0.5%

0.6% 0.5%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40%Long waits Red 8

2014-15 actual

2014-15 planBetter than plan

0.8%

1.0% 1.1% 1.1%

0.9%

1.54%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40%

1.60%

1.80%

2.00%Long waits Red 19

2014-15 actual

2014-15 plan

Improvement from July with better than target levels of long waits

6.3% 5.9% 5.8%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0% Hear & Treat

2014-15 actual 2014-15 plan

2013-14 actual

H&T slightly higher than last month but significantly off plan

0

100

200

300

400

500

Complaints

Actual MAT

Plan MAT

PY MAT

The plan takes account of growth - complaints on a MAT basis are slightly above plan (although have fallen by 25% from last month).

5.3% 5.4% 5.4% 5.3% 5.4% 5.2%

3.0%

3.5%

4.0%

4.5%

5.0%

5.5%

6.0%

6.5% Sickness Actual MAT

Plan MAT

PY MAT

The improvement in sickness last year was planned to be maintained with further improvement in 111. Keeping reasonably flat on a MAT basis

despite higher than plan for the month (5.8% versus 5.1%).

4.5%

3.4%

5.2%

6.3% 5.9%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0% Hear & Treat 2014-15 actual

2014-15 plan

2013-14 actual

Above plan although lower than July's level

43.5% 43.0%

42.4% 42.6% 41.7%

35.0%

36.0%

37.0%

38.0%

39.0%

40.0%

41.0%

42.0%

43.0%

44.0%

45.0%See & Treat

2014-15 actual

2014-15 plan

2013-14 actual

Slightly lower than plan this month (plan was 41.8%) although better than plan cumulatively

72.8%

71.3%

72.6%

64.8% 67.3%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

Dec-13 Feb-14 Apr-14 Jun-14 Aug-14 Oct-14

STEMI - Care

2014-15 actual

2014-15 target

2013-14 actual (Dec 12 to Nov 13)

Target is to improve our 12-13 national levels by end of this year - significant

improvement this month

Note: National CQI's are reported with a 4 month lag 98.4% 99.0% 98.2% 98.3% 98.4%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14

Stroke - Care

2014-15 actual

2014-15 target

2013-14 actual (Dec 12 to Nov13)

Stroke Care is consistently in line with target

Note: National CQI's are reported with a 4 month lag

88.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


STEMI - 150min to PPCI

2014-15 actual

2014-15 target


Close to target cumulatively (90.8% versus plan of 90%)

despite being slightly below for the month of April 2014

Note: National CQI's are reported with a 4 month lag 55.2% 55.9% 55.1%

60.3% 59.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

Stroke - 60min to stroke centre

2014-15 actual

2014-15 target

2013-14 actual (Dec 12 toNov 13)

Better than improvement trajectory

72.8% 71.3%

72.6% 64.8% 67.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


STEMI - Care

2014-15 actual

2014-15 target


Target for 2014-15 to reach national levels - below plan in the month and YTD due analgesia administration


50.0% 38.5% 42.9%

34.5%

53.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


ROSC (witnessed) 2014-15 actual

2014-15 target

2013-14 actual (Dec 12 toNov 13)

Above plan for the month and cumulatively


35.3%

33.3%

10.0%

69.6%

27.0%

5.0%

15.0%

25.0%

35.0%

45.0%

55.0%

65.0%

75.0%

Dec-13 Feb-14 Apr-14 Jun-14 Aug-14 Oct-14

Cardiac Arrest (witnessed) Survival

2014-15 actual

2014-15 target


This CQI varies greatly as a % due to small sample size (SCAS average last year was 21% and nationally was 22% - our target this year).


35.3% 33.3%

10.0%

69.6%

27.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%


Cardiac Arrest (witnessed) Survival 2014-15 actual

2014-15 target


Below plan for the month but better than plan cumulatively


Monitor rating

Financial indicators2013-14 - reported

Actual Actual Actual Actual Plan Plan Plan PlanQ1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Financial risk rating 3 3 3 4 4 4 4 4

Forward Financial Risk Indicators (non-compliance out of 10 indicators) 3 1 1 0 1 1 0 0

Commentary:

Governance indicators

Actual Actual Actual Actual Plan Plan Plan Plan

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Red 1 81.0% 77.1% 78.5% 79.2% 78.9% 75.0% 75.0% 75.0%Red 2 77.7% 75.1% 75.1% 75.7% 74.2% 75.0% 75.0% 75.0%Red 19 96.2% 95.0% 95.5% 94.4% 95.9% 95.0% 95.0% 95.0%

Failure to comply with requirements regarding access to healthcare for people with a learning disability No No No No No No No No

Risk of, or actual, failure to deliver mandatory services No No No No No No No No

CQC compliance action outstanding 31 March 2014 Yes No No No No No No No

CQC enforcement action within last 12 months up to 31 March 2014 No No No No No No No No

CQC enforcement notice currently in effect as at 31 March 2014 No No No No No No No No

Moderate CQC concerns or impacts regarding the safety of healthcare provision as at 31 March 2014 No No No No No No No No

Major CQC concerns or impacts regarding the safety of healthcare provision as at 31 March 2014 No No No No No No No No

Trust unable to declare on-going compliance with minimum standards of CQC registration No No No No No No No No

Has the Trust has been inspected by CQC No Yes No No No Yes No No

If so, did the CQC inspection find non compliance with 1 or more essential standards No No No No No No No NoOther governance factors/risks (data breaches) No No No No Yes No No No

Overall governance rating Green Green Green Green Green Amber-Green

Amber-Green

Amber-Green

Commentary:

The Red 2 target for Q1 was missed due to high levels of activity. No further action required following the data breach in Q1.

Below target due to capex being lower than plan.

2013-14 - reported 2014-15 Plan

Lead Director: Will Hancock

Measure 2014-15 Plan

Integrated Performance Report

Clinical performance Overall ratingA

5

National Clinical IndicatorsSCAS ranking National average

Actual Plan RAG Actual Plan RAG Forecast Plan RAG

STEMI care bundle 67.3% 73.0% A 69.8% 71.0% A 74.5% 74.5% G 11th 82.3% Off plan by 3% - continued focus on improving analgesia administration.

Stroke care bundle 98.4% 98.0% G 98.5% 98.0% G 98.0% 98.0% G 5th 97.2% No comment required

% STEMI with PPCI to treatment in 150 min 88.0% 90.0% A 90.8% 90.0% G 90.0% 90.0% G 6th 87.2% No comment required

% FAST patients to centre in 60 min 59.3% 54.0% G 57.2% 51.4% G 55.9% 55.9% G 11th 63.7% Action plan on track and this still remains a key area of focus.

% patients with return of spont's circul'n by hospital arrive (ROSC)

42.8% 35.0% G 37.8% 35.0% G 35.0% 35.0% G 1st 25.6% No comment required

% patients with return of spont's circul'n by hospital arrive (ROSC) - witnessed cardiac arrest

57.5% 40.7% G 44.7% 40.7% G 40.7% 40.7% G 4th 47.2% No comment required

Cardiac Arrest: % discharged alive following ambulance resus'n

15.1% 10.0% G 16.8% 10.0% G 10.0% 10.0% G 1st 7.9% No comment required

Cardiac Arrest: % discharged alive following ambulance resus'n - witnessed cardiac arrest


Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest

Lead Director: John Black

Measure (nationally submitted data - 4 month lag in reporting - relates to April 2014 with the exception of FAST which is August 2014)

Aug-14 Year to date Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)

Full year

Out of 11 English ambulance services

Year to date


Other clinical indicators


Hypoglycaemia care bundle 98.0% 98.7% A 98.0% 98.7% A 98.7% 98.7% G

Asthma care bundle 74.0% 88.8% R 83.6% 88.8% A 88.8% 88.8% G

Limb fractures care bundle 42.0% 52.7% R 48.4% 52.7% A 52.7% 52.7% G

Febrile convulsion care bundle 92.7% 87.7% G 88.1% 87.7% G 87.7% 87.7% G

Safeguarding


Number of adult referrals - this relates to vulnerable adults who may be at risk from abuse or neglect

400 350 G 2,080 1,750 G 4,530 4,200 G

Number of child referrals - this relates to children who may be at risk of abuse or neglect

119 113 G 654 563 G 1,442 1,350 G

Measure (care bundles are part of National Clinical Performance Indicators data gathering)

Target only just missed in the month - will continue to monitor.

Need to improve exception reporting of Peak Flow Reading

Need to improve reporting of immobilisation

No comment required

Measure Full yearAug-14 Year to date

Aug-14

No commentary required

Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)Full yearYear to date

Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)

Integrated Performance ReportHygiene & infection prevention & control 275


Vehicle deep cleans - A&E 100 107 A 584 570 G 1,319 1,319 G

Vehicle deep cleans - PTS 93 108 R 498 540 A 1,296 1,296 G

Vehicle routine cleans 5,843 5,613 G 27,858 27,637 G 65,910 65,910 G

Number of cleanliness compliance audits* 63 54 G 196 270 R 648 648 G

Medicines management


Number of adverse events due to administration errors* 0 1 G 2 5 G 12 12 G

Number of controlled drug incidents* 4 0 R 15 0 R 15 15 G

As above, the staffing issues and availability of PTS vehicles (due to shift times for PTS and Make Ready in North) has had a detrimental effect on the figures during August. The additional resources have been put in place to deal with the backlog and ensure that this situation is not repeated. PTS management now communicate with OSD to confirm vehicle availability. Plan to roll trial of Airsterile onto PTS vehicles, as follow on from the A&E trial

Better return this month. Area managers working to bring deficit back to catch up on a cumulative basis.

Measure Aug-14 Full year

Aug-14

YTD figures are on track; during August there have been staff shortages and Churchill have been actively recruiting replacement staff, who are now coming on board and being trained. A push of additional activity has been put in place during August, to address the overdue deep cleans, OSD are working closely with Make Ready to get vehicles moved to other locations to get the vehicles cleaned. Airsterile trial in Bletchley going well - results showing great improvement which will be communicated separately when trial completed.

Full yearYear to dateMeasure

Zero tolerance in this year's target. Last year's total was 34 incidents so our performance this year is similar.


No comment required


No comment required.

Year to date


Operational performance ROverall rating (other)

A

Performance Pressures


Incidents 5.1% 3.0% n/a 7.2% 3.6% n/a 5.9% 3.2% n/a

Calls 4.3% 3.0% n/a 9.0% 3.6% n/a 6.7% 3.2% n/a

Hospital delays

- Total handover delays over 15 minutes (hours)

751 766 G 4,010 3,832 A 9,196 9,196 G

- Total clear-up delays (hours) 415 368 R 1,843 1,839 A 4,415 4,415 G

Demand Measures Year to date Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)

Activity remains high compared to budget.

Both these targets are largely on track with a small blip on clear up this month. However they are much improved year on year.

Overall rating (national - Red8 & Red19)

Aug-14 Full year

Lead Director: Sue Byrne


SCAS ranking (July 14 - Aug 14 not yet published)

National average

Actual Plan RAG Actual Plan RAG Forecast Plan RAG Year to date

Call connect to call answer (min:sec) - 50th percentile

00:04 00:01 R 00:04 00:01 R 00:02 00:01 R =10th 00:01


00:43 00:08 R 00:32 00:08 R 00:18 00:08 R =7th 00:18


01:42 00:50 R 01:34 00:50 R 01:08 00:50 R 10th 01:00

% calls abandoned 1.6% 1.2% R 1.2% 1.2% G 1.2% 1.2% G =5th 1.48%

This is due to the deterioration of call answer in the month. Plans are in place to improve call answer and should see this target improve accordingly. We are on track ytd.

Red 1 % on scene within 8 minutes 76.6% 75.0% G 77.7% 75.0% G 75.0% 75.0% G 3rd 72.90% No comment required

Red 2 % on scene within 8 minutes 75.7% 75.0% G 74.4% 75.0% R 75.0% 75.0% G =6th 71.40%

August saw improved performance resulting in achieving the target at a SCAS level for August. The challenge for the quarter remains however and front line staffing has been increased wherever possible to meet that demand.

Red % conveying response within 19 minutes

95.9% 95.0% G 95.9% 95.0% G 95.0% 95.0% G 3rd 94.90% No comment required

Red 1 on scene within 8 minutes : 95th percentile (mm: ss)

13:23 13:45 G 13:11 13:48 G 13:36 13:36 G 4th 13:53 No comment required

Time to Treat - 50th percentile (min:sec) 05:51 06:00 G 05:57 06:00 G 06:00 06:00 G 3rd 06:27 No comment required

Time to Treat - 95th percentile (min:sec) 17:45 19:00 G 17:52 19:00 G 19:00 19:00 G 5th 18:12 No comment required

Time to Treat - 99th percentile (min:sec) 28:47 29:00 G 29:05 29:00 A 29:00 29:00 G 6th 29:00 This result has improved during August leaving us just over target for the ytd

% calls from frequent callers 2.8% 5.0% G 1.8% 5.0% G 5.0% 5.0% G 5th 0.80% No comment required

% calls with telephone advice only (Hear & Treat)


% resolved without convey to Type 1/2 A&E

41.7% 41.8% A 42.2% 41.6% G 42.0% 42.0% G 4th 36.90% No comment required

Aug-14

National indicatorsPerformance Measure Commentary on exceptions (Red - action to correct,

Amber - action to reduce risk, Green - nil)

Call connect continues to be challenging as we continue to experience high demand. Recruitment has been taking place which should improve the performance and a planned systems change in October should give us better interoperability and efficiency. We therefore should expect to see a modest improvement through October improving further in November onwards.

Year to date Full year

Out of 11 English ambulance services


% Hear & Treat re-contacts in 24 hours 12.5% 15.0% G 12.1% 15.0% G 12.1% 15.0% G 9th 8.20% No comment required

% See & Treat re-contacts in 24 hours 5.1% 5.0% A 4.8% 5.0% G 5.0% 5.0% G 4th 5.30% No comment required

Other indicators


Green 1 - response within 30 minutes 89.1% 90.0% A 87.9% 90.0% A 90.0% 90.0% G

Green 2 - response within 30 minutes 84.0% 90.0% A 83.3% 90.0% A 90.0% 90.0% G

Green 3 - response within 30 minutes 77.2% 90.0% R 80.2% 90.0% A 90.0% 90.0% G

Green 4 - telephone assessment within 60 minutes

93.7% 90.0% G 91.6% 90.0% G 90.0% 90.0% G

Efficiency indicatorsFrontline resources (rota hours per week)

43,379 39,050 R 40,221 39,454 A 40,612 40,612 A

VOR - scheduled maintenance3.0% 3.7% R 3.2% 3.7% R 4.0% 4.0% G

VOR - unscheduled 19.8% 18.0% A 20.4% 19.2% A 18.5% 18.5% G

Full yearAug-14 Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)

No comment required

Additional resources to support above budgeted demand and recover performance.

Vehicle reliability in general is improving but we did experience a spike of airconditioning problems during July and August which has mean that planned and unplanned are slightly off plan but are improving year on year.

Year to date

Although still not on target these results have improved through August, with Green 1 only just short of target. We continue to manage these less urgent patients with CSD to ensure that we do not cause harm and are proactively monitoring the long wait results in CQRM

Integrated Performance ReportA&E Performance by CCG Cluster


Red 1

Thames Valley Cluster 78.9% 75.0% G 78.2% 75.0% G 75.0% 75.0% G

Hampshire & MK Cluster 74.7% 75.0% R 77.4% 75.0% G 75.0% 75.0% G

Red 2

Thames Valley Cluster 75.9% 75.0% G 74.3% 75.0% R 75.0% 75.0% G

Hampshire & MK Cluster 75.4% 75.0% G 74.6% 75.0% R 75.0% 75.0% G

Red A19

Thames Valley Cluster 95.7% 95.0% G 95.9% 95.0% G 95.0% 95.0% G

Hampshire & MK Cluster 96.2% 95.0% G 95.9% 95.0% G 95.0% 95.0% G

No comment required

No comment required

No comment required

Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)Performance Measure Aug-14 Year to date Full year

Performance has improved through August with a great deal of focus being applied to get us back on target for the year

Performance has improved through August with a great deal of focus being applied to get us back on target for the year. However our efforts are being hampered by hospital delays at QA and Milton Keynes

Performance just missed in the month - year to date is well above target.

Integrated Performance ReportSafety and Risk Management Overall rating R Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest


Number of DATIX incidents - staff (this is the internal form to report incidents in SCAS - this covers all types of incident - accidents, injuries, missing equipment etc.)

125 77 n/a 588 384 n/a 1411 921 n/a No comment required

Number of DATIX incidents - non staff (this is the internal form to report incidents in SCAS - this covers all types of incident - accidents, injuries, missing equipment etc.)

221 223 n/a 1,200 1116 n/a 2880 2679 n/a No comment required

Number of incidents reported to the NPSA (CQC/NPSA reportable)

102 64 n/a 478 320 n/a 1147 768 n/a No comment required

% of incidents reported to the NPSA within 30 days 100% 100% G 100% 100% G 100% 100% G No comment required

Number of Serious Incidents Requiring Investigation (SIRI) reported

0 1 G 8 6 R 17 17 G

The Trust continues to monitor SIRI numbers and themes through the SIRI review group and ensure that actions are taken and trust-wide lessons learned and disseminated widely.

Number of SIRI investigations outstanding after 60 days (excluding events that are officially suspended)

0 4 G 4 21 G 4 4 G No comment required

Number of Never Events (CQC/NPSA reportable) 0 0 G 0 0 G 0 0 G No comment required

Clinical negligent claims (CNST) 1 1 G 4 5 G 10 10 G No comment required

Public liability claims 2 1 R 6 6 G 13 13 G No comment required

Long waits (Red 8)* - over 30 minutes 0.5% 1.0% G 0.5% 0.8% G 0.9% 0.9% G No comment required

Long waits (Red 19)* - over 30 minutes 0.9% 1.5% G 0.9% 1.2% G 1.3% 1.3% G No comment required

Year to date Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)

Lead director: Deirdre Thompson

Full yearPatient Safety Measure Aug-14


Long waits (Greens)* - over one hour 4.2% 2.2% R 4.4% 2.1% R 2.4% 2.4% G

Staff Safety


Number of RIDDOR reports (HSE reportable) 6 7 G 30 34 G 83 83 G No comment required

Number of Physical Assaults (NHS Protect reportable) 9 13 G 62 63 G 151 151 G No comment required

Number of Non-Physical Assaults (NHS Protect reportable)

25 14 R 108 68 R 204 164 R

Number of Security Incidents (NHS Protect reportable) 9 7 R 42 34 R 90 83 A

* These items are reported in the quality accounts as well

The introduction of the Trust's electronic incident reporting system, Datix has made it easier for staff to report incidents so consequently there has been an increase in the number of incidents reported. The Risk Team are to issue staff with guidance on security.

Year to dateAug-14

Staff Safety Measure Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)

Full year

Our green long waits are still beyond our targeted level however this is due to high volumes, very high increases in year on year acuity and our efforts to minimise long waits for our sickest patients. This is reflected in the red long wait results which have improved.

Integrated Performance ReportPatient Experience Overall rating R Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest

Complaints


- 999 Service 24 17 R 128 85 R 205 205 GSlight reduction in numbers for last month (27); high level this month for delay/non arrival EOC and clinical and staff attitude for 999 Ops

- PTS 7 7 G 45 35 R 81 81 G Reduction in complaints received this month; but 16 received last month has given Red YTD

- 111 Service 5 12 G 44 59 G 136 136 G No comment required

Total 36 41 G 217 194 R 422 422 G See above

Complaints responded to within 25 days target

(Data relates to July 14)83% 95% R 84% 95% R 91% 95% A

Overall improvement from April but drop again this month partly due to slow return of investigations but also due to substantial increase in numbers of complaints and Patient Experience (PE) issues received for capacity in PE Team; concern re increase in Hampshire PTS will provide further strain


Compliments No. No. No. No. No. No.

Total 108 41 G 457 368 G 882 882 G No comment required

Surveys


A&E frontline - no. of surveys 0 0 G 0 2 R 3 3 G

- satisfaction level n/a 75% n/a n/a 75% n/a 75% 75% G

A&E EOC - no. of surveys 0 0 G 1 1 G 1 1 G No comment required

- satisfaction level n/a 0.75 n/a n/a 75% n/a 75% 75% G No comment required

Measure

Aug-14 Year to date

Measure Aug-14 Year to date

Lead Director: Deirdre Thompson

Full year




Full year

Work still on-going in respect of how surveys for A&E frontline will be undertaken; WIGFY being undertaken directly with patients

Outcome of surveys

Aug-14 Year to date Full Year


111 Service - no. of surveys 2 1 G 7 8 R 21 21 G Hampshire and Beds and Luton surveys completed although delayed; outcome report not yet completed

- satisfaction level n/a 75% n/a n/a 75% n/a 75% 75% G No comment required

PTS - no. of surveys 0 0 G 3 1 G 4 4 G No comment required

- satisfaction level n/a 90% n/a n/a 90% n/a 90% 90% G No surveys due this month for PTS

Other - no. of surveys 0 0 G 1 1 G 4 4 G No comment required

- satisfaction level n/a 75% n/a 97% 75% G 75% 75% G No comment required

Total SCAS - no. of surveys 2 1 G 12 13 A 33 33 G See above


FOI (Freedom of Information Act) 50% 100% R 74% 100% R 89% 100% R

Data protection Act (DPA) - police, solicitor/medical, subject access

50% 100% R 74% 100% R 89% 100% R

Forecast

Resourcing issues have affected our ability to perform to the required standard. New staff now in place to address the back-log and meet target response rates.

Requests responses within timescales

Requests for Information

Measure

Aug-14 Year to date

Integrated Performance Report111 Service Overall rating G Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest

111 Measures


Oxford :

Oxford Calls (no. answered) 15,990 15,158 n/a 83,768 82,578 n/a 199,462 199,462 n/a No comment required

Call Answering (% within 60 seconds) 96.0% 95.0% G 89.3% 95.0% A 95.0% 95.0% G Monthly performance now achieved.

999 referrals (%) 8.1% 10.0% G 8.4% 10.0% G 10.0% 10.0% G No comment required

Calls Abandoned (target <5%) 0.6% 5.0% G 2.1% 5.0% G 5.0% 5.0% G No comment required

Transfers to clinician (%) 15.8% 20.0% G 16.3% 20.0% G 20.0% 20.0% G No comment required

Time taken for call back (% < 10 mins - target 95%)

99.7% 95.0% G 98.8% 95.0% G 95.0% 95.0% G No comment required


Hampshire :

Calls (no. answered, 111 and Dental) 41,619 38,288 n/a 218,082 205,615 n/a 491,174 491,174 n/a No comment required

Call Answering (% within 60 seconds, 111 only)

97.5% 95.0% G 93.5% 95.0% A 95.0% 95.0% G Monthly performance now achieved.


Calls Abandoned (target <5%, 111 only) 0.4% 5.0% G 1.2% 5.0% G 5.0% 5.0% G No comment required





Full yearYear to date

Year to date

Measure Aug-14

Measure Aug-14 Full year



Berkshire:

Berks Calls (no.) 17,827 15,825 n/a 94,263 89,161 n/a 220,282 220,282 n/a No comment required


999 referrals (%) 9.3% 10.0% G 10.1% 10.0% A 10.0% 10.0% G Referral rate now below 10% and in line with National Average 9-11%






Buckinghamshire:

Bucks Calls (no.) 11,496 9,879 n/a 60,142 53,820 n/a 130,000 130,000 n/a No comment required








Luton & Beds

Luton & Beds Calls (no.) 7,766 5,700 n/a 40,164 31,050 n/a 75,000 75,000 n/a No comment required







Year to date


Full year

Full year

Measure Aug-14

Measure Aug-14 Year to date

Measure Aug-14

Integrated Performance ReportFinance Finance rating A QIPP rating R

Monitor Continuity of Service Risk Rating


Debt service cover rating 4 4 G 4 4 G 4 4 G No commentary required

Liquidity Rating 4 3 G 4 4 G 4 4 G No commentary required

Continuity of Service Risk Rating 4 4 G 4 4 G 4 4 G No commentary required


Unplanned EBITDA variance for 2 Q's No No G No No G No No G No commentary required

FRR forecast variance < 3 No No G No No G No No G No commentary required

FRR 2 in any quarter No No G No No G No No G No commentary required

Overdraft used last quarter No No G No No G No No G No commentary required

Debtors > 90 days> 5% total balance Yes No R Yes No R No No G Higher in the month but expected to recover by the end of Q2

Creditors > 90 days> 5% total balance No No G No No G No No G No commentary required

2 or more change FD in last 12m No No G No No G No No G No commentary required

Interim FD > one quarter No No G No No G No No G No commentary required

Q end cash<10 days of op expenses or <£4m No No G No No G No No G No commentary required

Capex < 85% or >115% of ytd plan Yes No R Yes No R No No G Expected to recover in later months

Measure Aug-14

Monitor Forward Financial Risk Ratings

Lead Director: Charles Porter

Measure Aug-14 Year to date Full year Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)




Quality ImpactActual Plan RAG Actual Plan RAG Forecast Plan RAG

£k £k £k £k £k £k

Commercial Division

PTS Private Provider cost reduction 17 28 R 78 114 R 270 306 R Expected to improve once we recover costs from customer (agreed in principle) 6

PTS Porterage 0 4 R 0 4 R 68 77 R Delays have compromised delivery this FY 1

PTS Post SHIP vehicle review 0 0 G 0 0 G 20 40 R Delays have compromised delivery this FY 1

PTS Efficiencies from Talecom 14 9 G 25 22 G 103 99 G No commentary required 1

PTS Bucks reduction in unsocial allowance on T&D 0 0 G 0 0 G 35 35 G No commentary required 0

PTS Band 2 replacement of Band 3 in Bucks 2 2 G 5 6 R 18 18 G Recruitment delayed due to lack of suitable candidates - now delivering 9

Berks Logistics - Reduction in agency & vehicle costs 2 4 R 10 12 A 68 47 G Expected to catch-up. 2

Commercial Training -Utilise SCAS premises 0 1 R 0 2 R 4 8 R Not material 2

Call Centre North agency saving 2 2 G 15 8 G 26 20 G No commentary required 2

Changes to headcount within Commercial Trustwide 7 7 G 21 35 R 70 84 R Delayed but now delivering 6

Subtotal Commercial Division 43 56 n/a 153 203 n/a 683 734 n/a

Cost Improvement Plans (QIPP's)Measure Aug-14 Year to date Full year Commentary on exceptions (Red - action to

correct, Amber - action to reduce risk, Green - nil)

Integrated Performance Report999 Service

A&E Private Provider Efficiency 0 18 R 44 72 R 172 200 A No benefit in the month due to operational pressures 8

Loss of unit hours 56 15 G 95 45 G 311 300 G Now catching up as measurement has commenced 8

VOR Improvement 9 6 G 20 14 G 140 140 G No commentary required 8

Reduce time on scene0 30 R 0 30 R 210 240 A Benefits not in line with initial estimate and

delayed 8

Reduce hospital turnaround 28 0 G 94 0 G 213 120 G No commentary required 8

Inc indirect unique contribution 0 0 G 0 0 G 350 680 R Benefits not in line with initial estimate 2

Co Responder scheme NEOCE12 15 A 35 50 R 185 200 A Schemes operational and now working to

improve response times 2

Lease vehicles 10 10 G 34 34 G 100 100 G No commentary required 1

Workshop review 3 0 G 65 0 G 119 36 G Over-delivering due to agency saving 9

Make Ready13 8 G 52 42 G 120 105 G No commentary required 9

Area vehicles (5) 25 R 25 120 R 200 295 R Behind plan due to operational pressures from high activity 4

Unplanned overtime 54 15 G 54 15 G 200 200 G No commentary required 12

Meal Break reduction 0 1 R (0) 22 R 20 25 A Higher level of meal break missed due to demand pressures. 6

Consumables management 0 15 R 0 75 R 200 200 G Achievement not yet measurable until stock take 6

Printing Costs 5 2 G 13 8 G 26 20 G No commentary required 2

Fuel 31 5 G 111 25 G 169 85 G No commentary required 1

PP invoice management 5 8 R 33 42 A 301 100 G Expected to gain momentum as we agree adjustments with suppliers 1

Mind the GAP 0 0 G 0 0 G 250 249 G No commentary required 2

Increase Red Assistance 0 0 G 0 0 G 120 120 G No commentary required 8

Remove GP's from EOC 42 41 G 113 113 G 321 321 G No commentary required 4

Subtotal 999 Service 262 214 n/a 787 706 n/a 3,727 3,736 n/a


111 Service

111 sickness reduction 7 7 G 32 39 A 104 111 A On track now, earlier delay not expected to catch-up 6

111 Telephony Virtualisation 0 0 G 0 0 G 224 224 G No comment required 6

111 SHIP Resource Management 31 30 G 190 189 G 346 346 G No comment required 8

Subtotal 111 Service 37 37 n/a 222 228 n/a 675 682 n/a

Corporate 0

ICT agency savings7 10 R 43 48 A 89 114 A Savings delays due to reliance on agency to

provide resilience 6

Finance dept savings 21 7 G 63 35 G 107 85 G No comment required 2

Removal of ICT from Deanshanger & Wokingham 7 7 G 33 33 G 79 79 G No comment required 1

Cancellation of IT contracts 18 15 G 105 83 G 258 217 G No comment required 12

Aerial sites closed 0 0 R 0 1 R 2 6 R Delayed - not material 1

Estates reduction of maintenance costs 9 14 R 71 69 G 161 165 A No comment required 9

EPR & Qlikview 0 0 R 0 0 R 93 93 G No comment required 6

Estates site closures 12 7 G 29 28 G 50 74 R Portsmouth which was in the CIP's plan may be redeployed 1

Domestic Cleaning contract8 9 A 5 35 R 9 95 R Contract awarded but not sites

implemented yet 9

Unsocial Hours 8 8 G 11 16 R 453 400 G No commentary required 1

Annual report savings 2 0 G 12 0 G 33 4 G No commentary required 1

Bid Cost reduction 24 24 G 118 118 G 118 118 G No commentary required 1

Education savings 0 0 R 1 1 A 22 22 G No commentary required 2

CIPs B/fwd 17 17 A 287 287 A 310 310 G No commentary required 1

Subtotal Corporate 133 116 n/a 779 754 n/a 1,782 1,780 n/a

Contingency 0 -8 G 0 (8) G (335) (400) G

Total 475 416 G 1,941 1,883 G 6,532 6,532 G


1 to 3 Low risk4 to 6 Moderate risk7 to 12 Significant risk13 plus High risk

Quality Impact Assessment of the Cost Improvement Programmes 2014-15

Consequence

Likely

Increase PTS private provider efficiency 85 Wexham provision will increase PTS private provider usage but the costs will not increase proportionately.

3 Q 3

The use of less PP should improve consistency in care delivery and quality of services. Improve clinical governance. Potential impact may be in gaps in rotas/drivers.

9 Planned rotas. Demand profiles considered. 6

Reduction PTS reliance on private providers and hospital car drivers

220 PTS is expected to be fully staffed and implement new rota shifts, so reliance on third parties should decline.

3 Q 3The use of less PP should improve consistency in care delivery and quality of services. Improve clinical governance.

9

PTS patient satisfaction survey results. Monitor any incidents. Monitor complaints and performance. Reduced length driver course has been comprehensively piloted and is subject to on-going review.

6

PTS Porterage at large hospitals 77 Porterage at larger hospitals to reduce time spent on assisting patients to their appointments.

1 Q 1 Low risk - this will enhance quality 1 No further mitigations required. 1

Evaluation of Commercial division fleet and smart replacement

40

Replace PTS and Berks Logistics fleet with more appropriate vehicles with leases co-terminous with contract end dates.

1 Q 1 Quality improvement 1Improvements in fleet will result in most appropriate and reliable transport for patients.

1

Efficiencies gained from the use of Talecom devices within PTS

99

Talecom fitted to all PTS vehicles, the data provided should enable shorter waiting times, more efficient journey planning.

1 Q 1 Low risk 1 No mitigation required 1

PTS recruitment at Band 2 rather than Band 3.

18 PTS staff to be recruited at Band 2 not Band 3.

4 Q 3Impact on quality may be the calibre of staff applying and recruitment difficulties resulting in rotas not being filled.

12Continue to monitor incidents and complaints and survey results in this area. Ensure that the recruitment and training process is robust

9

Reduce agency within Berks Logistics 47 Reduce the use of agency staff in Berks Logistics by recruiting to full establishment.

2 Q 2ensure robust recruitment and training plan to ensure calibre of the staff employed 4 Use of permanent SCAS staff will aid

consistency. 2

Move Commercial Training from Regus buildings to SCAS buildings

8 Identify premises that Commercial Training can use permanently.

2 Q 2Training teams located together will aid planning/discussions around delivery of training thus improving communications.

4 ensure environment is sufficient to meet the needs of the Teams 2

Mitigating Actions£000’sMitigated Risk

LevelAction to Mitigate Downside Scenario

Quality/Deliver

Risk Rating

Potential Impact to Quality/DeliverySource of Saving

Commercial Division


Call Centre North agency saving 20 Reducing the number of agency staff in PTS call centre and replacing with permanent staff

2 Q 1 Low impact on quality as permanent staff to be recruited

2 No further mitigation required - low risk. 2

Reduce the number of contracts managers in commercial dept to 1 and make the Director of Commercial Services part-time.

3 Q 3Impact may be on contract negotiation and delivery of requirements with fewer staff. 9

Roles in commercial services will be considered regarding responsibilities required to ensure an effective and responsive service across all contracts.

6

Matching supply & demand (UHU) 1,120

Applying Unit Hours Utilisation model to optimise resources. Review shift patterns in the Southern cluster. Use Bank and part-time staff, reduce private providers

4 Q 3Possible risks to care if resources are too low - long waits are higher than last year 12

Weekly review of the effect of UHU model implementation on performance and quality to ensure that this does not result in an adverse effect on response times and all misses are reviewed in detail. The improvements in UHU has resulted in improving our responsiveness to incidents

8

Co Responder Scheme in NEOCE 880 Utilise other responders such as the Fire Brigade

3 Q 1 Quality and performance should improve. 4Training of co responders to reflect SCAS procedures and standards to ensure care is safe and effective

2

New vehicle leases 100 Ensure new vehicle leases are at lower rates.

1 Q 1 Low risk. 1 No mitigation required 1

Workshop review 36 Rationalise the number of workshops. 4 Q 3Need consideration to ensure full cover to reduce VOR. Potential of logistics issues in delivering vehicles to workshops reducing availability.

12Planned rotas and hours of workshop staff. Close scrutiny of VOR rates. OSD to ensure logistics.

9

Make Ready 105 Renegotiate cleaning contract to clean at longer periods and replacement of uneconomic make ready vehicles.

4 Q 3Potential infection risks and cleanliness standards reduction. 12

Review ATP testing of vehicles to show bacteria levels are not increasing. Safety walkrounds and inspections. IPR reporting. Review of KPIs with Make Ready regularly.

9

Area Vehicles; lost kit, damage repairs and vehicle moves

295 Make staff more accountable for lost kit, damage to kit, accident reporting. Reduced agency drivers to move

3 Q 2Reducing vehicle moves should improve quality in terms of responsiveness and lost hours. 6 Staff sign off sheets for equipment such as

radios and phones. 4

Reduce unplanned overtime 200 Reduce overtime whereby a new job is started close to the end of a shift so it overruns.

5 Q 3Possibility of delayed response due to shift changeover 15

Weekly review of the effect of UHU model implementation on performance and quality to ensure that this does not result in an adverse effect on response times and all misses are reviewed in detail.

12

Meal Break savings in A&E 25 Reduce the number of meal breaks taken outside of the lunchtime window.

3 Q 3Longer waits while staff take meal breaks during times of unplanned high demand 9 UHU and planning in line with forecast

activity to reduce risk 6

A&E consumables management 200 Reduce consumables costs by better stock management and linking usage to incidents. 5% saving

3 Q 3Impact should be to reduce out of date stock issues. Ensuring that levels are correct across all areas.

9Stock level project. Make ready teams to monitor. Staff checking consumables at start of shifts.

6

Sundry cost savings in A&E 20 Savings on uniform costs in EOC and printing

2 Q 2Potential risk to reputation and health and safety requirements if uniforms are not replaced. 4

Communications in teams to assess need for uniforms. Staff ensure responsibility for care of uniforms.

2

Commercial department to have only one Contract Manager and a part-time Director of Commercial Services.

84

999 Service


A&E fuel savings 85 Use of more fuel efficient vehicles 1 Q 1Quality impact low. Need to ensure those staff who respond on blue lights have capable vehicles to respond to calls.

1 Reassessment of vehicle requirements in directorate budget reviews. 1

Private provider invoice management 100 Ensure that private providers are only paid for services actually delivered.

1 Q 1 Should not affect quality 1 Good financial management and control and this should not impact on quality 1

Mind the Gap 249

Projects designed to enable students paramedics to undertake paid work as ACA's and ECA's in order to pay for their courses.

2 Q 2 Should benefit patient care and quality 4Close monitoring of hours work to ensure staff do not take ion to many hours between course work and ECA type work

2

Remove GP's from EOC 3 Q 2Loss of GP in EOC may impact on H&T but to date there is no evidence to suggest that GP has improved H&T rates

6

Continue recruitment programme for CSD staff. Introduction of NHS pathways to improve clinical assessments and integration of 111 and 999 services. Review of alternative HCP e.g. Mental Healthcare practitioners in EOC to assist with H&T

4

3 Q 3Potential to improve quality of worklives and care provision. 9

Sickness to be monitored weekly and resource levels adjusted through other variable resource if sick levels are higher than plan.

6

111 Telephony platform virtualisation 3 Q 3Moving to virtualisation should not create risk to the caller assessment process as it is no different to taking out of area calls.

9Standardise the SOPs and establish a project plan in order to pilot and test the proposed model with a gradual roll out

6

111 Resource management linked to demand

4 Q 3Possible risks to care if resources are too low - long waits for call answer and CSD support are higher than forecast / plan

12Weekly review of the effect of the planning model implementation on performance and quality to ensure that this does not result in an adverse effect on

8

Reduce ICT agency costs 4 Q 3Quality impact on telephony/IT systems can affect contacts with patients. 12 IM&T infrastructure internally

strengthened to meet demands. 6

Finance department cost reductions. 3 Q 2Low impact on quality with permanent SCAS finance team. Internal auditors 4 Ensuring robust internal audit plans and

delivery on areas for most benefit. 2

Vacate Deanshanger, Wokingham and Portsmouth sites

1 Q 1 No direct impact on Quality 1 New building at Portsmouth. 1

321 Stop using GP's for Hear & Treat.

Actively manage sickness across the trust to save 1%

111 sickness reduction

224

Reduce reliance on agency staff within ICT.

Linking resource within the call centre to demand.

Improve staffing, by process evolution, workforce board & virtualisation

79

Reduction in recruitment costs,agency fees and internal audit costs.

Vacate premises, remove fatpipes, cancel telephone lines

114

Corporate Areas

85

346

111

111 Service


Cancellation of ICT contracts 5 Q 3Quality and timeliness of response to critical systems needs to be maintained to ensure telephony and IT platforms are sound.

15 IM&T infrastructure internally strengthened to meet demands. 12

Aerial sites closed 1 Q 1 No direct impact on Quality 1 Managed closure plan 1

Reduce general Estates expenditure 4 Q 3Quality and timeliness of estates jobs may be affected which can adversely impact on compliance with CQC and Health and Safety standards.

12Estates plan of work. Monitor all jobs for delays and impact on staff/patients. Improve prioritisation of jobs.

9

Agency savings in PIT team 3 Q 3

PIT are essential to meet local and national data requirements and contracted performance data. Gaps in personnel potential so must ensure team is fully staffed internally.

9Less reliance on paper and manual data entry should result in reduction in human error and reliable data in real time

6

Renegotiate domestic cleaning contracts

4 Q 3

Ensuring standardisation should improve the quality of cleaning to meet Health and Social Care Act requirements. Potential impact is that cleaning times may be reduced affecting compliance. Need to ensure all SCAS sites are covered in the contract.

12Negotiation of cleaning contracts to include Director of Patient Care to mitigate any standards issues.

9

Unsocial - Reduction in payments (Incl. EOC)

2 Q 1Staff may feel they have to work when unwell with potential to cross infect. 2

Staff side engagement in local and national negotiations. Good trust communications. Team leaders and managers managing absence in line with policy.

1

Automate expenses and timesheet entry.

3 Q 1Training of staff required to ensure timely and accurate input to system. Possible delays in payments.

3 Training programme for staff with good communications. 1

Reduce Service Development spend on bid costs

1 Q 1Potential to lose bids if skillset of team is reduced - no impact on quality 1 No impact on quality 1

General reduction in driver training budget of 4%

2 Q 1No direct impact on Quality - control on budget management 2 No further mitigations required. 2

Reduce sickness absence 3 Q 3Potential to improve quality of worklives and care provision. 9

Consultation with staff side / local management by team leaders of staff returning from sick leave to ensure well enough and no infection risk. Sickness to be monitored weekly and resource levels adjusted through other variable resource if sick levels are higher than plan Reduction

6

Reduce attrition across the trust. 2 Q 2Low impact on Quality. Should improve continuity of care provision and staff satisfaction. 4 None required 2

National change in AfC - sickness absence will not attract unsocial payment.

Reduction of costs against budget headings.

Move to computerised data entry and online authorisation system for expenses and timesheets.

CIP's quality assessed not included in financial plan

-

383

Actively manage sickness across the trust to save 1%

-

Working Time Solutions, NEMA, MIS, Page One, NEXUS, Excelerate, PCTI, Terrafix smartphones and various phone contracts

165

6

Identify and address reasons for attrition, such as potential staff not appreciating the unsocial element of

4

22

Number of Commercial bids in 2014/15 reduced.

118

93

217

Renegotiation of cleaning contracts

Closure of Butser Hill and Woodcote.

95

Reduce estates spend generally and bring expenditure in the North in line with the South.

Electronic Patient records introduced, so less requirement for agency staff to manually enter information into system


Renegotiation of pay protection period 4 Q 2Impact on quality low. Potential for staff to feel aggrieved but to be worked through individually and with good trust communications.

8 Negotiations with staff and staff side. Sound communications. 6

Renegotiation of pay protection mileage.

3 Q 2 As above 6 As above. 4

Renegotiation of increment progression.

3 Q 2Impact on quality low. Potential for staff to feel aggrieved but to be worked through individually 6

Managing underperformance will have a positive impact on the quality of care to patients and ensure that staff are supported when required

4

Training delivered in the area. 2 Q 2Could improve quality of training provision - delivered locally more staff through training programmes

4 Monitor effectiveness of the change through feedback from staff post training 2

Education vehicle cost reductions 1 Q 1 No direct impact on Quality 1 No further mitigations required. 1

Increase employee contributions for lease cars

- Increase contributions for company cars with limited business use.

3 Q 3Staff may release their lease cars and travel less to SCAS and other meetings. Increased grey fleet costs.

9 Good communications. Use of IT systems/video to conduct meetings. 6

Reduced legal costs. 1 Q 1 Low risk to Quality. 1 No further mitigation required - low risk. 1

Insurance savings on vehicles moving to non-emergency tariff

1 Q 1 Low risk 1 No mitigation required 1

Annual Report produced in House 1 Q 1 Low risk 1 no mitigation required 1

Q

-

Renegotiate protection of mileage payments from 4 years to 2 years.

-

-

Utilise skills in-house rather than engaging 3rd parties to produce the Annual Report.

Reclassification of certain non-emergency vehicles.

-

Arrange to lease vehicles rather than short-term hire them.

-

Renegotiation of pay protection period from 5 years to 2 years.

-

Trainers travelling to deliver training in the area rather than pupils travelling.

-

Reduced costs associated with a case where a motorist ran into an ambulance attending a call in the New Forest.

Ensure that staff failing to attain the required proficiency in their work are identified before receiving an automatic increment.

-

working hours, increasing personal


Human Resources Overall rating R Red > 30% Red scores, Green > 70% Green and <10% Reds (but no key indicators), Amber - rest

Sickness absence (reported one month in arrears)


% % % % %

Trust 5.8% 5.1% R 5.5% 5.0% R 5.1% 4.9% A See comments below

- 999 6.3% 5.6% R 5.9% 5.2% R 5.5% 5.5% G

Managers and HR review absent staff on a weekly basis to ensure they are being managed in accordance with policy, monthly review meetings take place with Director of Ops to discuss cases and strategies for reducing overall absence in more depth

- A&E EOC 4.8% 6.5% G 5.7% 5.7% G 5.2% 5.9% GEOC recovering well from increase in M3-M4, expected to be within target in M5

- PTS 7.1% 4.3% R 6.1% 4.9% R 5.4% 4.5% RAbsence is reviewed on a monthly basis and there will be renewed focus on this.

- Other Commercial 4.3% 1.0% R 1.9% 3.7% G 2.3% 4.4% G CLS TUPE of Berks East area has seen increase in sickness levels

- 111 service 5.8% 6.3% G 5.9% 6.7% G 8.3% 5.0% RNo comment required

- Other 4.2% 1.3% R 2.6% 2.3% R 2.3% 2.5% G

Others' have been reclassified, pushing up the total staff within this IPR area. Sickness Plan has been adjusted and reviewed. Area remains on target

Jul-14

Lead Director: Will Hancock

Measure Year to date Full year Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)



% % % % %

Trust appraisals 77.0% 85.0% A 77.0% 85.0% A 95.0% 95.0% G

- 999 appraisals 84.0% 90.0% A 84.0% 90.0% A 95.0% 95.0% G

- A&E EOC appraisals 88.0% 90.0% A 88.0% 90.0% A 95.0% 95.0% G

- PTS appraisals 85.0% 95.0% R 85.0% 95.0% R 95.0% 95.0% G

- Other Commercial Division appraisals 74.0% 90.0% R 74.0% 90.0% R 95.0% 95.0% G

- 111 Service appraisals 47.0% 80.0% R 47.0% 80.0% R 95.0% 95.0% G

- Other appraisals 72.0% 85.0% R 72.0% 85.0% R 95.0% 95.0% G

Senior Management Team to be advised of slight fall in appraisal completion date and asked to produce plans to bring Trust back into upper Amber (85%)


Appraisals (% completed of those due)

Measure Aug-14 Year to date Full year



% % % % %

Trust attrition (external leavers - excludes internal SCAS transfers)

1.4% 0.9% R 6.2% 3.6% R 11.9% 9.3% R See comment below

- 999 attrition 1.2% 0.8% R 5.0% 2.9% R 9.3% 7.2% R 20 leavers (11 Clinical, 9 ECA's)

- A&E EOC attrition 2.5% 1.0% R 11.3% 5.9% R 19.4% 13.9% R 11 ECT's, of which 9 N EOC and 2 S EOC

- PTS attrition 0.7% 0.4% R 2.5% 3.1% G 7.9% 8.5% G No comment required

- Other Commercial Division attrition 0.0% 2.0% G 4.9% 2.0% R 7.1% 4.2% R Zero Attrition, Zero movers in July 2014

- 111 Service attrition 2.3% 1.7% R 14.3% 6.2% R 27.7% 19.6% R 16 leavers (including 13 Call Takers, 2 Clinical Advisors)


AttritionMeasure Aug-14 Year to date Full year

Integrated Performance ReportWorkforce


Trust - Workforce numbers 2,526 2,632 A 2,526 2,632 A 2,839 2,879 A

Trust - Vacancies 386 265 R 386 265 R 185 145 G

999 - Workforce numbers 1,347 1,414 A 1,347 1,414 A 1,440 1,480 A

999 - Vacancies 223 160 R 223 160 R 138 98 R

A&E EOC - Workforce numbers 262 285 A 262 285 A 288 288 G

A&E EOC - Vacancies 51 28 R 51 28 R 26 26 G

PTS - Workforce numbers 301 295 G 301 295 G 426 426 G

PTS - Vacancies 40 28 R 40 28 R 10 10 G

Other CS - Workforce numbers 61 60 G 61 60 G 58 58 G

Other CS - Vacancies 10 10 G 10 10 G 11 11 G

111 Service - Workforce numbers 233 254 A 233 254 A 293 293 G

111 Service - Vacancies 50 29 R 50 29 R 0 0 G

Other - Workforce numbers 322 325 A 322 325 A 335 335 G

Other - Vacancies 13 10 R 13 10 R 0 0 GNo comment required


9 New ACA's joined in August 2014. 8 New BANK starts due in PTS South in Sept, 6 in Berks PTS October. 130 TUPE due in October. Vacancies being put on hold due to tendering process in several PTS contracts. Bank appointments being made to bridge gap. Attrition is still high overall (including internal - not counted in attrition figures above)

Measure

No comment required

Aug result is affected by higher than anticipated attrition rate. Pipeline of EOC, 111 and 999 is now increasing

Aug-14

17 Joiners in Aug 2014 (15.41 FTE). Agency temp-to-perm making up 15 of the 60 shortfall. Recruitment team working with 111 to bridge gap through increased recruitment.

Agency temp-to-perm making up 10 of the shortfall. 4 joiner due in Sept (North). Recruitment team working with EOC to bridge gap through increased recruitment. Attrition has been higher than anticipated


11 Paramedics started in Sept 2014, 21 due in Oct + 3 MOD Paramedics, 21 due in Nov 2014. Attrition is higher than expected



Manual Handling 65.0% 63.0% G 65.0% 63.0% G 80.0% 80.0% G No comment required

Fire Awareness 71.0% 80.0% R 71.0% 80.0% R 95.0% 95.0% GHot News article released advising staff of compliance. Plans in place to increase compliance

Information Governance 77.0% 80.0% A 77.0% 80.0% A 95.0% 95.0% G Target only just missed - should be back on track soon

Health & Safety 56.0% 63.0% R 56.0% 63.0% R 80.0% 80.0% GHot News article released advising staff of compliance. Plans in place to increase compliance

Equality & Diversity 30.0% 58.0% R 30.0% 58.0% R 80.0% 80.0% GLarge fall due to stat & mand training in 2011 expiring. Education to work on compliance with this module to all staff

Conflict Management 42.0% 45.0% A 42.0% 45.0% A 80.0% 80.0% GHot News article released advising staff of compliance. Plans in place to increase compliance

Infection Control 50.0% 70.0% R 50.0% 70.0% R 80.0% 80.0% G

Safeguarding Adults 55.0% 70.0% R 55.0% 70.0% R 80.0% 80.0% G

Safeguarding Children 55.0% 70.0% R 55.0% 70.0% R 80.0% 80.0% G

Education working on plans to increase completion of these modules

Measure (% completed of staff requiring the training)

Full year Commentary on exceptions (Red - action to correct, Amber - action to reduce risk, Green - nil)

Aug-14 Year to date


Cat Red 8

Cat Red 19

Cat Red 1

Cat Red 2

Abandoned calls

Recontact 24hrs Telephone

Recontact 24hrs On Scene

Frequent caller

Resolved by telephone

Non A&E

ROSC

ROSC - Utstein

STEMI - 60

STEMI - 150

STEMI - Care

Stroke - 60

National Ambulance Clinical Quality Indicators (CQI's)

The number of patients who have been cared for and treated at the scene of the 999 call or taken to somewhere other than an A&E department for treatment (for example, an NHS Walk-in Centre).

The percentage of Category Red (immediately life-threatening) calls reached within 8 minutes – the target is 75%.

The percentage of Category Red (immediately life-threatening) calls where a vehicle able to transport the patient has arrived within 19 minutes – the target is 95%.

The percentage of 999 callers who have hung up before their call was answered in an emergency control room.

The number of patients who have re-contacted the ambulance trust within 24 hours of them having called 999 and been offered clinical advice over the phone.

The proportion of 999 calls that have been resolved by providing telephone advice and no ambulance response.

Red 1 call are the most time critical of Red call and cover cardiac arrest patients who are not breathing and do not have a pulse and other severe conditions such as airways obstruction.Red 2 calls are serious but less immediately time critical and cover conditions such as stroke and fits.

The total number of patients who having had suffered a cardiac arrest and stopped breathing have then been recorded as having had a return of spontaneous circulation (a pulse/heartbeat) at the time of their arrival at hospital.

The number of patients who have been witnessed suffering a cardiac arrest and stopped breathing, whose heart was then in a rhythm which allowed it to be shocked with a defibrillator and have then been recorded as having had a return of spontaneous circulation (ROSC) at the time of their arrival at hospital.

The number of patients who have re-contacted the ambulance trust within 24 hours of them having called 999 and then were discharged on scene following face to face ambulance assessment.

The number of patients who have re-contacted the ambulance trust within 24 hours for whom a locally agreed frequent caller procedure is in place. These patients are referred to as "patients at risk" in SCAS.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) – a type of heart attack – and who have received thrombolysis (treatment with a clot-busting drug) within 60 minutes of the original 999 call to attend them.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) - a type of heart attack - and who then been directly transferred to a centre capable of delivering primary percutaneous coronary intervention (PPCI) and received angioplasty treatment within 150 minutes of the original 999 call to attend them.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) - a type of heart attack - and who have received the correct treatment (appropriate care bundle) in line with ambulance guidelines.

The percentage of patients who have suffered a stroke, as confirmed by the face to face carrying out of a Face Arm Speech Test (FAST) and who were potentially eligible for stroke thrombolysis (treatment with a clot-busting drug) and who arrived at a hyper acute stroke centre within 60 minutes of the original 999 call to treat them.

Integrated Performance ReportStroke - Care

Cardiac - STD

Cardiac - STD Utstein

Time to Answer - 50%



Time to Treat - 50%

Time to Treat - 95%

Time to Treat - 99%

Handover improvement

Clear-up improvement

Turnaround improvement

CQC

NPSA

SHA

RIDDORHSENHS Protect

The percentage of patients who have been witnessed suffering a cardiac arrest and stopped breathing, whose heart was then in a rhythm which allowed it to be shocked with a defibrillator and were successfully resuscitated and survived to be discharged from hospital.

The percentage of suspected stroke patients who were assessed face to face and who received the correct treatment (appropriate care bundle) in line with ambulance guidelines.The overall percentage of patients who having suffered a cardiac arrest and stopped breathing were successfully resuscitated and survived to be discharged from hospital.

The time taken for a health professional working for the ambulance trust to arrive at the scene of a Category A (immediately life-threatening) call, measured by the time below which 50% of patients were reached.



The time taken to answer 999 calls in an emergency control room measured by the time below which 50% of calls were answered.



Other terms and abbreviations

NHS Protect leads on work to identify and tackle crime across the health service.

National Patient Safety Agency

Strategic Health Authority

Reporting of Injuries, Diseases and Dangerous Occurrences RegulationsThe Health and Safety Executive

Care Quality Commission

Clear-up time is the time from clinical handover above to the time that the ambulance vehicle departs hospital. This had a target of 15 minutes. Clear-up improvement is where the total clear-up time for all hospital visits has improved compared to the same period last year.

Turnaround time is the total of handover and clear-up time. This had a target of 30 minutes. Turnaround improvement is where the total turnaround time for all hospital visits has improved compared to the same period last year.

Hospital handover time is the time from hospital arrival by ambulance personnel to clinical handover to hospital clinical staff. This had a target of 15 minutes. Handover improvement is where the total handover time for all hospital arrivals has improved compared to the same period last year.

Agenda item: 11

BOARD PAPER IN PUBLIC 24 SEPTEMBER 2014


Title Finance and Estates Report for the month ended 31 August 2014

Responsible Director Charles Porter, Director of Finance

Recommendation (eg. note, approve, endorse) To note the current financial position of the Trust.










None noted.

Implications Regulatory and legal implications / impact (e.g. Monitor provider licence and Continuity of Services risk ratings, CQC essential standards, competition law etc.) The paper covers our Monitor financial risk rating – our current financial risk rating is a 4, which is in line with the plan.


The paper covers all aspects of our financial position (e.g. CIPs, FRR and year-end outturn)


The Public Finance Board papers are shared with the Council of Governors. In addition, periodic workshops for governors are held to develop their understanding of finance and the financial environment in which the Trust operates. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

The paper should be read in conjunction with the Quality and Patient Safety Report, recognising that the Trust’s objective is to ensure clinical quality whilst maintaining a sound financial position.

Other Previous considerations by the Board July 2014 and every bi-monthly Board meeting in public

Background papers / supporting information

This paper is presented as part of the process of the Board undertaking a continuous review of the Trust’s financial position. Background reading can be found at: Monitor Risk Assessment Framework http://www.monitor.gov.uk/raf

http://www.monitor.gov.uk/raf

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FINANCE AND ESTATES REPORT FOR THE MONTH TO 31 AUGUST 2014

PURPOSE

1 The purpose of the paper is to:

• Present an update on the Trust’s latest financial position, covering income and expenditure; cash, capital and liquidity; Monitor financial risk rating; and cost savings.

• provide assurance to the Board that actions are in place to address any areas where the Trust’s financial performance is adversely behind plan at this stage of the financial year.

EXECUTIVE SUMMARY

2 Income and expenditure - the Trust made a surplus of £36k in the fifth month of the financial year which is in line with budget for the month and £61k better year to date. There are increasing risks to delivering the full year surplus forecast as detailed below.

3 Cash and capital - the Trust’s cash balance at the end of August was £27.5m which was £8m higher than the forecast made in the July report due mainly to higher than anticipated receipts and reduced payments. In month payments on NHSD were lower than the level anticipated in July. Debtors that are 90 days old remain high and currently exceed the Monitor 5% sales debtor figure due to a marked decrease in sales debtors.

4 Monitor financial risk rating –the Monitor Continuity of Service Risk Rating comprises a capital service cover (debt interest cover) rating and a liquidity rating which were both 4 for August 2014.

5 Cost savings – overall the savings were £0.5m in the month bringing the year

to date savings to £1.9m which is slightly better than plan. INCOME AND EXPENDITURE 6 As can be seen from the table below, the Trust made a surplus of £36k in the

month which was in line with budget. Income was £0.1m higher due to higher than planned activity in our 999 and 111 services. Costs were higher too to support this additional activity as well as recover operational performance.

of 4

Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance to

budget

Variance to Prior

YearProfitabilitySCAS Income £k 13,275 13,170 105 67,092 66,128 963 165,501 162,317 162,387 3,184 3,114

SCAS Contribution £k 2,345 2,632 (287) 12,545 12,796 (251) 31,214 31,233 34,532 (20) (3,318)

% Contribution % 18% 20% -2% 19% 19% -1% 19% 19% 21% 0% -2%

Corporate overheads £k 2,308 2,595 287 12,354 12,666 312 30,690 30,710 33,015 20 1,912

EBITDA £k 603 801 (198) 3,764 3,949 (185) 9,223 9,716 11,149 (493) (1,926)EBITDA % % 5% 6% 6% 6% 6% 6% 7%

Overall Surplus/(Deficit) £k 36 37 (1) 191 131 61 524 524 1,517 0 (993)

% Surplus/(Deficit) % 0.3% 0.3% (0.0%) 0.3% 0.2% 0.1% 0.3% 0.3% 0.9% (0.0%) (0.6%)

Month Year to date Full Year

7 There are increasing risks to delivering the full year surplus forecast. Net risks

have increased from £0.9m at the time of the budget sign off to £2m. The largest issue relates to the difficulty and cost of delivering Red 2 performance. Further work is being done to assess this position.

Further information can be seen in the following appendices:

• Appendix A1 – income and expenditure monthly position • Appendix A2 – income and expenditure quarterly position • Appendix B – analysis of income • Appendix C – key operational ratios for income and expenditure

CASH AND CAPITAL

8 The Trust’s cash balance at the end of August was £27.5m which was over

£8m higher than the level forecast in July. The principal reason for this was an increase in sales ledger receipts of £4m attributable to receipt of EPRF funding from NHS England (£3m) and receipt of backdated A & E money resulting from agreement of contractual uplifts. Non pay payments at £4.6m were lower than the level forecast in July as a result of slower than expected payment of ambulance private providers. Day to day NHSD payments are also starting to level off and the level forecast for August (£3.7m) has not materialised due in part to lower than anticipated invoice settlements set against the amounts that were provided for by NHSD. Capital payments remain low, although the August figure was marginally higher (£0.4m) than the level forecast in July.

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Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance to budget

Variance to Prior

YearCash and capital positionEBITDA £k 601 799 (198) 3,761 3,946 (185) 9,223 9,716 11,149 (493) (1,926)Working capital mov't £k 4,619 (594) 5,213 3,088 (2,649) 5,737 (1,105) (1,483) (333) 378 (772)NHSD transfer £k (418) (429) 11 12,832 2,604 10,228 3,015 1,041 0 1,974 3,015Capital Expenditure £k (389) (287) (102) (1,397) (2,106) 709 (9,957) (9,957) (8,134) 0 (1,823)Disposals £k 322 0 322 899 549 350 899 863 72 36 827PDC paid £k 0 0 0 0 0 0 (1,708) (1,830) (1,900) 122 192Interest £k 1 3 (2) 11 17 (6) (62) (62) (45) 0 (17)Repayments of loans £k 0 0 0 0 0 0 (1,188) (1,188) (1,007) 0 (181)Other £k 0 10 (10) (1) 100 (101) (2) (1) 56 (1) (58)PDC & DOH Loans £k 0 0 0 0 0 0 7,000 7,000 170 0 6,830Cashflow £k 4,736 (498) 5,234 19,193 2,461 16,732 6,115 4,099 28 2,016 6,087

Cash balance £k 27,522 10,790 16,732 27,522 10,790 16,732 14,444 12,428 8,329 2,016 6,115


9 The 90 day debtor figure has increased this month by £30k and now stands at

£370k (mainly PTS ECRs, 111 CQUINN and 111 Floor). The 90 days debt as a % of the total sales ledger debt has increased to 7.6% from 4.5%. Sales debtors have decreased from £7.6m to £4.9m. As a consequence the Trust is currently outside of the allowable 90 day debtor target of 5% of total sales debt set by Monitor. Critical to getting back inside target will be progress on resolving outstanding PTS ECR and 111 Floor issues. There is a residual risk of debts within the 60-90 day category moving to the 90 day category in August of £0.2m but 50% of this has already been promised for payment in September.

10 Capital expenditure in August was low at only £0.4m with the only significant

spend incurred on three IT projects, Core Infrastructure, Vodafone virtualisation and Qlikview BI System. Capital is forecast at £0.9m in September which is within the Monitor re-forecast plan.

11 Further information can be seen in the following appendices:

• Appendix D – key financial ratios, including liquidity • Appendix E1 & 2 – cash flow forecast and reconciliation to 31 March 2016 • Appendix F – capital expenditure 2014/15 • Appendix G – balance sheet and forecast to 31 March 2015

MONITOR FINANCIAL RISK RATING 12 As can be seen from the table below, our rating is a 4 which is in line with plan.

Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance to

budget

Variance to Prior

Year

Financial Risk Rating

Overall Score 4.0 4.0 0.0 4 4 0 4 4 4 0 0


COST SAVINGS 13 As can be seen from the table below, overall the savings were £0.5m which

was 12% ahead of plan in the month and 2% ahead year to date

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Actual Budget Var Actual Budget Var Forecast Budget Var

PTS Private Provider cost reduction 17 28 (11) 78 114 (36) 270 306 (36)PTS Porterage 0 4 (4) 0 4 (4) 68 77 (9)PTS Post SHIP vehicle review 0 0 0 0 0 0 20 40 (20)PTS Efficiencies from Talecom 14 9 5 25 22 4 103 99 4PTS Bucks reduction in unsocial allow 0 0 0 0 0 0 35 35 0PTS Band 2 replacement of Band 3 in B 2 2 0 5 6 (2) 18 18 (0)Berks Logistics - Reduction in agency 2 4 (2) 10 12 (2) 68 47 21Commercial Training -Utilise SCAS pr 0 1 (1) 0 2 (2) 4 8 (4)Call Centre North agency saving 2 2 0 15 8 6 26 20 6Changes to headcount within Commer 7 7 0 21 35 (14) 70 84 (14)Subtotal Commercial Division 43 56 (13) 153 203 (50) 681 734 (53)A&E Private Provider Efficiency 0 18 (18) 44 72 (28) 172 200 (28)Loss of unit hours 56 15 41 95 45 50 311 300 11VOR Improvement 9 6 3 19 14 5 140 140 0Reduce time on scene 0 30 (30) 0 30 (30) 210 240 (30)Reduce hospital turnaround 28 0 28 93 0 93 213 120 93Inc indirect unique contri 0 0 0 0 0 0 350 680 (330)Co Responder scheme NEOCE 12 15 (3) 35 50 (15) 185 200 (15)Lease vehicles 10 10 0 34 34 0 100 100 0Workshop review 3 0 3 65 0 65 119 36 83Make Ready 13 8 5 52 42 11 120 105 15Area vehicles (5) 25 (30) 25 120 (95) 200 295 (95)Unplanned overtime' 53 15 38 53 15 38 200 200 0Meal Break reduction 0 1 (1) (0) 22 (22) 20 25 (5)Consumables management 0 15 (15) 0 75 (75) 200 200 0Printing Costs 5 2 4 14 8 5 26 20 6Fuel 30 5 25 110 25 85 169 85 84PP invoice management 5 8 (3) 33 42 (9) 301 100 201Mind the GAP 0 0 0 0 0 0 250 249 1Increase Red Assistance 0 0 0 0 0 0 120 120 0Remove GP''s from EOC 41 41 0 112 112 0 320 320 0Subtotal Frontline Ops 260 214 46 785 706 79 3,727 3,736 (8)1. 111 sickness reduction 7 7 0 32 39 (7) 104 111 (7)2. 111 Telephony Virtualisaion 0 0 0 0 0 0 224 224 03. 111 Resource Management 31 30 0 189 189 0 346 346 (0)Subtotal EOC & 111 37 37 0 221 228 (7) 674 682 (8)

9 9 0 13 18 (5) 474 480 (5)39 30 9 140 139 0 370 438 (68)25 24 1 148 130 18 347 331 1619 13 6 63 61 2 131 158 (27)43 41 2 417 405 12 461 432 29

Subtotal Corporate 134 117 18 780 754 26 1,783 1,838 (55)Target/(contingency) 0 0 0 0 0 0 -259 -383 124Total 475 424 51 1,939 1,891 48 6,607 6,607 0

7.2% 6.4% 29.4% 28.6%

Com

mer

cial

Div

isio

n

Month YTDProject Full Year

A &

E11

1C

orpo

rate

Education and HRFinance, Estates and InformationICT savingsProperties rationalisationOther overheads

CONCLUSIONS

14 Work will continue to carry out the actions to deliver our budgeted financial plan as well as the cost improvement programme. Further work will be done to clarify the risks, particularly relating the cost of delivering operational performance, and the action to improve the financial position.

RECOMMENDATIONS TO THE BOARD

16 The Board is asked to note the current financial position of the Trust, and the actions in place to address any areas where performance is behind plan.

Charles Porter Director of Finance

Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance to budget

Variance to Prior Year

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

TOTAL SCAS INCOME 13,275 13,170 105 67,092 66,128 963 165,501 162,317 162,387 3,184 3,114

Emergency Services (inc. 111)

Income 11,494 11,383 111 58,080 57,190 890 141,365 138,436 140,417 2,929 948

Direct costs 9,292 8,899 (393) 46,355 45,179 (1,176) 112,486 109,484 108,676 (3,002) (3,810)

Gross contribution 2,202 2,484 (283) 11,725 12,012 (286) 28,879 28,951 31,741 (72) (2,862)19% 22% -3% 20% 21% -1% 20% 21% 23%

Non-Emergency ServicesIncome 1,781 1,787 (6) 9,011 8,938 73 24,136 23,882 21,970 255 2,167

Direct costs 1,638 1,639 1 8,192 8,153 (38) 21,801 21,599 19,179 (202) (2,623)

Gross contribution 143 147 (5) 820 785 35 2,335 2,282 2,791 53 (456)8% 8% 0% 9% 9% 0% 10% 10% 13%

Contribution Operational Activities 2,345 2,632 (287) 12,545 12,796 (251) 31,214 31,233 34,532 (20) (3,318)

Central CostsClinical Services 224 213 (11) 1,085 1,066 (18) 2,762 2,559 2,500 (203) (262)Finance 218 244 26 1,239 1,203 (36) 2,911 2,845 3,205 (66) 294Estates 360 347 (12) 1,748 1,748 0 4,173 4,173 4,583 0 410IM&T 350 397 47 1,955 1,984 29 4,879 4,751 4,913 (128) 34Human Resources 171 172 0 854 858 4 2,064 2,059 2,032 (6) (33)Education Services 168 184 17 889 922 33 2,286 2,197 2,334 (90) 47Service Development 96 94 (2) 465 472 7 1,157 1,134 1,015 (23) (142)Communications & Public Engag't 40 42 2 186 202 16 487 496 455 9 (32)Corporate 71 63 (8) 323 319 (3) 768 759 702 (9) (66)Other (contingency) 45 75 30 40 75 35 503 545 1,648 42 1,103Loss/(Profit) on disposal (169) 0 169 (221) 0 221 (221) 0 (23) 221 (23)Depreciation 608 608 0 3,042 3,042 0 7,150 7,300 7,698 150 398Financing Costs 126 155 29 749 774 24 1,770 1,892 1,955 122 185Total overhead costs 2,308 2,595 287 12,354 12,666 312 30,690 30,710 33,015 20 1,912

Net surplus/(deficit) 36 37 (1) 191 131 61 524 524 1,517 0 (993)

Depreciation 608 608 0 3,042 3,042 0 7,150 7,300 7,698 150 548Public dividend capital 123 153 30 733 763 30 1,708 1,830 1,914 122 206Net interest payable 5 4 (1) 19 14 (6) 62 62 44 0 (18)Profit on disposal 169 0 (169) 221 0 (221) 221 0 23 (221) 198

EBITDA 603 801 (198) 3,764 3,949 (185) 9,223 9,716 11,149 (493) (1,926)% 4.5% 6.1% 5.6% 6.0% 5.6% 6.0% 6.9%

South Central Ambulance Service NHS Foundation Trust (Appendix A1)Financial results for Month 5 ended 31 August 2014


Actual Budget Variance Actual/ Budget Variance Forecast Budget Variance Forecast Budget Variance Forecast Budget Variance£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

TOTAL SCAS INCOME 40,256 39,720 536 40,202 39,612 590 42,426 41,731 695 42,618 41,254 1,364 165,501 162,317 3,184

Emergency ServicesIncome 34,906 34,358 548 34,734 34,248 486 35,764 35,155 610 35,960 34,675 1,285 141,365 138,435 2,930

Direct costs 27,742 27,215 (528) 27,733 26,959 (774) 28,522 28,009 (513) 28,488 27,301 (1,187) 112,485 109,484 (3,001)

Gross contribution 7,164 7,143 21 7,001 7,289 (287) 7,242 7,145 97 7,472 7,374 99 28,880 28,951 (71)20.5% 20.8% 20.2% 21.3% 20.2% 20.3% 20.8% 21.3% 20.4% 20.9%

Non-Emergency ServicesIncome 5,350 5,362 (13) 5,468 5,364 103 6,661 6,577 85 6,657 6,579 79 24,136 23,882 254

Direct costs 4,871 4,885 13 4,959 4,906 (53) 5,964 5,904 (59) 6,010 5,904 (106) 21,804 21,599 (205)

Gross contribution 479 478 1 509 458 51 698 672 25 647 675 (28) 2,332 2,283 498.9% 8.9% 9.3% 8.5% 10.5% 10.2% 9.7% 10.3% 9.7% 9.6%

Contribution Operational Activities 7,642 7,621 21 7,510 7,747 (237) 7,940 7,818 122 8,120 8,048 71 31,212 31,234 (22)

Central Costs (inc op overheads)0

Clinical Services 648 640 (8) 687 640 (47) 728 640 (89) 699 640 (59) 2,762 2,559 (203)Finance 731 665 (66) 656 682 26 670 659 (12) 654 639 (14) 2,711 2,645 (66)Estates 1,033 1,053 20 1,063 1,042 (20) 1,039 1,039 0 1,039 1,039 0 4,173 4,173 0IM&T 1,200 1,190 (9) 1,173 1,189 16 1,253 1,186 (67) 1,253 1,186 (67) 4,879 4,751 (128)Transformation & OD 1,326 1,351 25 1,356 1,351 (5) 1,413 1,343 (70) 1,413 1,343 (70) 5,508 5,389 (119)Communications & Public Engag't 110 118 8 119 126 7 129 126 (3) 129 126 (3) 487 496 9Corporate 181 192 12 207 190 (17) 188 188 1 192 188 (4) 768 759 (9)Contingency (5) 0 5 59 90 30 119 119 0 330 337 7 503 545 42Loss/(Profit) on disposal (52) 0 52 (169) 0 169 0 0 0 0 0 0 (221) 0 221Depreciation 1,825 1,825 0 1,804 1,825 21 1,761 1,825 64 1,761 1,825 64 7,150 7,300 150PDC 458 458 0 414 458 43 418 458 39 418 458 39 1,708 1,830 122Interest 10 7 (3) 9 7 (2) 24 24 0 19 24 6 62 62 0Injury benefit 50 50 0 50 50 0 50 50 0 50 50 0 200 200 0Total overhead costs 7,514 7,549 36 7,428 7,650 221 7,792 7,656 (136) 7,956 7,855 (102) 30,690 30,710 19

Net surplus 129 72 57 82 97 (15) 148 162 (14) 163 194 (30) 522 524 3

South Central Ambulance Service NHS Foundation Trust (Appendix A2)

Q1 Q2 Q3 Q4 Full Year

Financial results for Month 5 ended 31 August 2014

Appendix B

Income analysisActual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance

to budgetVariance to Prior

Year£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

Emergency ServicesE&U Contract 2013/2014 9,698 9,669 29 49,195 48,344 851 118,703 116,970 117,989 1,733 714HART income 259 257 2 1,297 1,287 10 3,114 3,089 3,081 25 33111 Service 1,258 1,205 52 6,418 6,264 154 16,074 15,252 15,284 822 790Public Events 49 18 31 105 92 13 220 220 281 0 (61)CBRN/Flu funding 42 21 21 112 106 6 254 254 306 0 (52)RTA Recoveries 42 42 0 208 208 0 500 500 506 0 (6)Training funding from Health Education England 111 156 (45) 555 580 (24) 1,881 1,621 2,104 260 (223)Workshop Income 0 9 (8) 4 43 (39) 10 104 59 (94) (48)Other Income 62 34 28 325 407 (82) 945 761 867 183 78AfC Transfer (28) (28) 0 (140) (140) 0 (336) (336) (363) 0 27Total Emergency Services 11,494 11,383 111 58,080 57,190 890 141,365 138,436 140,417 2,929 1,249

Non-Emergency ServicesPTS Hampshire 324 305 19 1,686 1,523 163 6,327 6,326 4,112 0 2,215PTS Berkshire 371 368 3 1,857 1,840 17 4,416 4,416 4,474 (0) (59)PTS Ox 408 439 (31) 2,118 2,196 (78) 5,270 5,270 5,395 1 (125)PTS Bucks 382 378 4 1,844 1,889 (45) 4,517 4,362 4,606 154 (89)PTS Bucks & Ox 3 0 3 10 0 10 3 0 9 3 (6)Out of Hours - Berkshire 0 0 0 0 0 0 0 0 28 0 (28)Out of Hours - Ox & Bucks 0 0 0 0 0 0 0 0 0 0 0Logistic Services - Berkshire 124 122 2 623 610 13 1,453 1,393 1,500 60 (47)Logistic Services - Ox & Bucks 97 95 2 481 477 4 1,149 1,147 1,122 2 27Community Equipment Provision 0 0 0 0 0 0 0 0 (0) 0 0Commercial Training 20 31 (11) 131 156 (26) 375 375 363 (0) 12Events Management 0 0 0 0 0 0 0 0 0 0 0TVEA 24 21 3 121 107 15 291 256 301 35 (10)AfC Transfer 28 28 0 140 140 0 336 336 363 0 (27)Total Non-Emergency Services 1,781 1,787 (6) 9,011 8,938 73 24,136 23,882 21,970 255 1,865

Total income 13,275 13,170 105 67,092 66,128 963 165,501 162,317 162,387 3,184 3,114

South Central Ambulance Service NHS Foundation Trust (Appendix B)

Financial results for Month 5 ended 31 August 2014


South Central Ambulance Service NHS Foundation Trust Appendix C

Actual Budget Variance Actual Budget Variance Forecast Budget Prior yearKey Operational Ratios Aug-14 Aug-14 Aug-14 YTD YTD YTD Full Yr Full Yr Full Yr

+/(-) +/(-)

Activity - % inc above prior year 5.1% 3.0% 2.1% 7.2% 3.8% 3.4% 3.2% 3.2% 6.6% - income from growth (£k) 180 167 12 1,511 836 675 2,727 2,052 3,902Delays at hospitals 0 - income from delays (£k) 49 58 (9) 316 292 24 700 700 963CQUINN (Clincal Quality Incentive) 0

- Potential income 230 230 0 1152 1,152 0 2,766 2,766 2,728 - Contingency/Other (54) (50) (4) (270) (246) (24) (582) (582) (481)Subtotal CQUINN 176 180 (4) 882 906 (24) 2,184 2,184 2,247

0 0Performance penalty 0 0 0 0 0 0 0 0 0

0Total income from activity related measures 406 406 (1) 2,710 2,034 675 4,936 4,936 7,112

Actual Budget Variance Actual Budget Variance Forecast Budget Prior yearKey Operational Spend (£k) Aug-14 Aug-14 Aug-14 YTD YTD YTD Full Yr Full Yr Full Yr

+/(-) +/(-)Overtime - A&E - North 148 122 (26) 750 651 (99) 1,747 1,694 2,059 - A&E - South 117 85 (32) 660 490 (170) 1,451 1,260 1,686 - A&E - Control 37 17 (20) 157 83 (75) 333 199 489 - A&E - Comm Resp/Emer Plan/Fleet 32 22 (10) 180 110 (70) 332 264 394 - Commercial Division - PTS 33 27 (5) 152 135 (16) 295 288 336 - Commercial Division - non-PTS 5 3 (2) 18 16 (2) 42 38 38 - Other 70 54 (2) 399 339 (60) 959 774 1,019Total Overtime 442 330 (97) 2,316 1,824 (492) 5,157 4,516 6,021

Private Providers - A&E - North 763 381 (381) 3,076 2,260 (816) 7,978 5,456 6,202 - A&E - South 244 51 (194) 774 346 (428) 1,542 568 2,157 - PTS 169 164 (6) 861 820 (42) 2,222 2,142 2,171Total private providers 1,177 596 (580) 4,712 3,426 (1,286) 11,742 8,165 10,531

Fuel - A&E 265 334 70 1,508 1,679 171 3,765 4,099 3,730 - Commercial Services 59 68 8 68 68 0 68 68 865 - Fleet central (10) 0 10 0 0 0 0 0 57 - Other 31 53 23 427 538 112 1,024 1,674 441Total fuel 345 455 111 2,002 2,285 283 4,856 5,840 5,093

South Central Ambulance Service NHS Foundation Trust

Monitor Financial Risk Rating Actual Budget Variance Actual Budget Variance Forecast Budget Variance

Capital Service Cover 4 4 0 4 4 0 4 4 0Liquidity 4 4 0 4 4 0 3 4 -1Overall (Continuity of Service Rating) 4 4 0 4 4 0 4 4 0

Aug-14 Jul-14 Jun-14 Last YearYTD YTD YTD Full year

Better payment practice target - Non-NHS by number 88% 88% 87% 88% - Non-NHS by £ value 95% 94% 94% 93% - NHS by number 91% 90% 91% 87% - NHS by £ value 97% 95% 95% 93%

Debtors > 90 days (£k) 370 340 174 112As % of total debts 7.6% 4.5% 4.0% 4.8%

% cost improvements secured (actual) 29.4% 22.2% 15.4% 100%% cost improvements secured (plan) 28.6% 22.2% 16.0% 100%

Appendix D

Comments

Aug-14 YTD Full Year

Nil of note

Increase due to disputed 111 invoices which are being actively discussed with commissioners. This has breached the 5% due

£1.9m delivered year to date which is slightly ahead of plan.

South Central Ambulance Service NHS Foundation TrustAppendix E

CASHFLOW Q1 Q1 Q1 Jul-14 Aug-14 Sep-14 Q2 Q2 Q2 Oct-14 Nov-14 Dec-14 Q3 Q3 Q3 Jan-15 Feb-15 Mar-15 Q4 Q4 Q4Aug-14 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Actl Budget Variance Actl Actl Fcst Fcst Budget Variance Fcst Fcst Fcst Fcst Budget Variance Fcst Fcst Fcst Fcst Budget VarianceIncomeSL Receipts 38,497 38,677 (180) 13,780 17,563 13,983 83,823 79,494 4,329 13,783 13,583 13,583 124,773 120,683 4,090 13,583 14,051 13,903 166,311 160,999 5,312Fixed Asset Receipts 577 0 577 321 898 0 898 898 0 898 898 863 35Interest 8 23 (15) 3 3 3 17 46 (29) 3 3 3 25 69 (44) 3 3 3 33 38 (6)Capital Loan From HA 0 0 0 0 7,000 7,000 7,000 0 7,000 7,000 0Other Income/PDC/VAT/RTA 1,220 1,013 208 328 262 350 2,160 2,025 135 375 375 375 3,285 3,038 247 375 375 276 4,311 4,500 (189)Other - NHSD 37,312 14,305 23,007 881 11 0 38,204 14,305 23,899 2 2 2 38,210 14,305 23,905 2 2 2 38,216 14,305 23,911Total Cash In 77,614 54,018 23,596 14,992 18,160 14,336 125,102 95,870 29,232 14,163 13,963 20,963 174,191 145,095 29,096 13,963 14,431 14,184 216,768 187,705 29,063

ExpenditurePay expenditure 24,027 24,433 406 8,140 7,984 8,175 48,326 49,963 1,637 8,425 8,425 8,625 73,800 75,856 2,056 8,625 8,625 8,625 99,674 103,497 (3,823)Non Pay expenditure 14,337 13,706 (631) 5,694 4,622 6,831 31,484 28,215 (3,269) 5,181 5,254 5,181 47,099 41,978 (5,121) 5,181 5,211 5,338 62,829 53,770 9,059Capital expenditure 513 1,532 1,019 495 389 859 2,256 2,393 137 522 354 3,271 6,403 7,825 1,422 2,402 832 320 9,957 9,957 0Dividends on PDC 868 868 915 47 868 915 47 840 1,708 1,830 (122)Loan Repayment 319 319 319 0 319 319 0 869 1,188 1,188 0Working Capital Loan 0 0 0 0 0 0 0 0 0Interest on DH Loans 31 31 35 4 31 35 4 65 96 100 (4)Other expenditure NHSD 23,463 4,838 (18,625) 1,480 429 240 25,612 11,701 (13,911) 100 100 9,389 35,201 12,284 (22,917) 35,201 13,264 21,937Total Cash Out 62,340 44,509 (17,831) 15,809 13,424 17,323 108,896 93,541 (15,355) 14,228 14,133 26,466 163,721 139,212 (24,509) 16,208 14,668 16,057 210,653 183,606 27,047

Net Cash In/(Out) 15,274 9,509 5,765 (817) 4,736 (2,986) 16,207 2,329 13,878 (65) (170) (5,503) 10,469 5,883 4,587 (2,245) (237) (1,873) 6,115 4,099 2,016

Balance B/fwd 8,329 8,329 0 23,603 22,786 27,522 8,329 8,329 0 24,536 24,471 24,301 8,329 8,329 0 18,798 16,554 16,317 8,329 8,329 0

Balance C/fwd 23,603 17,838 5,765 22,786 27,522 24,536 24,536 10,658 13,878 24,471 24,301 18,798 18,798 14,212 4,587 16,554 16,317 14,444 14,444 12,428 2,016

CASHFLOW Q1 Q1 Q1 Jul-14 Aug-14 Sep-14 Q2 Q2 Q2 Oct-14 Nov-14 Dec-14 Q3 Q3 Q3 Jan-15 Feb-15 Mar-15 Q4 Q4 Q4RECONCILIATION Fcst Budget Variance £000 £000 £000 Fcst Budget Variance £000 £000 £000 Fcst Budget Variance £000 £000 £000 Fcst Budget VarianceEBIT 544 604 (60) 726 719 880 880 1,208 (328) 972 901 1,470 1,470 1,812 (342) 1,699 1,832 2,071 2,071 2,416 (345)Depreciation & Amortisation 1,825 1,824 1 2,433 3,041 3,628 3,628 3,648 (20) 4,215 4,802 5,389 5,389 5,474 (85) 5,976 6,563 7,150 7,150 7,300 (150)EBITDA 2,369 2,428 (59) 3,159 3,760 4,508 4,508 4,856 (348) 5,187 5,703 6,859 6,859 7,286 (427) 7,675 8,395 9,221 9,221 9,716 (495)Impair/Other Non Cash 0 0 0 0 0 0 0 0

Stock (Inc)/dec 0 0 0 0 0 0 0 0 0 0Debtors (Inc)/dec (4,253) (450) (3,803) (5,799) (2,416) (2,350) (2,350) (1,000) (1,350) (1,573) (1,809) (1,653) (1,653) (754) (899) (509) (515) (519) (519) 818 (1,337)Creditors Inc/(dec) 7,861 6,907 954 6,680 5,191 3,702 3,702 259 3,443 2,802 2,804 1,869 1,869 (260) 2,129 65 (56) (1,438) (1,438) (2,107) 669Provisions Inc/(dec) 9,224 1,596 7,628 10,838 13,145 12,895 12,895 1,408 11,488 12,795 12,695 3,084 3,084 1,126 1,958 3,084 3,084 3,867 3,867 846 3,021Capital expenditure (513) (1,532) 1,019 (1,008) (1,397) (2,256) (2,256) (2,493) 237 (2,778) (3,132) (6,403) (6,403) (7,825) 1,422 (8,805) (9,637) (9,957) (9,957) (9,957) 0Capital disposals 577 549 28 577 899 899 899 549 350 899 899 899 899 549 350 899 899 899 899 863 36Free Cashflow pre finance 15,265 9,498 5,767 14,447 19,182 17,398 17,398 3,578 13,820 17,332 17,160 4,655 4,655 123 4,532 2,409 2,170 2,073 2,073 179 1,894

Interest 9 11 (2) 10 11 (19) (19) (15) (4) (17) (15) (13) (13) (6) (7) (11) (9) (62) (62) (62) 0Dividends on PDC 0 0 0 0 0 (854) (854) (915) 61 (854) (854) (854) (854) (915) 61 (854) (854) (1,708) (1,708) (1,830) 122Free Cashflow 15,274 9,509 5,765 14,457 19,193 16,525 16,525 2,648 13,877 16,461 16,291 3,788 3,788 (798) 4,586 1,544 1,307 303 303 (1,713) 2,016PDC Payment/(Repayment) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Loan repayments 0 0 0 0 0 (319) (319) (319) 0 (319) (319) (319) (319) (319) 0 (319) (319) (1,188) (1,188) (1,188) 0Lease Borrowings 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Capital Loan from DH 0 0 0 0 0 0 0 0 0 7,000 7,000 7,000 0 7,000 7,000 7,000 7,000 7,000 0

Net Cash In/(Out) 15,274 9,509 5,765 14,457 19,193 16,206 16,206 2,329 13,877 16,142 15,972 10,469 10,469 5,883 4,586 8,225 7,988 6,115 6,115 4,099 2,016

South Central Ambulance Service NHS TrustAppendix G

CASHFLOW Apr-15 May-15 Jun-15 Q1 Jul-15 Aug-15 Sep-15 Q2 Oct-15 Nov-15 Dec-15 Q3 Jan-16 Feb-16 Mar-16 Q4 Full YearApr-15 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget BudgetIncomeSL Receipts 12,764 12,814 12,617 38,194 12,801 13,352 14,181 78,528 13,352 13,605 13,750 119,234 13,352 13,851 13,784 160,221 160,221Fixed Asset Receipts 0 0 0 3,250 3,250 3,250Interest 3 3 2 8 3 3 2 16 3 3 2 24 3 2 2 31 31Capital Loan NLF 0 0 0 0Other Income /VAT 345 345 345 1,034 345 345 345 2,068 345 345 345 3,101 345 345 345 4,135 4,135Other 0 0 0 0 0 0 0Total Cash In 13,111 13,161 12,963 39,236 13,148 13,699 14,528 80,612 13,699 13,952 14,096 122,360 13,699 14,197 17,380 167,637 167,637

ExpenditurePay expenditure 9,038 9,038 9,038 27,114 9,038 9,038 9,038 54,229 9,038 9,038 9,038 81,343 9,038 9,038 9,038 108,457 108,457Non Pay expenditure 3,796 3,796 3,796 11,389 3,796 3,796 3,796 22,778 3,796 3,796 3,796 34,166 3,796 3,796 3,796 45,555 45,555Capital expenditure 742 742 742 2,226 742 741 742 4,451 742 741 742 6,676 742 741 742 8,901 8,901Dividends on PDC 985 985 985 985 1,970 1,970PDC/Loan Repayment 869 869 869 869 1,738 1,738Working Capital Loan 0 0 0Interest on DH Loans 57 57 57 58 115 115Other expenditure 0 0 0 0 0Total Cash Out 13,576 13,576 13,576 40,729 13,576 13,575 15,487 83,368 13,576 13,575 13,576 124,096 13,576 13,575 15,488 166,736 166,736

Net Cash In/(Out) (465) (415) (613) (1,493) (428) 124 (960) (2,757) 123 377 520 (1,737) 123 622 1,892 901 901

Balance B/fwd 14,444 13,979 13,564 14,444 12,951 12,523 12,647 14,444 11,688 11,811 12,188 14,444 12,708 12,831 13,453 14,444 14,444

Balance C/fwd 13,979 13,564 12,951 12,951 12,523 12,647 11,688 11,688 11,811 12,188 12,708 12,708 12,831 13,453 15,345 15,345 15,345

CASHFLOW Apr-15 May-15 Jun-15 Q1 Jul-15 Aug-15 Sep-15 Q2 Oct-15 Nov-15 Dec-15 Q3 Jan-16 Feb-16 Mar-16 Q4 BudgetRECONCILIATION £000 £000 £000 Budget £000 £000 £000 Budget £000 £000 £000 Budget £000 £000 £000 Budget £000Operating Surplus 213 426 639 639 851 1,064 1,277 1,277 1,490 1,703 1,916 1,916 2,129 2,342 2,554 2,554 2,554Depreciation & Amortisation 667 1,334 2,000 2,000 2,667 3,334 4,000 4,000 4,667 5,334 6,000 6,000 6,667 7,334 8,000 8,000 8,000EBITDA 880 1,760 2,639 2,639 3,518 4,398 5,277 5,277 6,157 7,037 7,916 7,916 8,796 9,676 10,554 10,554 10,554Impair/Other Non Cash 0 0 0 0

Stock (Inc)/dec 0 0 0 0 0Debtors (Inc)/dec (509) (638) (962) (962) (1,102) (1,250) (1,000) (1,000) (855) (682) (719) (719) (629) (61) (150) (150) (150)Creditors Inc/(dec) (97) (525) (955) (955) (1,383) (1,253) (590) (590) (654) (560) (143) (143) (251) (339) (60) (60) (60)Provisions Inc/(dec) 0 0 0 0 0Capital expenditure (742) (1,484) (2,226) (2,226) (2,968) (3,709) (4,551) (4,551) (5,393) (6,166) (6,908) (6,908) (7,650) (8,391) (8,901) (8,901) (8,901)Capital disposals 0 0 0 3,250 3,250 3,250Free Cashflow pre finance (468) (887) (1,504) (1,504) (1,935) (1,814) (864) (864) (745) (371) 147 147 267 886 4,693 4,693 4,693

Interest 3 7 11 11 14 17 (38) (38) (35) (32) (29) (29) (26) (23) (84) (84) (84)Dividends on PDC 0 0 0 0 0 0 (985) (985) (985) (985) (985) (985) (985) (985) (1,970) (1,970) (1,970)Free Cashflow (465) (880) (1,493) (1,493) (1,921) (1,797) (1,887) (1,887) (1,765) (1,388) (867) (867) (745) (122) 2,639 2,639 2,639PDC Payment/(Repayment) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Loan repayments 0 0 0 0 0 0 (869) (869) (869) (869) (869) (869) (869) (869) (1,738) (1,738) (1,738)Lease Borrowings 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Capital Loan from DH 0 0 0 0 0 0 0 0 0 0 0

Net Cash In/(Out) (465) (880) (1,493) (1,493) (1,921) (1,797) (2,756) (2,756) (2,634) (2,257) (1,736) (1,736) (1,614) (991) 901 901 901

SOUTH CENTRAL AMBULANCE NHS FOUNDATION TRUST Appendix F

Capital resources available F1 Budget Exp summary F1 Budget

CAPITAL EXPENDITURE 2014/15 Core Depreciation 7,300 7,300 Clinical

Disposal Receipts 863 863 Estates 1,010 930For the period to Available Surplus Operations 2,122 1,28231 August 2014 Capital loan 2,779 1,794 Fleet 5,359 5,328

Total capital resources available 10,942 9,957 IT 2,480 1,783Contingency (300) 634

Shortfall to be financed (270) 0 Total 10,672 9,957

Actual/Forecast Spend ProfileScheme Description Budget April May June July August September October November December January February March Total

Actual Actual Actual Actual Actual Forecast Forecast Forecast Forecast Forecast Forecast F/cast F/cast£000

ESTATESP873 Petersfield Ambulance Station Roof 5 5P994 Portsmouth Station reprovision 91 16 -81 10 36Battle PTS/Transcare 50 0Battle Fleet Facilities Replacement 300 25 25Estates -Maintenance works other 35 0Fit Garage Ambirads - Basingstoke 15 15 15WERC/HART Security 9 18 18Fit Out Boars Hill 20 10 10 20Convert WC to MR store - Nursling 30 10 10 10 30Install pigeon protection - Nursling 25 25 25EOC accoustic improvements - Southern House 35 12 12 21 45EOC air con improvements - Southern House 70 0Replace UPS capacitors - Southern House 9 5 4 9Create additional locker space - Hythe 10 0Create new drainage system - Bletchley 45 2 22 21 45Install new heating system - Bracknell 20 0New roller shutter doors - HWAS 24 0Install site access control - SMAS 15 0Replace female shower facilities - Bletchley 12 0Replace garage doors - Wexham 16 0Fit Out - ASAP 60 0MK ASAPs 130 20 10 9 10 27 27 27 130Estates Portfolio Upgrade - North 42 88 130Estates Portfolio Upgrade - NA 54 54Salto Locks 2 2Basingstoke Garage 10 10PTS Building Works SHIP 3 50 63 116FLEETFront Line Ambulances Incl replace/growth & Attr 4,977 2 2,496 1,560 780 154 4,992Training Vehicles 4 351 170 181 351Ex Lease Discoverys 16 16Vital Signs - Defibs 1,200 594 475 445 446 1,960Mangar Elk 114 114Timesheet System 9 9Mannequins 21 21Waveform Capnography 18 18ITNHS Pathways 445 4 102 18 9 7 58 36 36 26 94 100 490GP Dynamics 25 25 25Core Infrastructure Cleric & GRS 600 83 149 50 100 25 25 187 619Cybertech 80 2 102 104Vodafone Virtualisation and Service Enhancemen 251 17 121 60 42 50 20 54 45 36 445Network Infrastructure - Upgrade of Aged Kit 132 4 18 18 18 18 18 19 19 132Replace Mobile Worker Laptop Devices 30 15 15 30Terrafix Vehicles Bases 84 31 11 21 21 84Qlikview Upgrade 1 3 1 5Qlikview BI System 76 235 311CFR Airwave Pagers 12 12Media Information System 10 12 22Contingency 634 0General -300 -300TOTAL PROGRAMME 9,957 119 126 53 252 389 859 522 354 3,271 2,402 1,682 643 10,672

Appendix G

BALANCE SHEET Actual Actual ForecastAs at Aug 14 As at Aug 14 As at 31 Mch 14 As at 31 Mch 15

(£k) (£k) (£k)

FIXED ASSETS

Property, Plan & Equipment 62,427 64,442 68,081Intangible assets 1,471 1,559 1,611

63,898 66,001 69,692

CURRENT ASSETSStocks & Work In Progress 1,043 1,043 1,043

Assets held for resale 2,900 3,565 2,900

Sales Ledger Debtors 4,459 1,862 2,558Prepayments & Accrued Income 5,547 6,060 6,025Other Debtors 1,142 1,122 980NHSD Other debtors 312 0 100Trade & Other Receivables 11,460 9,044 9,663Cash and cash equivalents 27,522 8,329 14,444

TOTAL CURRENT ASSETS 42,925 21,981 28,050

CREDITORSPurchase Ledger Creditors (1,271) (1,641) (1,618)Accruals & deferred income (14,300) (8,413) (7,279)Other Creditors Incl Pensions, PAYE & NI (3,711) (3,338) (3,057)Other Creditors NHSD (63)Capital Accruals (462) (920) (1,905)Borrowings < 1 year (488) (488) (1,738)Provisions < 1 year (2,014) (1,978) (1,911)Provisions < 1 year NHSD (3,935) (105)CURRENT LIABILITIES (26,244) (16,778) (17,613)

NET CURRENT ASSETS/(LIABILITIES) 16,681 5,203 10,437

TOTAL ASSETS LESS CURRENT LIABILITIES 80,579 71,204 80,129

Borrowings (1,354) (1,354) (5,916)Provisions (2,668) (2,646) (3,565)Provisions NHSD (2,836) (2,910)Other Financial Liabilities (40) (40) (40)Non-Current Liabilities (6,898) (4,040) (12,431)

TOTAL ASSETS EMPLOYED 73,681 67,164 67,698

FINANCED BY:TAXPAYER'S EQUITYPublic Dividend Capital (57,874) (57,874) (57,874)Revaluation Reserve (9,545) (9,535) (9,545)NHSD (6,317)Other Reserve 350 350 350Govt Grant Reserve- bfwdRetained Earnings (105) (105) (105)I & E YTD (190) 0 (524)

TOTAL TAXPAYERS EQUITY (73,681) (67,164) (67,698)

Adjusted net current assets/liabilities for Liquidity 12,738 595 6,494

South Central Ambulance Service NHS Foundation Trust

Agenda Item: 12



Title Staff Survey (2013) update

Responsible Director Sharon Walters, Director of HR


The Trust Board is asked to receive and note the report










Implications Regulatory and legal implications / impact (e.g. Monitor provider licence and continuity of services risk ratings, CQC essential standards, competition law etc)

Outcomes from the annual staff survey are monitored by CQC. The survey included a basket of indicators to measure staff engagement, which is key to patient care.


There are no direct financial implications

Council of Governor implications / impact (e.g. links to governors statutory role, significant transactions etc)

Feedback from the survey and local action plans provides Governors with evidence of staff engagement.


The staff survey links to the NHS constitution of patient and staff rights, with results grouped under the following headings, being 4 of the 7 Staff Pledges, and 2 additional themes: Staff Pledge 1 To provide all staff with clear roles and responsibilities and rewarding jobs for

teams and individuals that make a difference to patients, their families and carers and communities.

Staff Pledge 2 To provide all staff with personal development, access to appropriate education and training for their jobs, and line management support to enable them to fulfil their potential.

Staff Pledge 3 To provide support and opportunities for staff to maintain their health, well-being and safety.

Staff Pledge 4 To engage staff in decisions that affect them and the services they provide, individually, through representative organisations and through local partnership working arrangements. All staff will be empowered to put forward ways to deliver better and safer services for patients and their families

Additional themes: Staff satisfaction and Equality and diversity

Other


The results from the Staff Survey are presented annually to the Board, and actions reported through Quality and Safety reports. The results of the 2013 Staff Survey were presented to the Board in march 2014.


Further information relating to the annual staff survey and results of this and previous years surveys for all English NHS Trusts can be found at www.england.nhs.uk

http://www.england.nhs.uk/

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STAFF ATTITUDE SURVEY 2013 - UPDATE

PURPOSE

1 The purpose of the paper is to update the Board on actions taken following the publication of 2013 staff attitude survey, and of plans for the 2014 survey. The Board is asked to note the contents of the report.

EXECUTIVE SUMMARY 2 The Trust response on the 2013 survey was the best ever achieved and is

being held up to others as best practice. Plans are in place to engage staff and get a similar response to the 2014 survey.

3 Actions have been taken in relation to all the areas of concern identified at a Trust level within the 2013 survey

4 Local action plans have been enacted in all departments and are reported on at monthly reviewed meetings. Actions taken will be used as part of the communications for the 2014 survey launch.

5 The 2014 survey opens on 22nd September and closes on the 1st December.

KEY ISSUES Staff Survey 2013 6 The staff survey was undertaken in October – November 2013, and all staff

were invited to take part. The trust undertook a fully electronic survey, with each member of staff receiving an email with a unique log in. The overall response rate for the Trust was 60%, the best ever achieved, with some departments achieving response rates in excess of 80%.

7 Of the 28 key findings, 2 showed significant improvement from 2012. These were:

• Percentage of staff receiving Equality and Diversity training in the last

12 months (increase from 23% to 55%)

• Percentage of staff receiving Health and Safety training in the last 12 months (increase from 42% to 56%)

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4 had significantly deteriorated since 2012, while the remainder were not significantly different:

• Percentage of staff believing the trust provides equal opportunity for

career progression or promotion (66% / 79%) • Percentage of staff suffering work-related stress in last 12 months

(48% / 38%) • Percentage of staff appraised in last 12 months (79% / 88%)

• Staff motivation (3.57 / 3.72)

8 SCAS was only lower than the average for all ambulance trusts in 1 key

finding:

• Percentage of staff saying hand washing materials are always available (26% / 38%)

9 In addition to the Trust report, each department received a detailed local

report, identifying the key areas of concern as reported by local staff. Each local management team has reviewed their own results and developed a local action plan.

Key Actions Taken 10 Actions were agreed to address the key areas for concern at both Trust and

local level. 11 Career Progression / Promotion Feedback from staff during leadership walkabouts and the most commonly

cited reason for leaving is career progression for ECAs and Technicians to paramedic. This year, in addition to the 20 places on the 1 year Oxford Brookes programme for Technicians, SCAS offered 14 fully funded places at Portsmouth University to ECAs.

SCAS has also launched a new 18 month Student Paramedic programme for

ECAS and suitably qualified new recruits, which has been very well received by staff. This programme will have 2 intakes a year, outputting up to 60 newly qualified paramedics.

SCAS continues to offer access to funding to all other staff to support their

continuing development. 12 Work related Stress The Trust continues to support staff through Occupational Health, the

Employee Assistance Programme, and TRiM. Additional TRiM practitioners have been recruited and trained this year, and all Team Leaders have been trained by the TRiM co-ordinators to debrief staff and make TRiM referrals where appropriate.

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A pilot has been undertaken in 111 South to address absence due to stress. ‘Be Happy, Be Healthy, Be Here’ has seen a significant drop in absence in 111 and is now to be rolled out across both Clinical Co-ordination Centres.

13 Appraisal Focus remains on ensuring all members of staff have an annual appraisal and

monitoring continues through performance management meetings. Additionally this year the focus has been on improving the quality of the appraisal, with managers receiving additional training to develop the skills to have difficult conversations and motivate staff.

14 Hand Washing Materials SCAS continues to monitor this area which has been reported as a concern in

previous surveys. All areas have soap dispensers which are checked by team leaders each day. Our programme of leadership walkrounds at resource centres and EOC’s check soap availability and stores to ensure a good supply. Hand hygiene awareness training is led by our Infection Control Lead supported by team leaders and nine dedicated link practitioners to highlight good practice and carry out hand hygiene audits.

15 Local Action Plans Following the publication of the survey results, each team responded to their

local results with a joint action plan. These are discussed and updated at monthly review meetings. A departmental example is attached as Appendix 1.

The actions are communicated to staff through station meetings and listening

meetings. They are also referenced in other projects and management meetings e.g. the rota review, where principles for the review have taken on board feedback from the survey regarding team working, working additional hours etc.

Some specific actions taken as a result of the local plans include:

• An appraisal audit to understand how we can improve appraisals • All Team Leaders have attended appraisal training • Improving Team time in the North (currently under consultation as part

of the rota review) • Local staff suggestion emails have been set up • Chief Operating Officer attending station meetings and contributed to

local newsletters • Appreciation / thank you letters sent from Area Directors for good

clinical care • CPD certificates are issued at HR training

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• Resource Centres have set up notice boards to reflect what staff take pride in at work, and celebrate successes

• Options for family friendly / flexible working through rota review

• Monitoring and responding to complaints, Team Leaders have been

trained in DATIX • ‘Work out at Work’ days to provide advice to staff on healthy lifestyles

A summary report from 999 South detailing progress against individual plans

is attached as appendix 2 Staff Survey 2014 16 Announcements regarding the 2014 Staff Survey will shortly be circulated to

all staff. Examples of the actions taken as a result of the feedback from 2013 survey will be included in the communications. The message is “we said, we did” to reflect a ‘team SCAS’ approach to handling issues. We are keen to promote a togetherness throughout the Trust, empowering people to take responsibility and influence changes at local levels, to improve their own working practices and working environment. This message was promoted by SCAS last year and is now being widely used by the NHS as best practice.

17 SCAS will again attempt to engage staff in the survey and improve on the

response rate from last year. The survey will be distributed by email, with a unique log in, an initial email and 2 follow up reminders. The innovative methods used by SCAS in 2013 through the weekly progress charts to encourage participation and team competitiveness, have been used as an example of best practice for other Trusts to consider as a model for implementation.

18 The survey will open on 22nd September and closes on the 1st December. Initial results are expected to be received by the Trust late December / early January 2015.

CONCLUSIONS

19 The Trust take the feedback from staff through the annual staff survey very seriously and have acted to address those areas reported as of most concern. Additionally with the ability to analyse local feedback, staff have seen actions specific to their area and their response to the survey, which should increase participation and confidence in the survey for future years.

RECOMMENDATIONS TO THE BOARD 20 The Board are asked to note progress against the action plans based on the

overall and local responses to the 2013 staff survey, and note the timetable for the 2014 staff survey to be undertaken.

Sharon Walters Director of HR, September 2014

Appendix 1 Staff Survey 2013 Local Action Planning - Guidance

NHS Staff Survey results for SCAS and every other NHS Trust in England are available at: http://www.nhsstaffsurveys.com/cms/

Additional Operations Analysis has been provided to assist with local action planning. Benchmarking information against other Ambulance Trusts is also available.

In order to prioritise actions, the following guidance is offered:

Focus on things which are important to SCAS or your team Things that will help to consolidate the Ops Clinical restructure and Team working Consider taking action where scores are significantly worse than others – within SCAS or beyond Look at areas where results are getting worse or are below average

Be realistic about what you can achieve and focus on the few things which you think are most important or will have the greatest impact. It is recommended that you aim to improve 4 scores during the next 12 months.

Set SMART objectives for some key areas where you would like to see your team score higher in the 2013 NHS Staff Survey:

Specific - Objectives should specify what they want to achieve Measurable - You should be able to measure whether you are meeting the objectives or not Achievable - Are the objectives you set, achievable and attainable? Realistic - Can you realistically achieve the objectives with the resources you have? Time - When do you want to achieve the set objectives?

ENGAGE WITH STAFF ENCOURAGE POSITIVE OPEN DEBATE

http://www.nhsstaffsurveys.com/cms/

Staff Survey 2013 Local Action Planning

PLEDGE #1 AREA OF WEAKNESS = TARGET SCORE IS LOCAL AREA IMPROVING IN 2013 SURVEY QUESTION NO SURVEY QUESTION Local

Result SCAS Result

1c,

Training – Training, learning or development. improve the training experience

1. No training in how to handle violence to staff / patients / service users

38.9% Last year

result 54%

24.3% Last year

result 25%

OWNER WHY DO WE NEED TO IMPROVE THIS SCORE? HOW WILL WE ACHIEVE THE IMPROVEMENT? Target Score

Head Of EOC

Although compared to last year’s staff survey there is an improvement of 15.1% on the local result to this question there is still room for improvement. Excellent fit for purpose training is essential within the EOC environment and is key to ensure staff are able to provide a 1st class service to the public and patients. The key to our success is training and EOC – South is undertaking a wide range of training for all levels of staff skill sets. The staff survey has highlighted areas of training that needs further exploration, (although violence to staff / infection control training could be assumed to be aimed at front line operational staff). Training has always been an excellent motivator for

• Clearly identify staff training needs in conjunction with the

EOC Training Team. • Ensure Control Managers / Shift Officers / SECT’s discuss

and review areas of training required / requested by their staff.

• Ensure training requirements are identified and added to the staff members PDP / appraisal.

• To monitor mandatory ‘on-line’ training on a monthly basis. • In discussion with the EOC Training Team identify

opportunities for Customer Service Training within the Control Centre environment to include:

- Training in violence / abuse over the telephone • Achieving a positive outcome on this question on next

year’s staff survey will rely heavily on input from the EOC Education Team.

25% (Improvement of 15% same as last year’s result)


staff and ensures a positive outcome, enabling staff to increase their skills and confidence to carry out their job functions. Therefore increasing standards Regular review of statutory & mandatory training against yearly trajectory for 100% staff compliance in line with CPI’s.

Staff Survey 2013 Local Action Planning PLEDGE #2 AREA OF WEAKNESS = TARGET SCORE IS LOCAL AREA IMPROVING IN 2013 SURVEY QUESTION NO SURVEY QUESTION Local

Result SCAS Result

14a, 14b, 14c

Your Health, Well-Being and Safety at Work

1. My job is not good for my health 2. Immediate manager does not take a positive interest in my health & well-being 3. Organisation does not take positive action on health & well-being

45% 24% 33%

55% 22% 43%


Head of EOC

Within the EOC South it is very important to all managers to ensure all staff are recruited, trained, looked after, supported and feel safe within their role and working environment. Staff should feel that they can be completely open and honest and not feel threatened in any way. It is important the managers are able to ensure their staff are fully supported and this isn’t just a tick in the box. Managers may well feel they are looking after their staff, but it also down to how staff perceive and feel their managers are dealing with them and any issues that may arise.

1. All EOC South managers to ensure they spend time with

their staff to ensure they get to know them better and to ensure staff are aware of the support that is available

2. All staff to have monthly 1 to1 performance review meetings with their line manager. At this meeting this is a good opportunity to discuss any issues that the staff member may have with their work.

3. Managers to hold 1/4ly meetings with O/H representative to discuss any issues relating to the health, well-being and safety at work of staff.

4. Luci Stephens – Assistant Director of EOC (Operations) to hold 1/4ly ‘surgeries’ in EOC South for any member of staff to discuss any issues that is affecting their work.

5. Continue with the bi-monthly meetings for the different staff skill sets, to enable staff to raise any issues they may have relating to health, well-being and safety at work.

6. To make arrangements to hold a staff health and well-being day at work. ‘Workout at Work Day 2014’. This to be arranged with the help of HR department, Occupational Health and Risk Department.

1. 30% 2. 10% 3. 15%

Staff Survey 2013 Local Action Planning PLEDGE #3 AREA OF WEAKNESS = TARGET SCORE IS LOCAL AREA IMPROVING IN 2013 SURVEY QUESTION NO SURVEY QUESTION Local

Result SCAS Result

3a, 3b, 3c, 3d

Appraisals and your Job – appraisal delivery, objective setting

1. In the last 12 months, have you had an appraisal, annual review?

2. Did the appraisal / review help you to improve how you do your job?

3. Did the appraisal / review help you agree clear objectives for your work?

4. Did the appraisal / review leave you feeling that your work is valued by your organisation?

Pos Result

80.9%

57.3%

78.7%

58.4%

Pos Result

76.6%

38.4%

66.9%

43.4%


Head of EOC

Each year staff are required to have an appraisal and this is undertaken by their line manager. This is essential to allow the manager and staff member to discuss progress over the previous year and to highlight excellent work and if there are any issues of concern. Also to provide clarity around performance targets for the coming year for:

• SCAS • EOC South • Team • Staff member personal targets

• Additional appraisal training for all managers who have to

conduct appraisals for their staff • Improve the planning and timeliness of appraisal delivery

to ensure all appraisals are completed by the end of December 2014.

• Ensure appraisals are conducted correctly and are not rushed or interrupted in a private meeting room, away from any distractions.

• Improve commitment of Control Managers / Shift Officers / CSD T/L’s / SECT’s to undertaking appraisals over the whole year

1. 100% 2. 75% 3. 90% 4. 80%


The appraisal process is very important to the staff member and it is very important that appraisals are carried out correctly by the manager. Although EOC South has achieved appraisals for all staff in the last year, I do believe improvements can be made to the appraisal process and the quality of the appraisal, also the performance targets that are set.

• Set overall staff objectives for the year in line with SCAS contractual obligations and EOC performance targets,

• Introduce pre-appraisal questionnaires for all staff and these are available 2-weeks prior to the planned appraisal. This will ensure the staff member is prepared for their appraisal.

• All staff members are to have 6 monthly appraisal reviews. This will ensure all actions agreed during the appraisal processes are completed in a timely manner.

• EOC Administrator to monitor 6 monthly reviews and to ensure reminders are sent out to both the appraising manager and also the member of staff

Staff Survey 2013 Local Action Planning PLEDGE #4 SHARING BEST PRACTICE = TARGET SCORE IS THE TRUST AVERAGE IMPROVING QUESTION NO SURVEY QUESTION Local

Result SCAS Result

Promotion of the NHS Staff Survey EOC South successfully promoted the 2013 survey, realising a 85.9% response rate from staff. This was significantly higher than other local areas and is a fantastic achievement. As a summary of the results the staff survey showed EOC South (compared to other areas of SCAS):

• Significantly BETTER than average on 26 questions • Significantly WORSE than average on 1 question • The scores are average on 64 questions

It is therefore important to ‘celebrate’ the excellent scores and to ensure this information is fed back to all staff and to thank them for their response to this year’s NHS Staff Survey.

OWNER HOW DID WE ACHIEVE THIS POSITIVE SCORE? HOW WILL WE SHARE BEST PRACTICE? Target Score

Head of EOC

The EOC South achieved a positive 85.9% result in staff completing the NHS Staff Survey by encouragement and engagement of all staff from the EOC Management Team. Prior to receiving the staff survey, discussions took place at the weekly Control Managers meeting to ensure all senior managers were on board with a positive attitude and a full understanding of what was required when promoting the staff survey. All senior managers were required to include the importance and benefits of completing the staff survey in the monthly performance review with their staff.

It is important to be open and honest and to share this with managers. If all managers are fully engaged and provide their full support for the Staff Survey and the eventual results, then this will be received positively by staff. I think the main issue for staff is confidentiality and the trust of their managers. Therefore staff need reassurance and confidence that their questionnaire will be completely confidential and they will not be able to be identified or receive any repercussions. This includes when staff receive reminders to complete the questionnaire! Re-assurance that it is only ‘Picker’ who have the personal information on staff who have completed and are still to complete the form.

OWNER HOW DID WE ACHIEVE THIS POSITIVE SCORE? HOW WILL WE SHARE BEST PRACTICE? Target Score

This was to promote the survey and to ensure staff were aware of the importance of completing the results and enforcing the confidentiality aspect of the results. I believe it is all about ‘trust’ of the managers and staff ‘believing’ they can be completely honest and open with their views and answers to the questions, without fear of repercussions! Each week managers were also tasked with speaking to staff to ensure a positive spin on the survey. Also to find out the staff who were still to fill out the survey, and as necessary encourage them to complete it. Last year EOC South achieved a 70% return rate and therefore it was important to equal and if possible exceed last year’s response rate to the staff survey. We can therefore compare the 2 sets of results for an even better analysis and outcome to put forward and work on the pledges. It will also be my intention to ensure the results are shared with all staff and any improvements are looked at and action taken accordingly. If staff see the results and see action has been taken this will ensure staff actively take part in next year’s survey!

It is important the results and action plans are shared with staff either by department or through the PR department – Staff Matters. To reinforce the confidentiality aspect of the survey, and reassurance for staff I purposely used one of the questions as an example to show that managers do not receive staff identified information: Q29b – Has your employer made adequate adjustment(s) to enable you to carry out your work? 3 members of staff replied ‘No’ that we hadn’t made adequate adjustments. I sent out an e-mail to all staff confirming the confidentiality aspect of the staff survey and as a result I had no way of knowing who the 3 members of staff were. I requested the staff to make contact with me confidentially and I would discuss their concerns and ensure that as an employer we would do as much as we can to address their requirements. Unfortunately to date no one has come forward.

NHS Staff Survey Results - Thank you!.

Staff Survey 2013 Local Action Planning – Further Information

A short introductory summary of the issues around staff engagement, including the benefits of high staff engagement and making the case for transformation is available from NHS Employers here:

http://www.nhsemployers.org/SiteCollectionDocuments/The_Case_for_Transformation_Dean_Royles_presentation_rd060411.pdf

NHS Employers also provide a comprehensive toolkit for making improvements in staff engagement and we'd recommend this as a great place to start when you're looking to begin making changes to improve staff engagement:

http://www.nhsemployers.org/SiteCollectionDocuments/Staff%20engagement%20toolkit.pdf

For a really in-depth look into the issues around staff engagement, both in the NHS and in the wider national context, the MacLeod Report is usually considered the "gold standard" report:

http://www.bis.gov.uk/files/file52215.pdf

If you would like any more information or literature regarding Staff Engagement, or would like to discuss any aspect of the Staff Survey, please email me at [email protected] and I'll be happy to help.

http://www.nhsemployers.org/SiteCollectionDocuments/The_Case_for_Transformation_Dean_Royles_presentation_rd060411.pdf

http://www.nhsemployers.org/SiteCollectionDocuments/Staff%20engagement%20toolkit.pdf

http://www.bis.gov.uk/files/file52215.pdf

mailto:[email protected]

Appendix 2

Area Question Number Actions to be implemented Actions taken to date Complete

/Outstanding Notes

North Hampshire

12a Publicise initiatives for patient improvements

Managers to attend team meetings, discuss actions, agree training

Outstanding 1 team meeting still to attend

Report on improvements of 3 key deliverables (IPT, Clin15, Assign to mobile)

TL/CM's report on standards at 1:1's, team performance collated. Delayed activations picked up by ESM/AM

Complete Ongoing reviews

Publish improvements to PPCI Discuss at Team meetings. Ask RK to prepare presentation on relevant data and present to TL/CM's to cascade.

Outstanding Ongoing reviews, awaiting data from RK

13a & 13b Publicise hand sanitation details Infection Control lead presented details at team meetings

Complete

Educate staff on use of hand sanitisation equipment

Infection Control lead presented details at team meetings

Complete

Invite Infection Control Lead to team meetings

Infection Control lead invited to team meetings Complete

11b Station meetings with OD/AM/ESM

Meetings arranged and commenced. AM/ESM attends team training days and other ad-hoc meetings such as roster review meetings

Complete

OD to attend team meetings Meetings arranged and commenced. Outstanding 1 team meeting still to attend

11d OD setting up internal communication project

Action plans via TL/CM from OD following meetings. AM/ESM also review/discuss at TL/CM 1:1's


Set up local forums and measure outcomes of staff concerns

AM/ESM to undertake operational shifts with staff to discuss issues

Outstanding Shifts planned for Aug-Dec

Publish on station actions taken / closed actions

Via TL/CM action plans Complete Ongoing reviews

11e More senior management presence on stations, more regular

Via TL/CM action plans


/Outstanding Notes

updates on current initiatives

AM/ESM to carry out operational shifts with TL/CM and be seen by staff in operations

AM/ESM to undertake operational shifts with TL/CM Outstanding Shifts planned for Aug-Dec

19b Invite Local Fraud Specialist to TL/CM meetings

LFS been to TL/CM meeting, LFS had drop-in session at SH which was advertised to staff. Fraud is standard agenda item at TL meetings


Invite Local Fraud Specialist to team meetings

LFS been to team meetings Complete Ongoing reviews

Advise staff of Datix incidents TL/CM to provide feedback at 1:1's Complete Ongoing reviews 20a CM's to ensure e-learning

compliance Done as part of team training day every 6 weeks. Compliance monitored against stats.

Outstanding Further work required to ensure compliance

Publish adverse incidents Process to be arranged Outstanding Monitor Datix and report findings Weekly reports from risk shared with TL's for

onward action Complete Ongoing reviews

22 Engage with WFB and HE to ensure support available for career development

Whole management team available for support on interview prep and skills. AM/ESM personally contacted all ECA's to advise on OBU advert and to provide assistance with applications.

Complete Ongoing

Ensure staff supported for funded HE and monitor stats on successful candidates

Whole management team available for support on interview prep and skills. AM/ESM personally contacted all ECA's to advise on OBU advert and to provide assistance with applications. Staff supported on other HE courses such as PTTLLS

Complete Ongoing

Publish names of successful staff Via Pride walls. Pride walls in place at each station with team ownership.

Complete Ongoing


/Outstanding Notes

South East Standardise team meetings 5 Point meeting package developed and being trialled

Complete

17a & 17b Datix presentation to all teams Risk Assistant invited to team meetings, has commenced attendance and scheduled in ongoing

Complete Ongoing attendance

18a & 18c Staff 1:1's with TL/CM to review progress

Have commenced within teams. Improvements in 1:1's for incident reporting and education

Complete Ongoing

5c Issues and morale to be discussed at 1:1's

Addressed in 1:1's with issues to be reviewed as a group. Improvements in 1:1's for incident reporting and education


Induction - station and team Welcome pack / induction pack developed and rolled out to new starters

Complete Ongoing for all new starters

Introduce Team Station Representatives

Form a committee from staff reps for new NHRC, for issues, developments etc.

Outstanding On hold until EPR training complete

Team Leader Guest Speaker Spreadsheet

Has been developed and introduced, is in use by all TL's

Complete

Pride Wall In production at North Harbour. On hold at Petersfield

Outstanding Petersfield awaiting redecoration following flood

Additional Achievements

Q&A sessions with AM/ESM at team meetings

South West

11b Station meetings to be booked every 8 weeks at each of the 5 stations

All booked in and in the diary going forward Complete

11d OD to present communications project to teams

OD attended 6/12 team meetings. Booked to attend remainder

Complete Some meeting still to attend

11e Improve senior management presence on stations

AM/ESM scheduled to visit all stations on a rotational basis

Complete Ongoing attendance


/Outstanding Notes

Update staff on current initiatives to improve patient outcomes

Action plans via TL/CM from OD following meetings. AM/ESM also review/discuss at TL/CM 1:1's


3d TL's to attend appraisal training over remainder of year

All TL's registered for courses Complete Ongoing

Appraisals to be spread more evenly

TL's pre-booking appraisals and updating SW spreadsheet to ensure more even spread through the year

Complete Ongoing

More specific appraisal objectives with more focus on clinical outcomes

Common goals and objectives set Complete Ongoing

17a Review quarterly reporting of Datix incidents

Ongoing review of area trends Complete Ongoing reviews

18a TL's to cascade lessons learnt at team meetings

Standard Agenda item Outstanding Team meetings currently only covering EPR training

18f Monthly review of incidents by AM/ESM and findings to be reported to TL's for discussion at team meetings

Standard Agenda item Outstanding Team meetings currently only covering EPR training


Agenda Item: 13


Title

Board Assurance Framework (BAF)




To note the risk scores and assurances, controls and actions









Please provide details of the risks associated with the subject of this paper Risks in delivering key corporate objectives and strategic aims. Ensure mitigating actions in place.

Implications

Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards, competition law etc)

Risks associated with response times or delays to patients to a HASU as outlined in risk 1.2 can impact on compliance with CQC outcomes 1 and 4 (Dignity, respect and welfare of patients). Risks associated with ageing patient monitoring systems as outlined in risk 1.6 can impact on compliance with outcomes 11. Risk of receiving inadequate rating following the CQC inspection as outlined in risk 4.3

Financial implications / impact (e.g. CIPs, FRR, year-end outturn) Financial risks may affect compliance with the Monitor Framework 2013/14. Risks associated with objective 6 (Commercial Viability) may have implications for Opportunity Pipeline and financial risks, 4.1 and 4.2 may impact on Monitor Compliance.

Council of Governor implications / impact (e.g. links to governors statutory role) Assurance from Council of Governors that risks identified have action plans in place.


Links to the NHS Constitution – principle 7 – NHS is accountable to the public and should therefore transparently take responsibilities for services. The NHS also commits to ensure continuous improvement of services.

Other


BAF presented to the Board at every public meeting. Corporate risks evaluated in the risk register by Executive Committee in the Risk and Compliance Group meeting in August 2014 and in the Executive Committee in September 2014. Corporate Risk Register considered in Audit Committee on 10th July 2014


SCAS NHS FT Corporate Risk Register Department of Health (2003) gate ref: 1054 Building the assurance framework. A practical guide for NHS Boards.

Good Governance Institute (2009) version 2.1 Board Assurance Frameworks: a simple rules guide for the NHS.


BOARD ASSURANCE FRAMEWORK (BAF)

PURPOSE 1 To highlight to the Board the principal risks to the successful delivery of

the Trust’s strategic objectives and the controls and assurances in place to mitigate these.

2 The report sets out an updated BAF for Month 06 (September) 2014 /

2015. In addition a monthly risk profile is included which gives a view of the mitigated scores of identified risks.

3 The Board are asked to note the risk scores, assurances, controls and

actions in place.

EXECUTIVE SUMMARY 4 The BAF is presented to include quarter 4 2013 / 2014, quarter 1 and

month 6 risk profiles for 2014 / 2015 year to ensure Board visibility.

5 There is currently 2 red risks and 14 amber rated risks on the BAF as reviewed by the Executive Directors on a monthly basis (latest review September 2014).

6 Risks 1.1, 1.3, 1.5, 2.3, 3.2 and 4.3 have all been reduced as a result of

actions taken to further mitigate the likelihood or impact of the risk.

7 Risk 5.3 – Ability to recruit and retain staff This risk has been increased from an amber 12 rated risk to a red 16 rated risk as actions to reduce this risk are in the early stages and also due the failure to secure 100% of Oxford Brookes University and University of Portsmouth graduates.

8 New Risks added to the BAF since July 2014

Risk 5.4 – Consequences of strike action if Sept 2014 TU ballot vote in favour of action The above risk is being mitigated down from a red rated 20 to a red rated 15 as a result of a number of actions described in the actions within the BAF document attached.

9 Risks on the BAF have been reviewed in full to ensure that

appropriate controls and assurances have been identified, and that any action plans have agreed timescales allocated and necessary updates are provided. They have also been reviewed in terms of their alignment with the Trust’s Corporate Risk Register. The BAF is a key mechanism used to reinforce strategic focus and improved management of risk.

NEXT STEPS

10 The BAF will continue to be reviewed by the Executive Directors at their

meetings with an updated report being presented to the Board of Directors meeting.

CONCLUSION

11 The BAF has been further reviewed and updated since the last report to

the Board in July 2014 and reflects the risks for the current year.

RECOMMENDATIONS TO THE BOARD 12 The Board are asked to confirm that the principal risks have been

identified and are being adequately mitigated. Deirdre Thompson Director of Patient Care

September 2014

RAG

Strategic Objective Risk Principal Risks Date Co Lik Tot Current Control Measures Gaps in Controls Current Assurance Gaps in Assurance Action to be taken Respons. Timing / Co Lik Tot

Stroke data for CTD times being audited.

8

12Deirdre Thompson Director of Patient Care

Monthly review

3 12

•Negative media stories•Increase in complaints and incidents in 2012- drill down to reasons – staff attitude, delay and not sending an ambulance remain the main reasons•Risk identified with non conveyance current theme for experience - learning identified with CSD surveys• Numbers of incidents reported as a delay. CSD peer reviews to be routine. Fleet improvement plan not yet implemented fully.

82

4

4

1.2 Failure to convey patients to HASU in a timely manner and

failure to provide adequate pain relief to STEMI patients

1. Clinical Excellence: Quality of care, patient safety and experience

Deirdre Thompson Director of Patient Care Sue Byrne COO

Monthly review and daily analysis

2 & 30 June 2014: Some early evidence of improvement Need to ensure that the trajectory for improvement is achieved through monthly monitoring of performance

Sep-141.3 Availability of resources (fleet and staff) and turnaround times at hospitals, resulting in delays to patients and inability to meet targets - red and green calls consistently

8,9,11

16

34

Sep-14

Sep-141, 3, 5,

Board Assurance FrameworkRaw Risk

RatingMitigated

Risk Rating

44

Review July 2014

4 2

1) CRG monitor network developments - stroke, ppci and trauma. 2) IPR data set reported to board 3) Clinical audit programme 4) Clinical memos and directives to staff 5) SIRI review group minutes and lessons learned 6) incident reporting April 2014: Stroke and STEMI interogation and campaign with senior OPs and Clinical Team members driving changes - Sept-14 Stroke interogation and campaign with senior OPs and Clinical Team members driving changes. Robust action plan and trajectory in place and being monitored. Robust action plan and trajectory in place

8 8April 2014: The benefits following the introduction of 999 to clinical pathways should further improve the earlier recognition of these patients that require a resource to be deployed hence making better use of resources and H&T. Further work around timing of Dispatch with the introduction of Pathways underway ensuring correct disposition is reached at the optimunm time hence better / more intelligent allocation of resources.- GP triage and access to this with commissioners TV & SHIP June 2014: Further analysis and remodelling of the deployment model underway. Escalation to REAP 3 instigated in times of over-activity to release futher frontline resource. Implementation of EPR with Non-conveyance page clearly prompting staff to 'safety net' and alternative support for patients and introduction of new non-conveyance patient information guidance agreed and being implemented. Sept-14 Update - Procurement work to ensure all suppliers are accesible on Proactis. New contract agreed with supplier to take effect from April 2014 will gives increased assurance and visibility. - Continued auditing of the impact on Long Waits on patients demonstrates that patients are not being harmed and that the distribution curve for the time waiting is reducing month on month for those patients that are waiting thereby reducing the impact on patients care overall. Continues to be monitored by the Exec Team, Q&S committee, CRG and CQRM - New Patient Information Leaflet (PIL) enhancing the safety netting and worsening advice given to non-conveyed patients now agreed by CRG and being printed for disctribution by crews at scene.

• DH quality indicators and measures for 111 and 999 services• JRCALC guidelines/Pathways for 111 audit process 1% of calls• Trust Board and Quality and Safety Committee assures clinical and quality governance processes• Audit committee reviews and cross references quality domain • Executive Team monitors all quality and clinical processes and policies and performance • Performance, complaints and incidents reviewed by the PERG and Quality and Safety Committee • Clinical Review Group reviews • Processes and education for all staff to raise awareness• Monitoring of clinical work streams through clinical committee and governance structure• Quality and clinical metrics embedded in Integrated Performance Report • CQC Quality Risk Profiles• New evidence supporting new care pathways (STEMI, stroke and trauma) . Planned programme of equipment maintenance in place monitored through H&S committee. Internal audititors report Feb 13 of equipment.

12

• Action plan in place for STEMI and stroke (in IPR) rate SCAS performance mid table

•Safety Peer reviews•Consistent data quality/thematic HCP feedback collation for 111 services further development required•Organisational learning from incidents, complaints and SIRI’s and patient experience data. Learning triangulation from legal claims/complaints/incidents. Need for Qlikview to have consistency in all its reporting. need a safety culture audit planned for Q2 2013. CQUIN plans for ACP's and GP triage and Non Conveyance. Timeliness of clinical data. Consistency of clinical data.

• Improved CQC QRP• Patient satisfaction surveys• Staff satisfaction surveys/ staff safety culture audit• increase in reported compliments • CQC compliance with Outcomes 1,4 and 7• Quality Accounts and national ambulance benchmarking• Audits of patient care records and delays to care• Information on complaints and incidents shared with staff • Production of ‘you said we did ‘ news letters • Trust lead human factors work stream across south central –conference March 2012 with LD Patient Champion• New Appraisal system implemented• Random reviews / audits of delays provided assurance of quality of care, but also identified learning or improvement areas – (key priorities for quality accounts)• CSD governance framework reviewed Jan 13. Compassion element applied to appraisals May 2013. Team leader training in patient experience in June 2013. Time critical transfer policy reviewed. Penalties in new acute trust contracts for A&E delays.• Double verification now live across SCAS focusing A&E departments on timely handover• Weekly deep clean performance data in line with vehicle availability being monitored• KPI performance management meeting with MAKE READY Directors monthly• Pilot of 9 week deep clean schedule commenced 4th Nov

•Patient outcomes and experience due to delays through whole organisational learning from SIRI’s and complaints.•Action required to address complaints pertaining to attitude of staff. Analysis of National Ambulance benchmarks (Sept 2012)•Staff training requires an element of customer services as a thread running through all programmes of education. Review Francis report findings and apply robust learning programme and assurance.

•Deirdre Thompson Director of Patient Care •John Black, Medical Director Sue Byrne COO

April 2014: Changes made to resource allocation up to 3 hours for patients with FAST + and Request from HCP to confirm category of call specifically for Stroke Patients. Face to Face training in Q1 to include Stroke and Stemi care and' FAST meaning fast concepts'. Level one team meetings being attended by area by the Campaign Team to review processes and blocks by area. June 2014: The benefits following the introduction of 999 to clinical pathways should further improve the earlier recognition of these patients that require a resource to be deployed hence making better use of resources and H&T. Further work around timing of Dispatch with the introduction of Pathways underway ensuring correct disposition is reached at the optimunm time hence better / more intelligent allocation of resources.- Inclusion and exclusion criteria refined against the national definition ensuring the right patients receive the time sensitive response and reporting reflects this evidence of improvement folowing implementaion of actions described above. - September 2014: Improvement trajectory slightly ahead of target with continued forcus with all elements of the action plan led by operations and training and monitored via the Executive team CQRM, Q&S committee and CRG. Continued focus on practices at shift level with reviews by TL's and monitored via the CQRM, Q&S committee and CRG

• All front line staff have JRCALC manuals and pocket books • PCI indicators benchmarked nationally • Individual scorecard for staff through the CARS system• Quality Report Account• KPMG audit of quality account• SCAS clinical strategy/CAG meetings 111/ Quality Contract reports 111• CQC compliance with Essential Standards • Green 4 action plan to increase hear and treat• Research and development strategy in place with research resource developing • Clinical Audit plan in place and agreed by CRG and Q&S April 2013• Internal audit provided substantial assurance against CQC standards • New pathways of care in place for PCI. And Stroke with demonstrated outcome benefits. CRM monitoring of stroke improvement plan.• Patient survey plan agreed at PERG June 2013 /111 satisfaction surveys• Internal audit of medicines management – substantive assurance of safety of medicines storage and administration processes . Contract Performance reports and scruitiny.• Performance on national quality indicators improving from previous months (Oct data) • SCASCADE launched to share learning

April 2014: Continue to monitor via IPR and reinforce dual verification at Acute Hospital Level June 2014: Minimal evidence of delays following the successful introduction of double verification and hospital handover across all Acute Trusts. Failure to achieve all targets for Q1. REAP 3 escalation instigated to mitigate resource risk. Further discussion with PP to provide additional lines of resource. Recovery action plan now being implemented -

1.1 Inconsistency in providing clinically excellent, evidence based and safe patient care as outlined in national quality measures / indicators .(Long Waits, Non-Conveyance and availability of equipment)

5 • DH quality indicators and measures• Patient Experience Group scrutinising data and developing actions• Executive Team monitors all quality and clinical processes and policies and performance • Complaints, concerns, comments and compliments monitored through the PERG. Delay to backup audit commenced. Fleet review 2013. Increased workshop hours for fleet. Contracts in hospitals to apply penalities for delays. UHU project to meet supply and demand needs. Daily monitoring, Resources adjusted as per demand, Roster management, UHU project and modelling, REAP escalation plans and CSD reviews

204

RAG



RatingMitigated

Risk Rating

6 1.4 Private providers not consistently meeting required standards resulting in poor patient outcomes and experience

Sep-14 5 4 20 1)Bi monthly quality assurance monitoring and checks of all PP's used by SCAS. 2)Liaison with CQC when PP's are inspected. 3) Revise list of approved PP's and policy to ensure assurance.4) SIRI investigations where required and learning applied. 5) Using a limited number of companies 6) Tender process to reduce number of providers

1) Learning from SIRI's ongoing. 2) Monitoring of all PP's used if a company outside of agreement used.. 3) National tender to be agreed. 4) Local contract to be agreed. 5) Vehicle communication infrastructure (not standardised))

Bimonthly quality assurance monitoring. Weekly reviews of PP's used. Strengtened template of assurance process. Heightened awareness for SLT of approved PP's. SCAS liaison with CQC inspections of PP's. Redefining service specification.Clinical Governance framework developed - awaiting ratification. • Clinical governance framework for PP’s approved by Q&S committee Sept 13 • Agreed a zero tolerance approach when staff have not administered the “basic” level of care & assessment

1) Use of non approved PP's when demand is high. 2) Contract in negotiation. 3) Clinical Governance framework to be developed.

April 2014: Continued monthly review to ensure safe, effective care provided using SCAS Clinical Standards of Care June 2014: governamce arrangements for Private Providers now extended to all Private Providers including PTS. 999 ops extended list of Private Providers from the approved list and also included in the governance reviews. September 2014: PP clinical and operational performance reviews continue demonstrating evidence of compliance with SCAS standards of care and operational efficiency

Sue Byrne COO

Weekly review with formal bi-monthly monitoring

3 2 6 6

4 1.5 Inaccurate Clinical Data Sep-14 4 4 16 External audit recoomendations for improvement now agreed and being implemented across the ROSC and Stroke and Stemi Data

Comparative data against other trusts following change to controls and logic

1) Electronic patient records to be rolled out across SCAS. This is set up so that the clinical data can be calculated from the directly input clinical information 2) Links made to local Acute Trusts to obtain outcome data for cardiac arrest with IG sharing agreements 3) Focus on improving AQIs where we benchmark poorly (Stroke and Stemi) - as part of this data issues are being corrected and data quality is improved.

Introduction of new controls and logic implemented in June awaiting comparison data from other Trusts

April BDO recomenadtions for collating and reporting on ROSC being implemented to ensure all incidents are captured and reported correctly going forward. All othe indicators to be audited over the next 3 months to ensure rigor with regards to data capture and reporting om a standard way. May 2014: New Data rpeorting Logic signed off by the Executive Team incorporating all BDO recommendations for ROSC June 2014: Logic behind CQIs prepared for EPR. EPR trialled on first shift. Stroke performance improving with data cleansing. Initial BDO findings from review of Stroke and STEMI data sets resulted in further inclusion / exclusion criteria logic into the data gathering process - September 2014: New logic implemented for ROSC, Stroke and STEMI and BDO have commenced phase 3 of the Clinical Data review


4 2 8 8

29 Ageing Patient Monitoring systems in areas of the Trust and ack of availability of Waveform Capanograpy / CO2 monitoring system across all areas

Sep-14 5 3 15 1. Roll out of waveform capnography throughout SCAS as part of monitoring replacement programme. 2. Update airway training as part of annual CPR training programme.3. Issue of Clinical Memos/Updates and Directives on Advanced Airway Mananagement, Unexpected Cardiac Arrest, Post Resusciation Care, and on the manditory use of End-tidal capnometry and capnography. 4. Despatch of Enhanced Care to support post ROSC care when available. Workforce review of future CCP role.

Timeline for replacement / purchase of equipment

Business case being considered following a full tender evaluation - now complete

Timeline for purchase and impementation plan

July 2014: 1. Roll out of waveform capnography throughout SCAS as part of monitoring replacement programme. 2. Update airway training as part of annual CPR training programme.3. Issue of Clinical Memos/Updates and Directives on Advanced Airway Mananagement, Unexpected Cardiac Arrest, Post Resusciation Care, and on the manditory use of End-tidal capnometry and capnography. 4. Despatch of Enhanced Care to support post ROSC care when available. Workforce review of future CCP role. September 2014: Business case agreed at Board level and procurement progressing

John Black Medical Director

Monthly 5 1 5 5

2. Emergency Performance 10 2.1 Poor IT Resilience Sep-14 4 4 16 1) Programme of resilience improvements approved by the Board Nov 12 following peer review of resilience 2) Virtual telephony business case approved for implemenation Aug 14 3)Back up procedures strengthened.4) Replacement of the UPS at Northern House Mch 14.

April 2014: Major resilence work has now been undertaken to ensure that if there are failures contingencies plans are undertaken more rapidly to reduce impact on the services. July 2014: Business case approved for virtualisation. Further resilience work completed and progress against the action plan presented to the Executive Management team 15th July. Aug 14 Timetable confirmed for phased implementation of virtulisation in Sept


Weekly review

4 3 12 12

12 2.2 Inability to consistently review incidents and conduct audits in 111 services in a timely manner and meet operational performance. Poor operational Performance in 111 service North and South

Sep-14 5 4 20 Fall back procedures. Rostering daily adjustments against activity and demand. Recruitment plan. Close analysis of call answering and abandonment rates daily. APR-14 Business case to increase number of call auditors apporved and 2014/15 budget adjusted. Clear monthly audit plan in place, with suitable tracking/monitoring systems.

Staff still to be trained to be work effective.Managing demand/high call volume. Leadership in teams to be strengthened.

Performance data. Programme board. Daily conference calls. Incident management and clinical governance processes in place. Clinical Assurance Groups. Call audit plan.Roster management using Erlang C model. Budget adjustment. • Sept/Oct 2013 – Resource increased to address backlog of incidents outstanding & complaints• Q&S Committee report on specific 111 quality issues presented

Call audits not yet 1% of calls against DH requirement. Patient survey of 2% of patients in Oxfordshire to be repeated Q2. Performance not consistent particularly in times of high demand on Saturdays and Sundays. Developing trends/themes from incidents and lessons learned.

April 2014: Business case to increase number of call auditors approved and 2014/15 budget adjusted. Clear monthly audit plan in place, with suitable tracking/monitoring systems.

Sue Byrne Chief Operating Officer

Daily review

4 3 12 12

13 2.3 Inability to deliver 999 NHS Pathways Transition programme and realise benefits

Sep-14 4 4 16 1)Adverse impact on financial position, reducing financial risk rating 2)ICT technical issues - unable to implement and deliver to programme 3) incorrect/ineffective call triage leading to incorrect patient disposition 4)Red (1&2) performance below national standards leading to failure to achieve (monitor) quarterly performance targets 5)Programme slip 6) Inadequate staff training 7) Identified benefits not achieved

1) Clear change control/quotation management with 3rd party suppliers. Strong programme budget control 2)Clarity of technical output spec - robust FAT & SAT testing - clear change control processes 3)Well constructed & delivered training backed up by effective mentoring & coaching processes - history (through NHS 111) of delivery of high quality, highly effective NHSP training. Training "back fill" arrangements in place. Additional staffing requirements identified & additional staff recruited & trained 4)Detailed modelling with full operational involvment ahead of "go live". Phased transition/implementation minimising any impact & allowing time to make any futher necessary changes to operational deployment model to counter impacts. 5)Close overview of programme activity (weekly reporting, monthly reporting up to Execs) Whole time head of programme, Whole time programme support Programme built into (integrated)overall SCAS portfolio 6)Benefits tracker identified. Programme brief clearly identifies each benefits & programme succcess dependant upon benefits being realised

April 2014: Pathways is currently being rolled out to ECT & CSD in Southern EOC using the agreed methodology and monitoring programme. Review of performance daily and assessment of impact on % of red calls underway with review of trigger words and timely intervention by- CSD: AUGUST 2014 - Following further Exec gateway review, introduction of Green Key words and "Auto Standown" advise functionality, roll out continued in NEOC. All metrics are within project scope, August performance at acceptable levels (above National Standards for Red incidents), H&T rates already exceeding planned out turn position, Red proportions contiue to reduce to plan. Programme remains on schedule and on budget with "Phase One" closure recommended - moving into BAU

Sue Byrne Chief Operating Officer

Monthly review

4 1 4 4

14 2.4 Inability to deliver the ePCR deployment programme & realise the benefits

Sep-14 3 4 12 1) Financial Pressures 2) Will lead to competitive disadvantage 3) Poor reputation

Early project phase 1) Membership Engagement Strategy 2) Membership and Engagement Committee 3) Support for governors e.g. engagement toolkit 4) Charter of Expectations inc no. of engagement events 5) Programme of Engagement events inc. constituency meetings and patient forums 6) Training commenced in the pilot areas

Early project phase June 2014: Medical Director and Director of Patient Care undertook a full clinical and quality review of the EPR system to ensure full compliance with clinical standards standards, patient safety elements and general user ease and functionality. Full gateway review planned for 7th July 2014 pre 'go Live'

Charles Porter, Director of Finance

Monthly review

3 3 9 9

•FT Membership increase still ongoing. Stakeholder engagement by different levels of managers delivering same message to all

Review monthly through

July 2014: SCAS has formal review meetings with key commissioners of our core services, where contract performance is openly discussed and issues raised Ongoing issues with performance are tracked and reviewed on a

James Underhay Executive

15,16 3.1 Non effective areas of stakeholder engagement, to build effective external relationships

Sep-143. Stakeholder Perceptions and Trust Reputation

• Targeted organisational visits• Partnership projects to reduce demand/costs• Stakeholder management strategy

1535• CCG's still developing. Risk of over scrutiny from external

4 4• Communications strategy in place • Quarterly stakeholder newsletter• Strengthened commissioner relationships from successful PCT visits

2 2

RAG



RatingMitigated

Risk Rating

27 3.2 Serious Information Governance Breach

Sep-14 4 5 20 June 2014: • The process for loading files on to the website has been modified. The controls have been enhanced to ensure Senior manager sign off, • publishing rights to the Web manager alone, pending a review and retraining of all editors, • Controls have been enhanced in the HR team for handling sensitive data

1) Through rapid response to the incident led by FD 2) Communicating to staff regarding the extent of the issue 3) Full Co-operation with the ICO 4) Improvement programme to significantly reduce the likelihood of a similar incident happening again 5) Managers are ensuring that their staff have completed the online IG refresher training. Additional IG steering group meetings to monitor. Sept 2014: Wider review of IG commissioned with BDO

percentage of staff completing IG online refresher training uptake throughout the trust

June 2014: • 2,346 files on the SCAS website were reviewed to ensure that there were no other similar occurrences • The process for loading files on to the website has been modified. The controls have been enhanced to ensure Senior manager sign off • We have restricted publishing rights to the Web manager alone, pending a review and retraining of all editors • Controls have been enhanced in the HR team for handling sensitive data • Managers are ensuring that their staff have completed the online IG refresher training. Additional IG steering group meetings to monitor. September 2014: Action plan in place following BDO audit, with copletion of 10 out of 13 actions.


Jul-14 4 2 8 8

17 4.1 Risk to achieving financial targets and realise CIP’s.

Sep-14 5 5 25 • Cost improvement plans agreed and monitored• Board approved budget & performance management of budget• LTFM aligned to Monitor framework• Monthly financial monitoring by Board and Executive Team. Board agreement in Sept 12 to spend additional monies at operational level.• Challenge by Audit committee• Internal Audit reviews or accounts• Local Counter Fraud work• External Audit & SIC . Cashflow reporting and analysis. Performance management of CIP's

Austerity measures to be identified and agreed. Ensuring end of year position with CIP's identified.

• History of good financial management• Board approved budget on 25th March 2012 • CIP meetings• Internal and external audits inc. year end audit reports• Minutes of Board, audit committee and executive committee. • 6 monthly budget reviews • External Review Boards each month with commissioners • Benchmarking against peers• Improved SLR• Performance management of CIP’s through business programme board and executive team • Clean audit report and value for money conclusion

Forecast readjusted therefore increased risk. Demand continues at a high level. Period 7 surplus and cost savings behind budget

Further improved robust CIP development process with schemes actioned to get additional savings. - Full Quality Impact Assesment undertaken and mitgation actions and monitoring agreed - Sept 2014: Working hard with CCGs to get funding with will give additional resilience over the winter period.

Charles Porter, Director of Finance

Monthly review

4 3 12 12

18 4.2 Cost of delivering performance levels in 111 higher than assumption

Sep-14 5 4 20 1) Monthly reporting to the board. 2) Monthly Performance Review meetings. 3) Detailed improvement plan

111 business is new so control measures need to be adapted.

• Track record of delivery of budgeted financial surplus• Track record of financial recovery programmes• National acceptance that the 111 service is different to originally envisaged (giving opportunity for variations)

• No Track record of 111 business controlling cost or delivering the of budgeted financial surplus• Service is still new so cost may vary for reasons which are not known. High sickness and attrition affects cost.

Delivery of fully networked (virtual) ACD telephony platform in plan for later this year. Further contracts via NHSD step in for Luton, Beds and Bucks have improved profitability of NHS 111 overall . -Workforce planning review underway along with improved demand (and ERLANG) modelling (Process Evolution). Plans to improve staff rostering in place - introduction of GRS tool (KRONOS alternative). Further contracts via NHSD step in for Luton, Beds and Bucks and winter resilience have improved profitability of NHS 111 overall. Telephony virtualisation project. - Sept 2014: Contract negotiations underway with commissionres to balance cost and quality service

Charles Porter, Director of Finance. John Nichols Director of 111

Monthly review

4 3 12 12

28 4.3 Risk of receiving an inadequate rating following the planned 8th September 2014 CQC regulatory inspection

Sep-14 4 3 12 1) Monthly reporting to the board. 2) Bi- Weekly Plan to Executive meetings. 3) Detailed project and readiness / compliance plan

Pilot inspection - first wave with unclear methodolgy for the sector

• Track record of delivering projects• Track record of positive judgements of compliance following previous CQC inspections• Leadership drive and focus to receive outstanding rating and focus in all areas by the Exec and SLT

• Inspection methodology is still new and untested.

June 2014: Learning from other sectors and NWAS with site visits undertaken. Campaign approach adopted and being designed for frontline engagement with staff in prepartion for what to expect from the inspection. Logistics planning underway, Evidence / data gathering and validation in progress. Comms plan in progress for internal and external engagement, Trust Board Seminar undertaken 6th June regarding new inspection regime and plan. Innovation and good news stories being compiled for evidence and sharing internally. Leadership engagement walkabouts fully schdeduled for the full year ahead to enure all areas visited. and supported by the Trust Board September 2014: CQC inspection project plan on track as outlined in the project plan and all staff and stakeholders engeged fully with the planned inspection. All requests for information sumitted ahead of time and joint logistical planning in progress with the CQC.


Weekly Review

4 2 8 8

5. Leadership and

4. Sound Governance

of managers delivering same message to all stakeholders. Stakeholder strategy to be revised based on CCG's. Public engagement to be stregthened.

through Executive Management Committee

raised. Ongoing issues with performance are tracked and reviewed on a monthly basis with improvement trajectories agreed and monitored if required. Other routine engagement activities are underway, with attendance at key meetings (HOSC's UCB's etc) led by Area Managers, and operational directors as required. Ongoing programme of profile raising underway, which includes local politicians, MP's & senior healthcare partners - including visits to SCAS to witness service delivery at first hand. M&E Committe is now focussed on engagement rather than building menbership. A minimum requirement to deliver engagement events as opposed to membership activities has been agreed, and support for these activities has been put in place by the SCAS M&E officer, including a revised toolkit to simplify activities. SEPT 2014 - Continuing engagement and dialogue with stakeholder groups, particularly in relation to challenging performance issues. Clear action & improvement plans developed and shared with relevent stakeholders as necesarry.

Executive Director

effective external relationships and enhance organisational reputation. reputation.

Reputation

• Stakeholder management strategy • Performance packs to PCT clusters - development of Integrated Performance Report • Commissioner external review meetings with commissioners• Joint and local HOSCs communication and meetings

over scrutiny from external stakeholders and poor reputation.

• Strengthened commissioner relationships from successful PCT visits – • CQC compliance • CQC QRP• Engagement throughout Quality Account development• Positive response from stakeholders including HOSCs• Contacts and develop relationships with new CCG's• Council of Governors in place. Workshop programme for COG. Executive workstream to develop further, relationships with 111 Stakeholders/commissioners.

RAG



RatingMitigated

Risk Rating

19 5.1 Failure to support staff and provide access to education and training to meet mandatory, clinical and organisational requirements

Sep-14 4 4 16 • Education training programme• Statutory and mandatory training • Training needs analysis• Integrated workforce plan• Appraisals and training monitored through scorecard by Exec Committee and Board

•Operational pressures . Northern cluster rota not yet operationalundermines ability to deliver against the trajectory•Sustainability of provision of training•CQC outcome 14 compliant but requires an outcome lead. Appraisal data not yet available for 12/13. Compliance with elearning for IG and Fire not yet achieved.

• Training remains on trajectory adhering to programme• Staff feel valued and have received training applicable to role – as reviewed by SHA and CQC visit • Recruitment plan trajectory aligned to integrated workforce plan. Training needs analysis and review of needs for commercial sector. • Staff survey results. Elearning programme to be introduced making learning more accessible. Monitoring of uptake to be done.Face to face training commenced May 13

•Loss of hours due to recovery action plans. TNA to be reviewed and developed.•Plans in place to deliver statutory and mandatory training•Rostering system will ensure correct availability of staff •Potential breach of H&S legislation not actioned in a timely manner. Review of reasons for absence with personal accident data.

April 2014: 2014 Face to face training programme signed off by Workforce Board March 2014. Programme roll out in 3 phases. Phase 1 begun April 2014. Includes Stat & Mand Training to be completed within 4 weeks of attendance. Reporting system set up to monitor completion. Follow up with Team Leaders. Additional CPD e learning modules contiue to be added to OLM. May 2014: Face to face training begun April and continues to end June. Education Managers monitoring uptake and requesting axction from Operational Directors to ensure trajectory met. June 2014: Team Training Days introduced in the North of SCAS to improve training locally within teams. Dynamic training days designed around team requirements. positive uptake on 'Face to Face' training days. July 2014 - Leadership training days introduced.

Will Hancock, CEO. Sharon Walters Director of HR

ongoing 4 2 8 8

20 5.2 Ability to effectively manage sickness absence.

Sep-14 4 4 16 Area Managers action plans to reduce sickness absence. Monitoring at Workforce Board.

All ops managers to be trained to use Kronos absence module.

Team leaders trainined in absence management and use of policy. Joint working with Occupational Health to rehabilitate staff back to work. Slight decrease in absence showing.

Figures not showing consistent month on month reduction in all areas.

Sickness following seasonal trend, but overall absence rate decreased 2013/14. Management action to continue, supported by HR.


Ongoing 4 2 8 8

21,22 5.3 Ability to recruit Ability to retain staff

Sep-14 4 3 12 1) Continued recruitment programme 2) Increase GP use in CSD 3) Monitor at WFDB1) Attrition data further analysis 2) increase CPD opportunities 3) Monitor at WFDB

31 5.4 Consequences of strike action if Sept TU ballots vote in favour of action

Sep-14 4 5 20 Maintain positive and open communications with TU's and staff through the JNCC. Review business continuity plans for possible strike or work to rule action. Review media and communications strategy. Regular updates nationally and communication with other Ambulance Services, understand business continuity plans for local acute and outpatients.

This is a national issue, to an extent any resulting action is out of SCAS's control as the national agreement will be applied. First business continuity planning meeting scheduled for 4 September 2014, all core directorates to be respresented Mark Ainsworth to chair the meeting supported by HR and Emergency Planning.

Sharon Walters, Director of HR

Oct-14 3 5 15 15

16 16Recruitment plans kept under review with Operational Managers. Action plans in place to increase acceptance of Grad Paramedic offers. Actively engaging with student paramedics from neighbouring universities. Project to increase recruitment 1. international recruitment being scoped, 2. RAF Paramedics. Recruitment for 111 and EOC on-going. Project to widen recruitment pool for PTS recruitment begun. - Projects to reduce attrition. Contact staff when reference request received to understand reasons for leaving. Contact with leavers to assure them they can wok for SCAS in future. Offer of Bank contracts to staff. Increasing opportunities for staff development - greater number of FD places available,increeased places on BSc top up programme. Exploratory meetings with external agency to consider vocational training route ECA to paramedic. September 2014: Actions taken to improve assessment centres and on-boarding for Graduate Paramedics failed to secure !00% of OBU and UoP graduates. Review of reasons for offers declined being undertaken. New Student Paramedic programme launched August and recruitment to 2015 cohorts in hand. Recruitment to EOC /111 remains good. September 2014: Student Paramedic programme introduced to address career development reason for attrition. New ESR forms introduced to gain greater detailed reasons for leaving.

Increasing competition for staff from neighbouring trusts

Conitued recruitment programme and CPD1) Reduced performance 2) Poor outcome for patients 3) Hear and treat not improved 4) Poor staff morale 5) Increased use of temporary staff

4

Culture


Ongoing 4

4 April 2014: SCAS continues to focus heavily on the performance of its 111 contracts to ensure that we meet our contractual obligations, challenging environment against backdrop of rising demand and staff shortages

James Underhay Executive

Monthly review

• Creation of a pipe line of opportunities monitored through the Trust Board

24 6SCAS performance with 111 services has continued to improve, and SCAS is now generally regarded as a strong provider

NHS 111 continues to have a key focus within the organisation to ensure that we are delivering consistently strong performance, at optimal cost to SCAS Service improvements are routinely being implemented and

None at present 682

Exec and Board review bi monthly

None at present

3

3 3

2

6. Commercial Viability Contract performance is routinely monitored and reviewed with Commercial Management team. In addition this is reported to and discussed with commissioners, which may include actions for service or performance improvements and innovations. Performance issues identified are addressed as part of ongoing action planning with clear responsibility for rectification as apporpriate.

1234Sep-146.1 Potential loss of PTS contracts and the failure to deliver required outcomes following the implementation of the SHIP PTS contract

23,25

Sep-146.2 Retendering of 111 contracts

9 9Both Hampshire and Ox/Bucks PTS contracts may be retendered during 2013/14. Currently it is unclear as to the exact timetable when this may occur, or the likely content of the retendered services. The outcome of these will largely depend on the content and weighting of the ITT requirements

Significant engagement ongoing with key stakeholders, scenario analysis developed re potential outcomes and discussed at Trust Board Level. Mitigating actions re service and service performance are underway

Significant activity is underway to assess current delivery against tender specifications & service re-design is underway. External support is being accessed to support the relaunching process for both ITTs and financial evaluation of the current delivery model completed-APR -14 - SHIP implementation plan in progress - see risk number 25 below - Contractual negotiations underway, early engagement has been had with commissioners and other key stakeholder groups Dedicated project team established for the implementation of the SHIP PTS contract with clear oversight and goverance processes, review by executive team. Joint governance arrangements with Commissioners and key stakeholder groups Sept 2014: Sept 2014: Good progress on project implementation, with key milestones & deliverables met. Fleet / IT / Technology streams now close to completion. Risks around staff numbers to deliver service on go-live as a number of inbound staff will now not transfer to SCAS. Also potential risk with TUPE costs for redundancy - potential mitigation through re-deployment opportunities. Contingency plans for staff recruitment being implemented. Gap analysis process with comissioners have identified 90% of service will go live by 01/10/14.

James Underhay Executive Director

RAG



RatingMitigated

Risk Rating

26 6.3 Inadequate oversight of NHS D Legacy Management office

Sep-14 2 3 6 Establish a programme board chaired by CEO with FD and other executive representation - fortnightly meetings arranged with NHS D legacy management team, all decisions to be ratified by SCAS executive

April 2014: Steering group established meetings now diarised with key attendees avialable, clear governance process in place with high risk items as standing agenda items. JULY 2014: Final NHSD LMO closure board meeting completed, ongoing leacy activity now contained fully within SCAS - funding in place which includes additional resources to employ additonal staff to carry out the work in HR and Claims.

James Underhay Executive Director

Monthly review

3 1 3 3

RAG Key:Green - Risk is low and or is being adequately mitigated (<8)Amber - Risk is high and is being adequately mitigated (More than 9 but less than 15)

environment against backdrop of rising demand and staff shortages continues to remain the focus of the 111 management team. SCAS continues to engage with the National re-design team on the future model for 111 services. July 2014: Continued scruting on contract perfomance in light of ongoing performance issues. Increased demand continues to grow, and additional resources being identified. Ongoing consultation with staff in relation to leave policy to mitigate pressures at times of system stress. SCAS team has launched a reprocurement project team to work on developing our new service offering. New enhancements / partnerships are being identified to provide added value for the new service, or to ensure that we meet the needs of the new specifications. Sept 2014: Continued focus on NHS111 performance across all contracts has seen continued improvement against contract KPIs. Continuing engagement with both local and national groups to ensure SCAS input into new service models and procurement approaches. Internal SCAS tream continue to focus on prospective procurements.

Executive Director

generally regarded as a strong provider. Issues still remain with key relationships at commissioning bodies, which may have an influence upon future successes at retender.

SCAS. Service improvements are routinely being implemented, and outstanding backlogs of QA are being addressed with a formal planned approach

Board Assurance Framework 2014/15

PROFILE OF RISK RATINGS 2014/15 (September 2014 Updated BAF)

RISK REG REF

JAN FEB MAR 14/15 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR Expected Y/EPredicted Actual

Y/E Position

1.1 Inconsistency in providing clinically excellent, evidence based and safe patient care as outlined in national quality measures / indicators (long waits, non-conveyance and equipment availability)

1, 3,5 12 12 12 12 12 12 12 12 8

1.2 Failure to convey patients to HASU in a timely manner and failure to provide adequate pain relief to STEMI patients 2 & 30 16 16 16 12 12 12

1.3 Availibility of resources (fleet and staff) and turnaround times resulting in delays and inability to meet targets - red and green calls consistently 8,9,11, 12 12 6 6 6 6 12 12 8

1.4 Private Providers not consistently meeting required standards resulting in poor outcomes and experience for patients 6 6 6 6 6 6 6 6 6 61.5 Inaccurate Clinical Data 4 16 16 16 12 12 81.6 Ageing Patient Monitoring systems in areas of the Trust and lack of availability of Waveform Capanograpy / CO2 monitoring system across all areas

29 New 5 5 5

2.1 Poor IT Resilience 10 15 15 15 12 12 122.2 Inability to consistently review incidents and conduct audits in 111 services in a timely manner and meet operational performance. (Ox, Berks, Hants) from Poor operational performance in 111 service - North and South

12 12 12 12 12 12 12 12 12 12

2.3 Inability to deliver 999 NHS Pathways Transitons Programme & realise benefits 13 12 12 12 12 12 12 12 12 4

2.4 Inability to deliver the ePCR deployement programme and to realise the benefits 14 9 9 9 9 9 9 9 9 9

3.1 Failure to engage fully with stakeholders and commissioners, to build effective external relationships and enhance organisational reputation. Particularly new CCG's

15,16 8 8 6 6 6 6 4 4 43.2 Serious Information Governance Breach 27 New 16 16 8

4.1 Failure to achieve financial targets and realise CIP’s. 17 20 20 9 12 12 12 12 12 124.2 Cost of delivering performance levels in 111 significantly higher than assumptions 18 16 16 8 12 12 12 12 12 12

4.3 Risk of receiving an inadequate rating following the planned 8th September 2014 CQC regulatory inspection 28 New 12 12 12 8

5.1 Failure to support staff and provide access to education and training to meet mandatory, clinical and organisational requirements 19 12 12 12 12 12 12 8 8 8

5.2 Ability to reduce sickness absence 20 8 8 8 8 8 8 8 8 8

5.3 Ability to recruit and retain staff 21,22 12 12 12 16 16 12 12 12 16

5.4 Consequences of strike action if Sept 2014 TU ballots vote in favour of action 31 New 15

6.1 Potential loss of PTS contracts and failure to deliver required outcome SHIP PTS Contract 23 &25 New May 13 9 9 9 9 9 9 9 96.2 Retendering of 111 contracts 24 New May 13 4 4 4 4 4 6 6 66.3 Inadequate oversight of NHSD Legacy Management Office 26 New 6 6 6 3 3 3

OBJECTIVE 5: LEADERSHIP AND CULTURE

OBJECTIVE 6: COMMERCIAL VIABILITY

OBJECTIVE 1: CLINICAL EXCELLENCE QUALITY OF CARE, PATIENT SAFETY AND EXPERIENCE

OBJECTIVE 2: EMERGENCY PERFORMANCE

OBJECTIVE 3: STAKEHOLDER PRECEPTIONS AND TRUST REPUTATION

OBJECTIVE 4: SOUND GOVERNANCE

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Item 14 - Summary Upward Report Upward reporting from the Quality & Safety Committee to the Trust Board 24th September 2014 Issues identified by the Quality & Safety Committee on 10th August 2014

Topic Issue Action Taken

Items with issues not achieved/ compliant

1. None to report from this meeting.

Areas of Concern/ Risk

2. Estates Strategy The committee discussed the Estates Strategy and processes for logging estates issues/jobs required and the prioritisation of such requests. SCAS require a clear process of referencing jobs and the dates that the work will proceed.

Director of Finance to present at the December Q&S committee a process for estates management.

3. SHIP PTS contract The committee were appraised of work to date on implementing the new SHIP PTS contract. The Committee noted that there is a certain amount of risk associated with this project and have requested to see a report that lists all the contingencies for all the possible issues. Risks discussed included safeguarding training assurance, call volume and TUPE’s staff numbers to ensure a safe service.

The committee gained assurance that the roll out is running to schedule for the SHIP mobilisation (monitored by Executive Management Group) To assure the committee on the mobilisation of the contract the Director for Strategy, Business Development and Communications would be invited to present at the December meeting.

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Items for awareness / assurance

4. CQC inspection preparedness The committee were updated on the workstreams and project plan for readiness for the forthcoming CQC inspection.

Full assurance that SCAS are preparing/prepared was accepted.

5. Aggregated learning report The committee were presented with the first aggregated learning report which covered the learning strategies SCAS has in place to learn and share across the organisation. This included learning across incidents, feedback, complaints, claims and coroners rulings. This work will continue to evolve and develop throughout the year.

Assurance was given to the committee that the organisation is utilising a variety of methods for learning from a number of sources of intelligence and feedback and was welcomed.

6. Long waits The Chief Operating Officer presented a comprehensive deep dive analysis of the audits and work being undertaken to address long waits in respect of our responsiveness, safety for patients, improving patient and public experience and providing the best effective care. Operations review each long wait incident and consider performance improvements and harm levels (if any) in order to improve the service.

It was agreed that the Committee was assured that detailed work is being completed and actioned.

Operations have commenced a piece of work on HCP calls – making best use of our resources. At the December meeting the Chief Operating Officer will present the HCP work to Quality and Safety Committee as a deep dive analysis.

Best Practice / excellence

7. Leadership walkrounds

The new programme of leadership walkrounds was presented to the Q&S committee. This included a Q1 review of themes and findings and triangulation with commissioner led visits.

The committee noted the report and were assured of the good practice and level of station and staff engagement.

8. Annual Report for Patient and Public experience 2013/14

The committee received the first SCAS Annual Report on Patient and Public Experience.

The Q&S committee welcomed the report.

9. Simbulance The Simbulance is the first one of its’ kind and is operational. It will provide a safe and real learning environment for staff.

The committee noted the innovative practice.