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Delivering safe, effective, person-centred careScottish Ambulance ServiceAnnual Report and Accounts 2011/2012

03Annual Report and Accounts 11/12

Contents:

6.7

The average response time for life-threatening

emergencies has improved to

minutes acrossScotland.

854,547We answered

telephone calls.

600,000We responded to over

accident and emergencyincidents.

Chair and Chief Executive Statement

Rosie Smith from Edinburgh

Our Services

Agnes Cook from the Western Isles

How we Performed

Our Quality Scorecard

Our Committee Membership

Ronald Johnstone from Thurso

Our Activity

Top 10 Emergency Chief Incidents

Top 10 Category A Chief Incidents

Operating Cost Statement

Balance Sheet

Independent Auditors’ Report

Mr and Mrs McCabe from Glasgow

Audit and Inspection

Voice of the Patient

Capital Investments and Annual Statement on Sustainable Growth

Board Members and Positions

Key Action Points

Letter from Deputy First Minister and Cabinet Secretary for Health, Wellbeing and Cities Strategy

£7.5millionof cash releasing efficiency

savings have been re-invested.

Alan Linton

from Fife Alan Linton is a cardiac patient and is accompanied

by his friends, Paul Pinkney, Mikey Rennie and Paramedics Alan McIntyre and Gordon Christie, and

Student Paramedic Nicola McDonald.

“ It is hard to believe that I am here today because of the fast actions of my friends, the Ambulance

Service and a Bee Gees song. I was playing a game of golf with friends at Charleton Golf Course

when I had a cardiac arrest. My friend Paul realised I was having a heart attack and remembered the

“Staying Alive” TV Campaign, and started CPR on me, Mikey cleared my airwaves and Brian

called for an ambulance. The Dispatcher, Karen, gave instructions over the phone to Brian, whilst an ambulance crew were on their way. It arrived

quickly, followed by an air ambulance. Thanks to my friends, the Dispatcher and the Paramedics, as well

as the song, all of which helped save me.”

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04 Annual Report and Accounts 11/12 05Annual Report and Accounts 11/12

Chair and Chief ExecutiveStatement. Working for you.

During the year we reached more patients, more quickly than ever before and saved more lives. Despite an increase in demand of 4%, we improved our response times to life-threatening incidents within 8 minutes, achieving an increase from 72% in 2010/11 to 73% in 2011/12. The average response time was 6.7 minutes. We also increased our Return of Spontaneous Circulation (ROSC) rate across Scotland in cardiac arrest from 14.5% to 16.9% in 2011/12. More Hyper-acute stroke patients were taken to the appropriate hospital within 60 minutes, which has improved from 75.5% to 78.4%. In relation to stroke and cardiac care, the Service has supported initiatives such as the FAST (Face, Arm, Speech, Time) campaign led by Chest Heart and Stroke Scotland. It has also continued to work with the British Heart Foundation on a range of activities, including the teaching of Emergency Life Support skills to school children.

Over the last 12 months, the Service has enhanced focus on patient safety. 2011/12 saw the introduction of a full programme of patient safety walkrounds by Service leaders, including all members of the Service Board. 94 visits to ambulance stations have taken place since August 2011, which has generated staff feedback on a range of topics and led to changes being introduced to improve patient safety. Throughout 2011/12 the Service has been working in partnership with staff and Trade Unions to agree a resolution to terms and conditions, ensuring that staff are able to respond to emergency incidents whilst having appropriate rest periods during their shift. The Service has also continued to see improvement in the appropriate implementation of the Peripheral Vascular Cannulation (this is a small catheter which is placed in a patient’s vein to administer fluids or drugs). The use of this bundle contributes to the reduction of the risk of infection.

Investment in our staff remains central to the development and professionalisation of the Service, culminating in the Scottish Ambulance Academy, in partnership with Glasgow Caledonian University, developing a BSc in Paramedic Practice. They have also established new diploma and certified programmes which are providing staff with a better grounding in clinical skills than ever before. We have invested in additional clinical advisors within our three Ambulance Control Centres, to enhance clinical support and decision making. We have also introduced ambulance-based access to the Emergency Care Summary and we are rolling out the Professional to Professional Line to further strengthen real time decision support for crews.

2011/12 has been a pivotal year for the implementation of the Scheduled Care Improvement Programme. The Service has worked in partnership with members of the public, patients, key stakeholders and other NHS Health Boards to develop and implement the Service improvement plan. Ahead of launching a new direct patient booking

line in 2012, the Service has also invested in mobile technology within all Patient Transport vehicles. As a result, patient access to PTS will improve, since these resources are designed to enable greater responsiveness to patient needs. We also invested in the first electric ambulance, which has zero emissions and the potential to significantly reduce operating costs.

Our commitment to developing more patient-centred care pathways with key partners has moved forward this year with an evaluation of a more consistent and appropriate care referral pathway for frail and elderly fallers. This was developed in partnership with the Long Term Conditions Collaborative, the Joint Improvement Team and Re-shaping Older Peoples Care. Furthermore, the Service has supported a joint approach with NHS Highland for Paramedics to deliver health checks as part of the wider anticipatory care programme, which helps maintain Paramedic skill levels in remote areas as well as boosting Primary Care resources. There has been continued partnership working with NHS 24 in the development of the new clinical content to support the implementation of the Single Clinical Triage Tool, which is on track for summer 2013.

We are working towards developing a comprehensive patient experience programme. Patient satisfaction remains high, with 97% of Accident and Emergency patients and 94% of Patient Transport Service patients expressing satisfaction with their experience of care from the Scottish Ambulance Service. This year the Service became one of seven Health Boards which have taken part in the Patient Opinion pilot, an online forum for patients to provide feedback. We have continued to embed our own system which captures Feedback, Complaints, Concerns and Comments. This system has improved governance around our complaints process and is providing one single view of all feedback into the Service.

We have continued a programme of engagement to understand local needs and work with communities to build resilience in 2011/12. There has been an increase in the number of public access defibrillators in both rural and urban settings, in partnership with a number of leading Scottish organisations, and we continue to support a growing number of communities to develop Community First Responder schemes. We procured a new state-of-the-art Air Ambulance contract which will see the introduction of two new, larger helicopters into the air ambulance fleet in 2014.

We will continue to work in partnership with patients and communities, key stakeholders and our staff to provide better patient care as we move forward into 2012/2013. Everyone at the Service is committed to bringing our vision to life: to deliver the best patient care to the people of Scotland when and where they need us.

Welcome to the 2011/12 Annual Report for the Scottish Ambulance Service, in which we review our performance and highlight a number of the improvements we have developed for patients over the course of the last year. We are well into the delivery phase of our Strategic Framework, “Working Together for Better Patient Care 2010-2015” and we are proud of the improvements we have made which support the Scottish Government’s ambition of person-centred, safe and effective care.

David GarbuttChairman

Pauline HowieChief Executive

Investment in our staff remains central to the development and professionalism of

the Service.

“

”


from Edinburgh

Rosie Smith

Rosie has been a patient of our Accident and Emergency services. She is with Gerry Egan, our Paramedic Clinical Director.

“I have used the A&E Service a couple of times in recent years. And although I’ve been very grateful for

the quick attention of the Ambulance Service, I felt that there were improvements the staff could make

in the way they had spoken to me. I decided to make a comment on the Patient Opinion website about my experience. The Service invited me in to talk through

what happened with Gerry. I felt comfortable and free to say what I needed to, and I now feel very validated

and understood.””


Our Services.

A Special Health Board, the Scottish Ambulance Service is a national operation based at over 180 locations in five Divisions. The Service is now co-located with NSS Scotland, NHS 24, NHS Boards’ Out of Hours services and within hospital and GP practice premises. As such, we continue to cover the largest geographic area of any ambulance service in the UK.

The Scottish Ambulance Service provides scheduled, unscheduled and anticipatory care for patients in remote, rural and urban communities across Scotland. We save lives by responding to life-threatening emergency calls. We help people to live well at home by treating or referring people at the scene, preventing unnecessary hospital admissions. We also take patients requiring clinical care during transport to hospital, in time for their appointment.

Accident and Emergency care -

we respond to 999 calls from the public and

healthcare partners such as general practitioners (GPs), in addition to requests for

an urgent response by clinicians.

Patient Transport Service – the Service plays a vital role in

caring for patients with a medical or mobility need who require transport to and from their hospital

appointments.

The Air Ambulance Service provides an

emergency response and a vital hospital

transfer service for the islands and remote

and rural areas across Scotland.

The Scottish Ambulance Service delivers Accident and Emergency care to patients the length and breadth of the country. This care is delivered by specially trained staff who, last year, responded to over 474,324 emergencies across Scotland.

999 calls are handled by one of three Ambulance Control Centres (ACCs) which are co-located with NHS 24 and NHS Boards’ Out of Hours teams. Ambulance crews are dispatched from stations and deployment points which are situated near to areas where the fastest response can be provided to where it is needed.

Accident and Emergency crews provide life-saving emergency medical care. Having assessed the medical needs of the patient, they may take patients to hospital, treat them at the scene or refer them to an appropriate clinic. In 2011/12, we worked with NHS Boards to reduce unnecessary attendances at A&E. We treated 57,977 patients at scene, which was 12.2% of all emergency incidents. In addition, our award-wining Cab-Based Technology (CBT) is playing an increasingly important role in the Service’s selection of appropriate care pathways and in the provision of decision making support to enable Paramedics and Technicians to provide high quality care to patients en route to hospital or at the appropriate receiving centre.

Last year, the Patient Transport Service (PTS) undertook 1,289,513 patient journeys across Scotland.

PTS provision is prioritised according to clinical need. The service is delivered by specially trained Ambulance Care Assistants who are increasingly providing this service to patients with more complex needs, for example, those requiring palliative care. All PTS vehicles are now fitted with shock boxes, so that staff can provide basic life support skills, while requesting an emergency response, should they encounter a cardiac arrest incident.

In the course of 2011/12 the Service has delivered a significant part of the implementation of a comprehensive improvement programme to PTS.

These improvements included the launch of a dedicated patient telephone booking line, providing better access for patients to the Patient Transport Service. All PTS vehicles are now fitted with mobile technology, improving staff communication and enabling more responsive patient care.

The air ambulance service comprises four purpose-built aircraft: two helicopters and two fixed wing aircraft. 3,382 air ambulance missions were flown in the course of 2011/12, providing high quality medical care to patients all over Scotland. Furthermore, we have completed a national re-procurement process for the next generation of Scotland’s air ambulance service. This contract was awarded to the incumbent air operator, Gama Aviation, and will run for seven years, commencing in April 2013. The new service will comprise the two existing King Air 200c fixed wing aircraft based in Aberdeen and Glasgow. Two new EC 145T2 helicopters, purpose built to Scottish Ambulance Service specifications, will replace the current EC 135 helicopters in Inverness and Glasgow. Our Air

Ambulance Service is the only integrated, publicly funded air ambulance service in the UK.

The Service is also leading the implementation of ScotSTAR (Specialist Transport & Retrieval Services). This will bring together the Scottish Neonatal Transport Service (SNTS), the Transport of Critically Ill & Injured Children, and the Emergency Medical Retrieval Service (EMRS) as one national service facilitated by the Scottish Ambulance Service. This will mean that we will manage these other services to ensure that there are agreements in place with other Health Boards to employ the doctors and nurses working within the teams. This will result in an improvement in the provision of critical care interventions and definitive surgical care across the country.

Agnes Cookfrom the Western IslesAgnes Cook has been a patient of our Accident and Emergency services. She now lives with her daughter Catriona Cook. Agnes received care from Paramedics Roddy MacDonald and Sine Nicolson.

“My mum fell ill when I was on holiday. My brother had been looking after her and she had got progressively breathless. Following a home visit by Dr Walker, he called the ambulance. The Paramedics were fantastic. They helped to stabilise her and got her to the hospital very quickly. She has heart failure and the build-up of fluid was causing her significant difficulties with breathing. Mum was strong enough to allow the consultant to take the fluid away. Since then, Mum has moved in with me, and although she has suffered a couple of falls since, the Paramedics have been able to treat her at home.”

Annual Report and Accounts 11/12 11Annual Report and Accounts 11/1210


Target for 2011/12

Target for 2011/12Performance Indicator Performance Indicator

HEAT Summary (Continued)

Performance in 2011/12


SAS E4: Sickness Absence

Sickness absence in 2011/12 was 6.29% compared to 5.9% in 2010/11. This needs improvement; the Service continues to employ a range of measures for effectively managing sickness absence. This work is now showing signs of improvement with performance in the first quarter of 2012/13 with the overall percentage of staff absent reducing to 5.7%

6.3%<5%

How we PerformedHEAT Summary.

SAS H2: Cat A cardiac arrest patients responded to within 8 minutes

Throughout 2011/12, the Service responded to 78.3% cardiac arrest patients within 8 minutes, improving on 77.4% from last year.

78.3%80%

NHSS E1: Meet Financial Targets

The Service met its financial targets for the year 2011/12. *The full financial statement can be read on page 22-24.

£23,000*under spend of

Revenue Resource Limit - Core

Target Achieved

SAS H3: Respond to life-threatening emergencies in 8 minutes (Cat A)

The average emergency response time for Category A during 2010/11 reduced from 6.9 minutes to 6.7 minutes. The Service improved the average Category A response times within 8 minutes from 72% in 2010/11 to 73% in 2011/12.

73%75%

SAS E3: Reduce Energy Consumption

Throughout 2011/12 the Service improved its energy efficiency across the whole estate

2.7%2.5%

SAS H4: Respond to serious but not immediately life-threatening emergencies in 14,19 or 21 minutes (Cat B)

Overall emergency demand has increased over the year 2011/12, particularly for Category B, the Service is working towards improving this target.

92.4%95%

SAS H5: Respond to all emergencies in 8 minutes (Orkney, Shetland & Western Isles NHS Boards)

The response to emergencies within the Island Boards has improved with an increase from 54% responded to in 8 minutes to 54.5%.

54.5%55%

There has been an increase from 14.5% to 16.9% in Return of Spontaneous Circulation (ROSC) across Scotland for patients in cardiac arrest.

16.9%12 - 20%

SAS H1: Return of spontaneous circulation (ROSC)

NHSS E2: Meet Cash Efficiency Targets

The Service met its financial targets for the year and successfully delivered 3.9% cash releasing efficiency savings.

3.9%

£7,451,0003%

£5,850,000


Target for 2011/12Performance Indicator Performance Indicator

HEAT Summary (Continued)HEAT Summary (Continued)


SAS A1: Respond to all 1 hour urgent calls within 1 hour

Overall emergency demand has increased, a further 4.0% increase in overall emergency demand was experienced in 2011/12, the Service has taken account of its performance in 1 hour urgent calls and is working towards improving this area.

86.3%93%

SAS A2: PTS Punctuality for appointment

Although demand in PTS has reduced significantly, the acuity of patients has increased. The Service is supporting a much higher population of older people with multiple complex conditions, to access their healthcare appointments.

68.9%72%

SAS T1: % emergency incidents treated at scene

The Service has delivered an increase of 0.8% to emergency incidents treated at scene, this means 57,977 patients avoided an unnecessary attendance at A&E.

12.2%12%

SAS T2: Hyper-acute stroke patients to hospital within 60 minutes of call

The percentage of Hyper-acute stroke patients taken to hospital within 60 minutes has improved from 75.5% to 78.4%.

78.4%80%

SAS A3: PTS Punctuality for pick up after appointment

This increased level of dependency requires more double crews within patient transport vehicles. In the short term this may have an impact on the level of resources available and hence impact performance. The Service will make improvements in 2012/13 through the implementation of Mobile Data (in-vehicle technology) and the Scheduled Care Improvement Programme.

80.1%90%

SAS A4: PTS Cancellations by SAS

There has been a significant reduction in the number of scheduled care cancelled journeys with cancelled journeys reducing from 1.5% to 0.6% between 2010/11 and 2011/12.

0.6%<0.5%

Target for 2011/12


AR1: Respond to life-threatening emergencies in 8 minutes (Cat A)

AR2: Cat A cardiac arrest patients responded to within 8 minutes

AR3: Respond to serious but not immediately life-threatening emergencies in 14,19 or 21 minutes (Cat B)

AR4: Respond to all emergencies in 8 minutes (Orkney, Shetland & Western Isles NHS Boards)

AR5: Respond to all 1 hour urgent calls within 1 hour

AR8: PTS Punctuality for Appointment

AR9: PTS Punctuality for Pickup After Appointment

AR10: PTS Journeys Cancelled by SAS

CE1: ROSC

CE2: Hyper Acute Stroke To Hospital < 60 mins

EP3: PTS Aborts and Cancels

EP6: Emergency Incidents Treated at Scene

AR11: Time from Take Off to Land on Scene <60mins

SAS H3

SAS H2

SAS H4

SAS H5

SAS A1

SAS A2

SAS A3

SAS A4

SAS H1

SAS T5

SAS T1

SAS E4

NHSS E1

NHSS E2

Heat Target Performance

16 Annual Report and Accounts 11/12

Our Quality Scorecard2011/12.

OrganisationalDevelopment

Engaging withPartners

ClinicalExcellence

Accessand Referral

Air Ambulance

Accessand Referral

Scheduled Care

Accessand Referral

Unscheduled Care

OD3: Sickness Absence

OD4: Meet Financial Targets (£000)

OD5: Meet Cash Efficiency Targets (£000)

68.9%72%

16.9%12-20%

<18%

95%

80.1%90%

78.4%80%

12.2%12%

0.6%<0.5%

73%

78.3%

92.4%

54.5%

86.3%

Measure

75%

80%

95%

55%

93%

6.3%<5%

£23,000Break Even

(3%) £5,850,000

(3.9%) £7,451,000

17Annual Report and Accounts 11/12

Our CommitteeMembership 2011/12.

Clinical Governance CommitteeThe Clinical Governance Committee currently comprises four Non Executive Directors: Ms Suzanne Dawson (Chair); Mr Andrew Richmond; Mrs Neelam Bakshi and Ms Theresa Houston. Mr David Nelson is the Public/Patient representative. The Committee meets approximately four times per year to monitor standards of care and measure the effectiveness of pre-hospital treatment.

Audit CommitteeThe Audit Committee currently comprises four Non Executive Directors: Mr Andrew Richmond (Chair); Ms Moi Ali; Mr Eddie Frizzell and Councillor David Alexander. Mr Frizzell took up his position at the start of July 2011, replacing Mr Douglas Marr. Councillor Alexander replaced Ms Christine Humphries at the same time and Mr Richmond took up the position of Chair of the Committee. The Audit Committee meet four times per year to consider the various reports from both internal and external auditors to assess the risks which may arise in the Service.

Staff Governance CommitteeThe Staff Governance Committee comprises four Non Executive Directors: Mr Matt Bell, Employee Director (Chair); Ms Moi Ali; Councillor David Alexander; Mrs Neelam Bakshi and the Chairman, Mr David Garbutt. The Committee meets four times per year to ensure effective monitoring of staff governance within the Service.

Remuneration CommitteeThe Remuneration Committee currently comprises the Chairman, Mr David Garbutt and three Non Executive Directors: Mr Eddie Frizzell; Ms Suzanne Dawson and Councillor David Alexander. The Committee is chaired by the Chairman, Mr David Garbutt. It meets at least three times per year to consider the evaluation of performance and pay awards for Executive Directors. The Committee has an important role in ensuring consistency of policy and equity of treatment of staff across the local NHS system, including remuneration issues, where they are not already covered by existing arrangements at a national level.

There has been an increase in the

number of public access defibrillators in both rural

and urban settings


Ronald Johnstone

from ThursoRonald Johnstone is a Patient Representative

on the Scheduled Care Programme Board.

“I retired in March 2011 after 27 years as a Parish Minister in Thurso. I first got involved with the Service when it was conducting a national consultation and seeking

feedback. Afterwards I was asked to become a member of the Scheduled Care Programme Board as a Patient

Representative. I feel I have an understanding of how local folk think and what they want and need but I am also aware of the difficulties of providing services in a rural area. It has

been a busy year but it is rewarding to start to see the roll out of the new direct patient booking line,

for the Patient Transport Service.”


Transfer / Interfacility / P

Falls

Unconscious / Fainting

Chest Pains

Breathing Problems

Overdose / Poisoning

Convulsions/Fitting

Assaults

Sick Person

Traffic / Transportation Acc

Paramedics

Technicians

PTS, including ACAs, Drivers, and PTS Ambulance Assistants

Emergency Medical Dispatch (EMDC) staff

Administrative and Clerical

Professional and Managerial

Others

Total number of staff

Chest Pains

Unconscious / Fainting

Breathing Problems

Convulsions/Fitting

Falls

Haemorrhage / Laceration

Cardiac / Respiratory Arrest

Stroke / CVA

Heart Problems / AICD

Overdose / Poisoning

Chief Complaint Group

Our Staff

Chief Complaint GroupAll EMG Count

Numbers of staff as at 31 March 2011

All Cat A Count

Our Activity. Top 10 Emergency Chief Incidentsand Category A Chief Incidents.

119,700

1,387

31,520

22,183

12,649

104

5,909

2,550

59,818

951

25,012

21,847

81

4,027

4,846

36,306

892

20,862

32,224

17,269

311

11,605

2,970

28,343

18,575

302

10,106

3,172

Argyll & Clyde

Ayrshire & Arran

Borders

Dumfries & Galloway

Fife

Forth Valley

Grampian

Greater Glasgow

Highland

Lanarkshire

Lothian

Orkney

Shetland

Tayside

Western Isles

Scotland Total

139,983

126,229

41,935

51,134

140,250

83,865

77,922

209,303

54,156

129,674

117,281

1,082

843

113,426

2,430

1,289,5131

57,038

49,923

13,018

16,776

46,309

30,583

57,272

121,994

27,905

74,525

101,118

2,065

2,132

46,824

3,788

662,6282

798

105

7

22

0

0

225

457

622

3

25

395

297

7

391

3,3823

999(Average response mins)

Potentially Life Threatening

Calls(Average response mins)

AirAmbulance

MissionsA&E

IncidentsPTS

JourneysSub Division

8.0

9.6

9.8

10.4

9.5

6.3

7.1

6.5

n/a

n/a

9.3

8.6

6.9

6.8

9.8

10.2

11.1

8.1

6.6

n/a

10.3

9.7

9.2

7.9

7.9

6.7

8.2

8.3

6.4

6.4

Footnote 1: The figures published at the Scottish Ambulance Service Annual Review for the number of Patient Transport Service journeys undertaken was 1,276,945. This figure did not include some Day Hospital activity, which has been updated since the Annual Review and is included in the total figures below.

Footnote 2: The Scotland total includes incidents not aligned to any sub-division.

Footnote 3: This figure excludes air missions stood down prior to arrival at patient.

Operating Cost Statementfor the year ended 31 March 2012.

Clinical services costsHospital and Community

Less: Hospital and Community Income

Family Health

Less: Family Health Income

Total Clinical Services Costs

Administration Costs

Less: Administration Income

Other Non Clinical Services

Less: Other Operating Income

Net Operating Costs

Other comprehensive net expenditureNet (gain)/loss on revaluation of Property Plant and Equipment

Net (gain)/loss on revaluation of Intangibles

Net (gain)/loss on revaluation of available for sales financial assets

Other Comprehensive Expenditure/(Income)

Total Comprehensive Expenditure

2011£000

205,179

6,030

199,149

0

0

199,149

2,696

0

2,696

2,104

352

1,752

203,597

(21)

0

0

(21)

203,576

2012£000

204,638

5,588

199,050

0

0

199,050

2,502

0

2,502

2,037

(19)

2,056

203,608

(374)

0

0

(374)

203,234

Summary of core revenue resource outturnNet Operating Costs

Total Non Core Expenditure (see below)

FHS Non Discretionary Allocation

Total Core Expenditure

Core Revenue Resource Limit

Saving/(excess) against Core Revenue Resource Limit

Summary of non core revenue resource outturnCapital Grants to / (from) Other Bodies

Depreciation/Amortisation

Annually Managed Expenditure - Impairments

Annually Managed Expenditure - Creation of Provisions

Annually Managed Expenditure - Depreciation of Donated Assets

IFRS PFI Expenditure

Receipt of Donated Assets

Total Non Core Expenditure

Non Core Revenue Resource Limit

Saving/(excess) against Non-Core Revenue Resource Limit

2011£000

2012£000

203,608

(12,482)

0

191,126

191,149

23

0

11,500

(8)

990

0

0

0

12,482

12,500

18

203,597

(12,143)

0

191,454

191,498

44

0

10,220

1,410

513

0

0

0

12,143

12,145

2


191,126

12,482

203,608

44

2

46

191,149

12,500

203,649

2012 Resource

£000

2012 Expenditure

£000

2012 Saving/

(Excess) £000

2011 Saving/

(Excess) £000Summary resource outturn

Core

Non Core

Total

23

18

41


This report is made solely to the members of the Scottish Ambulance Service as a body, the Auditor General for Scotland and the Scottish Parliament, in accordance with Public Finance and Accountability (Scotland) Act 2000. Our audit work has been undertaken so that we might state to the members of the Scottish Ambulance Service as a body, the Auditor General for Scotland and the Scottish Parliament those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than to the members of the Scottish Ambulance Service as a body, the Auditor General for Scotland and the Scottish Parliament, for our audit work, for this report, or for the opinions we have formed.

Respective responsibilities of Accountable Officer and Auditor As explained more fully in the Statement of the Chief Executive’s Responsibilities as the Accountable Officer of the Health Board set out on page 22, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and is also responsible for ensuring the regularity of expenditure and income. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland) as required by the Code of Audit Practice approved by the Auditor General for Scotland. Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income.

Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts, disclosures, and regularity of expenditure and income in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the board’s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the directors’ report and accounts to identify material inconsistencies with the audited financial statements. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report.

Opinion on financial statementsIn our opinion the financial statements:

• give a true and fair view in accordance with the National Health Service (Scotland) Act 1978 and directions made thereunder by the Scottish Ministers of the state of the board’s affairs as at 31 March 2012 and of its net operating cost for the year then ended;

• have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2011/12 FReM; and

• have been prepared in accordance with the requirements of the National Health Service (Scotland) Act 1978 and directions made thereunder by the Scottish Ministers.

Opinion on regularity In our opinion in all material respects the expenditure and income in the financial statements were incurred or applied in accordance with any applicable enactments and guidance issued by the Scottish Ministers.

Opinion on other prescribed matters In our opinion:

• the part of the Remuneration Report to be audited has been properly prepared in accordance with the National Health Service (Scotland) Act 1978 and directions made thereunder by the Scottish Ministers; and

• the information given in the Operating and Financial Review and Directors’ Report for the financial year for which the financial statements are prepared is consistent with the financial statements.

Matters on which we are required to report by exceptionWe are required to report to you if, in our opinion:

• adequate accounting records have not been kept; or• the financial statements and the part of the Remuneration Report to

be audited are not in agreement with the accounting records; or• we have not received all the information and explanations we require

for our audit; or• the Governance Statement does not comply with Scottish

Government guidance; or• there has been a failure to achieve a prescribed financial objective.

We have nothing to report in respect of these matters.

Deloitte LLPAppointed Auditors Glasgow27 June 2012

We have audited the financial statements of the Scottish Ambulance Service for the year ended 31 March 2012 under the National Health Service (Scotland) Act 1978. The financial statements comprise the Statement of Comprehensive Net Expenditure and Summary of Resource Outturn, the Balance Sheet, the Statement of Cash Flows, the Statement of Changes in Taxpayers’ Equity and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2011/12 Government Financial Reporting Manual (the 2011/12 FReM).

Balance Sheetfor the year ended 31 March 2012.

Total non-current assets

Total current assets

Total assets

Total current liabilities

Non-current assets plus/less net current assets/liabilities

Non-current liabilities

Provisions

Financial liabilities:

Trade and other payables

Total non-current liabilities

Assets less liabilities

Taxpayers’ Equity

General fund

Revaluation reserve

Total taxpayers’ equity

Summary of capital outturnNet Capital Expenditure

Core Capital Resource Limit

Saving (excess) against Core Capital Resource Limit

2011 £000

83,797

14,571

98,368

(20,593)

77,775

(3,928)

0

(3,928)

73,847

69,608

4,239

73,847

19,483

19,484

1

2012£000

87,111

15,534

102,645

(17,409)

85,236

(4,047)

0

(4,047)

81,189

76,602

4,587

81,189

13,873

13,881

8

Independent Auditors’ Reportto the members of the Scottish Ambulance Service, the Auditor General for Scotland and the Scottish Parliament.


Mr & Mrs McCabe

from GlasgowMr and Mrs McCabe are regular Patient Transport Service

users and live in sheltered housing in Glasgow.

“ My husband and I have used PTS for various healthcare appointments over the years. I suffered a stroke earlier in my life and have recovered and lived with a mobility issue ever since. My husband is now

90 and has appointments at the Orthopaedics and Anticoagulation clinics in Glasgow on a monthly basis. The Crews are very professional and always put us at

ease. PTS is a lifeline to us and I am very grateful to the ambulance service for all their help.”


Audit and Inspection.

Governance and Audit ArrangementsThe Board meets annually to review and add to the Corporate (very high level) Risk Register. The key risks identified are prioritised through a risk matrix scoring methodology that examines the likelihood and impact.

Thereafter, the key risks have controls or mitigating actions developed which allow the organisation to manage these risks. The Risk Management Steering Group meets on a quarterly basis to review these key risks and monitor the appropriateness and effectiveness of controls and mitigating actions. This group also ensures that organisational risks which require escalation can be fed into the Corporate Risk Register.

The Audit Committee receives updates on how these risks are managed to assure the Board that the management team is taking

Clinical Governance and Risk ManagementThe Clinical Governance Committee is responsible for oversight of the clinical governance of the Service, in order to assure the Board that the arrangements are effective and to notify the Board of regular reports on the operation of the system and specific reports on any problems that emerge.

The Committee monitors:

• The delivery of quality clinical care being provided in the Service

• The procedures in place for effective clinical practice

• Measured performance against those procedures

• The arrangements and achievement of continuous professional development

• Clinical complaints and commendations and the lessons learned from them

• The reporting of critical clinical incidents

• The arrangements for clinical risk management and patient safety

• The Service’s programme of clinical audit

• The Services clinical research and development programme.

Information GovernanceInformation Governance has continued to develop and become embedded in the daily tasks of all staff, due to the continued focus and leadership of the Information Governance Committee and the Senior Information and Risk Officer (SIRO). The Information Governance Framework strategy has been published and awareness of key responsibilities has been raised through the Information Governance Portal on the Intranet, through e-learning programmes and online surveys.

One of the new initiatives this year is the introduction of a “pop up” message system on all staff PCs. This is allowing the Service to communicate important national messages across the Service quickly; staff have to confirm they have read the message before they can access their computer, enabling the Service to record and monitor compliance.

Hand Hygiene Compliance MonitoringHand hygiene is one of the most effective ways to prevent and reduce the incidence of Healthcare Associated Infections (HAIs). As part of a zero tolerance approach to non-compliance with hand hygiene standards, the Service continues to undertake a programme of regular hand hygiene compliance audits across all Divisions. The Service submits bi-monthly hand hygiene compliance data for reporting as part of NHS Scotland national hand hygiene compliance reports. The Service continues to demonstrate good practice in line with the “Five Moments for Hand Hygiene” when care is being delivered, maintaining results between 94-96%. The Service also completes regular hand hygiene audits to monitor compliance with best practice hand hygiene techniques; our results range between 91-95%. In order to further promote best hand hygiene practice, fob watches have been introduced to replace wrist watches. The increased number of Cleanliness Champions across the Service also continues to aid the promotion of best practice.

NHS Scotland National Cleaning Services Specifications (NCSS)Ensuring the healthcare environment is clean and well maintained is essential to prevent the spread of infections. The Service continues to monitor the cleanliness and maintenance of ambulances and stations as part of a planned audit programme. The national target is to maintain compliance with NCSS standards at above 90%. The Service

effective action. Internal Audit utilise the high level register and the findings from the annual risk workshop to develop their work plan for the forthcoming year. This process ensures that Internal Audit is focused on the areas of greatest risk to the organisation.

The Service has also reviewed the Risk Management Strategy and Policy for 2012/2015, which includes the identification of risk appetite and a reviewed Risk Register template.

Robust governance arrangements are in place to ensure that continued strong progress towards the goals of the Service’s five year strategy “Working Together for Better Patient Care” is driven by sound project management, incorporating sound risk management, financial controls and the required standards of involvement of our patients, the public and other key stakeholders, as well as our staff.

continues to demonstrate good overall compliance with this. Station compliance scores are reported to Divisional Management Teams to ensure they continue to meet high standards and embed continuous improvement in performance. The overall result for NCSS compliance for the year was 93% for cleaning.

The Service, along with all other NHS Scotland Boards, implemented the new national web based monitoring system called the Facilities Monitoring Tool (FMT) from April 2012. This has replaced the previous Excel based manual data collection process used to monitor the cleanliness of the healthcare environment.

Financial Governance The Scottish Ambulance Service again met its financial targets for 2011/12, both in terms of managing budgets and in meeting its cash releasing efficiency target for the year. The service ended the year 2011/12 with a £23,000 surplus. The Capital Resource Limit and Cash Requirement targets were achieved in the year. Capital Resource ended the year £8,000 under. In addition efficiency savings have amounted to £7.4 million.

The Service ensures that both financial processes and controls are in place and are working effectively through a system of internal audit reviews. The Corporate Register is used as a basis for developing the Internal Audit Plan. The Service commissioned 26 Internal Audit Reports during the year to 31 March 2012.

Staff Governance2011/12 proved to be a busy year for the Scottish Ambulance Service. Our Service Strategy “Working Together for Better Patient Care” and its underpinning programme boards have continued to shape our future direction. Much of what we do is dependent on our ability to bring about change whilst maintaining our values and beliefs. Fundamental to that approach is an effective partnership between the Service and our staff. Throughout 2011/12, and in the face of some considerable challenges, we have continued to live out the values and principles of partnership working, ensuring that effective staff governance exists at all levels in the Service. For example, we have achieved high levels of staff input into the introduction of a new Recognition and Awards scheme and Leadership Patient Safety Walkrounds. We also launched the Career Framework and undertook an evaluation of Leadership and Management Development across the Service. We will continue this work next year, focusing on implementing the new Staff Governance Standards from June 2012.

Equality and Diversity and Reducing Health InequalitiesThe Service has made good progress in embedding the principles of equality and diversity in the Service over the course of the year, both as a service provider and as an employer. In line with the introduction of the Equality Act 2010, the Service ensures the work it does has due regard to eliminating discrimination, harassment and victimisation, advances equality of opportunity and fosters good relations. In keeping with the new Public Sector Duty, work is underway to develop and set equality outcomes for the Service. We will continue to mainstream equality activity in all that we do and to review and revise our current procedure for conducting Equality Impact Assessments of all our proposed policies and practices, as well as the changes we make to our existing policies.

The Service continues to monitor its Anti-bullying and Harassment campaign. The aim of the campaign is to raise awareness of unacceptable behaviour and encourage staff to speak out about any concerns and issues at the earliest opportunity.

The Equality and Diversity Steering Group continues to meet bi-monthly to take some of the key areas of work forward. Membership includes representatives from across the divisions.

Table 1: Governance of the strategic framework

SAS Board

Executive Team

Strategic Implementation

Programme Board

eHealthSteering Group

Access &Referral

Unscheduled Programme

Board

Access &Referral

Scheduled Programme

Board

Engaging Rural & Urban Communities Programme

Board

‘Doing TheRight Thing’

SteeringGroup

ClinicalGovernance

StaffGovernance

AuditCommittee

SystemsSpecifications

ReferralPathways

Patient Needs Assessment

ImprovedSystems

AlternativePathways

Remote &Rural Urban

30 31Annual Report and Accounts 11/12

We build and maintain a current picture of how our patients, carers and families experience the Service in a number of ways.

Formal mechanisms, such as our patient survey and our carer survey have identified areas of good practice on which to build, as well as opportunities to improve the quality of patient care. The number of formal complaints has been significantly reduced, from 410 in 2010/11 to 270 for 2011/12, achieving 71% for the national compliance target of 70%. At the same time, 178 concerns and comments have been recorded and managed appropriately. In line with the Patient Rights (Scotland) Act 2011, the Service has developed a new system called Viewpoint, which holds and tracks both formal and informal responses which the Service has been given after being contacted by patients and their carers. Feedback was formerly categorised as Complaints, Concerns, Comments and Compliments, known as the “four Cs.” National terminology for the four Cs has recently changed to: Feedback, Comments, Concerns and Complaints, and the Service’s systems and processes have been amended to reflect this. The Scottish Ambulance Service is represented on the Scottish Government’s National Steering Group for Education and Training for Feedback, Comments, Concerns and Complaints.

The Service has introduced less formal feedback mechanisms, such as Patient Opinion and other social media channels including Twitter and Facebook, to increase the number of ways service users can let us know what was good about their care experience, and what we can do to improve the quality of care we provide. These are increasingly helpful temperature checks for the Service, in understanding the current standard of care for service users.

Capital Investments.The Voice of the Patient is Driving Service Improvement.

Major Projects included:

The Scottish Ambulance Service completed the implementation of Mobile Data technology into Patient Transport vehicles, facilitating better utilisation of vehicles and enhancing real time communication with crews. Refurbished and new build stations and other estate included Lockerbie, Helensburgh, Clydebank, Cumbernauld and Kirkcaldy ambulance stations. The Service continued to invest in defibrillator equipment and medical equipment over the course of the year, supporting staff to provide better patient care.

The total expenditure of the acquisition during the year was £13.8 million. Of this, £8 million was required for vehicles, £1.9 million was on property, £0.4 million on defibrillators and £3.2 million on IT equipment.

The Scottish Ambulance Service is focused on providing safe, effective and person-centred care. We are striving to build mutually beneficial partnerships between patients, their families, and Service staff, which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.

Key to our preparations for the launch of the Patient Charter in October 2012 will be ensuring Service staff are empowered to listen to and act upon feedback, comments, concerns and complaints and that learning from the full range of patient experiences of the Service is shared and embedded.

The ongoing Patient Safety Leadership WalkRound programme, which was introduced last year, will continue to ensure regular two-way communications with staff, so that staff can also help to improve the care we give to our patients and improve patient safety.

Service staff across our five Divisions continue to play a key role in ensuring that communities have early involvement in service change. They also achieve this through activities which build community resilience, for example, through Community First Responder Schemes, by teaching school children Emergency Life Support skills (ELS) and by building new response models with communities for communities. The Service is continuing to work closely with the Scottish Health Council to build Patient Focus Public Involvement (PFPI) capability at divisional level. We are committed to working with patients, the public, carers and community groups in accordance with the guidance set out in CEL 4 (2010) “Informing, Engaging and Consulting People in the Development of Health and Community Care Services.” This commitment is evidenced in the quality of the engagement strategy and plan for the Air Ambulance Re-Procurement project and in our comprehensive, ongoing engagement strategy and plan for improving both access to the Patient Transport Service and the responsiveness of our systems.

The Service is committed to a programme of continual improvement in order to minimise the environmental impact of our operations. The Service has a number of policies and procedures in place in support of this commitment. These include:

• The organisation achieved a 2.66% reduction in energy consumption, 0.16% over and above the expected 2.5% savings

• The introduction of new chassis for Accident & Emergency ambulances is expected to reduce emissions. In addition, the Scheduled Care Programme will result in improving the efficiency of Patient Transport vehicles and their mileage will decrease over the next four years. An electric Patient Transport vehicle is due to go into service in August 2012 for evaluation

This is the Scottish Ambulance Service’s first Public Sector Sustainability Report for the financial year 2011/12. As such, this will provide baseline data for future years’ reports, which will eventually include a rolling three year summary of performance.

• There has been an increase in recycling provisions across stations and facilities were introduced at the new National Headquarters

• The leased vehicle essential-user car scheme now has a limit of 140g, which has been imposed on all vehicle choices except for a small number of 4x4 vehicles, which are required for resilience purposes

• We are continuing to install energy saving devices in our upgrades and new builds. In particular, we have installed thermostatic valves to all radiators, time clocks to all heating systems and automatic devices for lighting and energy saving insulation.

The full Scottish Ambulance Service Public Sector Sustainability Report 2011/12 can be read here www.scottishambulance.com

We are striving to build mutually

beneficial partnerships between patients, their

families, and Service staff, which represent individual

needs and values.

Annual Statement on Sustainable Growth.

Annual Report and Accounts 11/12


Board Members and Positions2011/12.

NameHouses, Land & BuildingsPosition

Shares & SecuritiesRemuneration

Non Financial Interests

RelatedUndertakings

Voluntary/CharityWorkContracts

Relative(s) in Scottish Ambulance

Service

Pauline Howie Chief Executive

Scottish Ambulance ServiceNone None None None None None None

Suzanne Dawson Non-Executive Director

Fellow of Chartered Institute of Marketing; Lay member of the Council of the Law Society of Scotland; Member of the Board of Newbattle Abbey College

Scottish Ambulance ServiceSelf Employed Marketing Consultant

None None None None None None

Christine Humphries (to 30/06/11)

Non-Executive Director

Member British Association of Social WorkersScottish AmbulanceService

Vice Chairman, Scottish Borders Valuation Appeal CommitteeNone None None None None

Andrew Richmond Non-Executive Director and Deputy Chairman

Associate of Society of Investment Professionals (ASIP); Member of Church of Scotland; Trustee Tayside NHS Board Endowment Fund; Lay Court Member of the University of Dundee; Trustee of the University of Dundee Superannuation and Life Assurance Scheme.

Scottish Ambulance Service;Non-Executive Member of NHSTayside; Chair of Angus CHP; Non-Executive Director of Frontier IP Group PLC


David Alexander Non-Executive Director

Member and National Office Bearer Scottish National Party; Member C.N.D Scotland; Member Central Scotland Fire Board

Scottish Ambulance Service; Falkirk Council Elected Member None None None None None None

Theresa Houston Non-Executive Director

Scottish Ambulance Service; NHS Education for Scotland None None None None None None None

David Garbutt Chairman Chartered Fellow of Chartered Institute of Personnel and Development; Fellow, Scottish Police College ; Visiting Fellow Australian Institute of Police Management

Scottish Ambulance Service; Self Employed Consultant

MacMillan Cancer Support Volunteer; Member Tweed Valley Bike Patrol

None None None None None

Moi Ali Non-Executive Director

Scottish Ambulance Service, Education Scotland, JudicialComplaints Reviewer; Self Employed Consultant

None None None None None NoneFellow, RSA; Governor, Napier University

Douglas Marr (to 30/06/11)


Scottish AmbulanceService None None None None None None

Chair Threipmuir Investment Club Rotary Club Currie & Balerno


Board members and positions continued

NameHouses, Land & BuildingsPosition

Shares & SecuritiesRemuneration

Non Financial Interests

RelatedUndertakings

Voluntary/CharityWorkContracts

Relative(s) in Scottish Ambulance

Service

Shirley Rogers Director of Human Resources


Matt Bell Employee Director


George Crooks Medical Director

Scottish AmbulanceService; MedicalDirector NHS 24

None None None None None None None

Daren Mochrie (from 1/12/11)

Director of Service Delivery


Pete Ripley (until 5 August 2011)

Director of Service Delivery


Pamela Mclauchlan Director of Finance and Logistics

Executive Member CIPFA in Scotland; Non-Executive Member of the Audit Committee of the National Theatre for Scotland

Group Scout Leader; Church of Scotland Elder; South Queensferry First Responder

Scottish Ambulance ServiceNone None None None None

Neelam Bakshi (From 01/07/11)


Member Chartered Institute of Personnel & Development (Affiliate); Federation of Small Businesses; Cooperative Society; National Autistic Society; Royal Horticultural Society; Member BBC Audience Council Scotland; Approved Training Institute American Board NLP

Scottish Ambulance Service; NB Associates-owner; Scottish Government, Non-Executive Member; Lay Member Employment Tribunals Scotland; Reserve Forces Tribunal & Lay Race Equality Assessor to Judiciary; Member Scotland Committee of Equality & Human Rights Commission


Edward Frizzell (From 01/07/11)


Scottish Ambulance Service Vice-Chair of Court of Abertay University, Dundee; Visiting Professor, Queen Margaret University, Edinburgh

Director of TrefoilNone None None None None


Deputy First Minister and Cabinet Secretaryfor Health, Wellbeing and Cities Strategy

Nicola Sturgeon MSP

T: 0845 774 1741E: [email protected]

David Garbutt, ChairScottish Ambulance ServiceNational HeadquartersGyle Square1 South Gyle Crescent Edinburgh, EH129EB

2 September 2012

SCOTTISH AMBULANCE SERVICE ANNUAL REVIEW: 21 AUGUST 2012 This letter summarises the areas of discussion and actions

agreed at the Annual Review and associated meetings at Caledonia House on 21 August 2012. I would want to offer my thanks to everyone involved in organising what was a very successful day, I am aware of the hard work that goes in to planning these events.

As part of my visit, I was able to spend time in the Ambulance Control Centre and be given an update on the scheduled care improvement work being progressed by the service. I was given a demonstration of the new arrangements that give patients direct access to book patient transport to and from their scheduled care appointments, and shown the improvements made in the technology for planning journeys and tracking the vehicles through the mobile data technology. I was also shown an electric ambulance, a new addition to the vehicle fleet and a real demonstration of your efforts to protect the environment by reducing carbon emissions, and met with a Patient Transport Service crew to hear from them what benefits this new vehicle, and the mobile data technology, can deliver for patients. I would be grateful if you could pass on my thanks to the ambulance service staff who met with me, and in particular to Mr and Mrs McCabe who came along to give me a real patient insight into the support provided by the scheduled care service to those who rely on it.

Meeting with Clinical Advisory Group I had an extremely useful meeting with a range of clinical advisers

who support the ambulance service to deliver safe and effective care for patients across the country and I would want to thank them for their attendance and contribution. There was a real sense of enthusiasm and commitment round the table for the opportunities that lie ahead as the organisation continues to develop as a clinical service.

One of the significant areas of work undertaken in recent times has been the reprocurement of the air ambulance service contract. As we know, the air resource is critical in a country with the geography and dispersed population of Scotland. The input and interface with the clinical community has been extensive, enabling the service specification to meet the needs of patients and the clinicians who care for them. The ongoing work to develop the specialist retrieval service, which will cover the full spectrum of acute care and bring together the range of professions involved, will apply the same principles of clinical input and engagement. We noted the importance of an integrated healthcare system and of not allowing fragmentation to appear.

More generally, I was given an account of improved integration between the ambulance service and both secondary and primary care, enabling smoother and quicker patient pathways and allowing the advances by the service on stroke and cardiac care to become part of the established service. We also spoke about the strong partnership with BASICS Scotland and the GPs who support the emergency service, the work undertaken to ensure robust clinical governance and optimal tasking, and the opportunities that may exist for the tasking of out-of-hours clinicians in response to emergency calls. I was pleased to hear that infection control and cleaning standards remain a high priority across the service, regular audit processes are in place to identify areas for improvement and action plans will support the delivery of the recommendations of the Healthcare Environment Inspectorate.

We had an interesting discussion around the balance between measuring process, such as response times, and clinical outcomes. Of course both are important, and I stressed the role of the latter in terms of public perception, but collectively we all want to see progress in how we measure outcomes for patients through their entire journey of care. Utilisation of technology, using the CHI number and data linkage, will be essential in how we achieve this. Other areas of development include enhanced clinical support in the Ambulance Control Centres and the audit and evaluation that will ensure patient safety, and the work to develop a trigger tool to proactively audit clinical care.

Key Action Points.

Ensure a focus, across all parts of the organisation on achieving and embedding the Category A HEAT standard of 75%.One

Ensure focus on implementing the requirements and recommendations from theHealthcare Environment Inspectorate and continue to review, update and maintainrobust arrangements for the prevention and control of Healthcare Associated Infection.

Four

Maintain effective partnership working and engagement with the range of NHScolleagues, other partners, and local communities in support of our remote and rural areas.

Two

Ensure effective management and delivery of the scheduled care improvementprogramme, in collaboration with patients, partners and staff, to realise the fullbenefits and provide the best possible quality care.

Five

Ensure that robust clinical governance remains a priority across the organisation,particularly in relation to future service redesign and the implementation of the Single Common Triage Tool.

Three

Maintain focus on sustaining, and improving, attendance levels across the organisation, in partnership with staff and their representatives.Six

Ensure sKSF review completion and record levels reach 80% by 31 March 2013.Seven

Ensure that partnership structures and mechanisms operate effectively to ensure staff and their representatives are fully engaged in the development and operation of the organisation. This applies to both national and local partnership arrangements.

Eight

1

2

3

4

5

6


It was helpful to be updated on the various improvement programmes and monitoring ongoing to deliver Category A performance of 75%, particularly the utilisation of data and evidence to ensure demand and resources are effectively aligned and the enhanced clinical support in the Ambulance Control Centres. These same improvement programmes will support the service to meet the Category B and Urgent response time targets. I was pleased to hear that performance so far in 2012-13 has continued to improve with the last three months exceeding 75%, and to be advised that you are confident that can be sustained going forward.

We do, of course, recognise that emergency response times are only one measure of performance and must be balanced with the quality of outcomes for patients. Appropriate tasking and triage of resources enables the correct resource to get to the incident and then ensure that the patient reaches the correct location for definitive care. The work you are progressing on data linkage will be key in enabling you to track the journey of care for patients and the cardiac and stroke pathways are two excellent examples of evidence based care, supported by technology, that can deliver improved outcomes for patients. It was interesting to hear that you continue to benchmark yourselves against other ambulance services across the world, and I agree that the integrated healthcare system in Scotland provides us with the best opportunity to deliver genuinely seamless patient care.

We had a detailed discussion about how the healthcare system, including the Scottish Ambulance Service, can support our remote, rural and island communities. While the way in which services are delivered might be different, these communities should still receive high quality and effective care. As we agreed, the key to this is working with communities to develop solutions tailored to them, in partnership with territorial NHS Boards, other public service organisations and the voluntary sector. There are now over 120 Community First Responder Schemes and over 80 BASICS GP supporting the service as well as innovative service models (such as the retained ambulance scheme in Shetland and the emergency responder scheme in West Ardnamurchan) being developed and evaluated for potential adoption in other areas. The air ambulance service will continue to be a vital resource for the whole of Scotland and demand continues to be closely managed, in partnership with the clinical community, to ensure the air fleet can effectively support the patients who require it.

Healthcare is safe for every person, every time I was pleased to hear about your programme of patient safety

walk rounds, during 2011-12 visits were conducted across the country by the Board and Senior Management team. You advised that these had been very well received by staff, particularly as the issues raised were considered swiftly and responses / actions taken conveyed back to staff.

In relation to the clinical targets within your Local Delivery Plan:

• Return of Spontaneous Circulation (ROSC) has increased from 14.5% to 16.9% (against a target range of 12-20%).

• Cat A cardiac arrest response times were up from 77.4% to 78.3% within 8 minutes (against a target of 80%).

• 78.4% of hyper-acute stroke patients were at hospital within 60 minutes (up from 75.5% and against a target of 80%).

In addition to this the Scottish Ambulance Service has implemented the peripheral vascular cannulation care bundle and compliance has improved from 22% to 68% over the last two years. In support of this, you are working closely with territorial boards to ensure single points of contact for feedback on the care provided, to share learning, and to participate in joint clinical governance meetings. I think this is hugely positive and a great example of integration to deliver high quality patient care.

It was helpful to get a comprehensive oversight of the way the Scottish Ambulance Service identifies, investigates and learns from critical incidents and adverse events. Robust governance and structures are in place locally and nationally, ensuring learning is captured and lessons are learned. Related to this, we talked about the value of interrogating variation of clinical practice, in particular to support staff development.

As discussed in the morning meeting with the Clinical Advisory Group, infection control remains a high priority for us and I welcome the high levels of compliance that have been achieved with hand hygiene (92.5% against a target of 90%), and with cleaning specifications (93% against a target of 90%). The Scottish Ambulance Service has received two challenging reports from the Healthcare Environment Inspectorate and I welcome your commitment to addressing the recommendations within those.

Child protection and the protection of vulnerable adults is hugely important across all parts of the healthcare system and I note that you continue to keep your policies under review to support staff where they identify concerns. This includes enhanced education in support of best practice around this challenging issue.

As we discussed, the impact of alcohol continues to be a huge challenge for the ambulance service, particularly at weekends and in city centres. As well as requiring to manage this significant demand, the service also sees increases in the numbers of assaults on its staff. In partnership with police colleagues and other partners procedures are in place to manage people who are drunk and incapable and to reduce the pressure on A&E Departments.

Everyone has a positive experience of healthcare 2011-12 was a year of significant focus and redesign of the

scheduled care service, recognising the important role of this service in supporting people to attend their healthcare appointments. As demonstrated to me earlier in the day the direct booking arrangements, supported by the patient needs assessment to enable the most appropriate transport to be provided, will improve access to care.

Patient Transport Service (PTS) activity continued to fall, down 5.5% to 1,276,945 journeys in 2011-12, and the service is increasingly well placed to deliver high quality care to those who most need it. Excellent performance has been achieved in reducing cancellations; only 0.6% of booked journeys were cancelled by SAS which is down from 1.5% the year before. In relation to the other PTS targets:

• 68.9% of outpatients arrived at their appointment within 30 minutes or less of their appointment time, under the target of 72% and down from the 71.7% achieved in 2010-11.

• 80.1 % of outpatients were collected within 30 minutes of the agreed time against a target of 90%, again down from the 81.2% achieved in 2010-11.

We were able to consider the priorities and challenges that the service, supported by the Clinical Advisory Group, will be focussing on in the coming months, most notably the implementation of the Single Common Triage Tool where it will be critical to ensure safe and effective patient pathways, supported by robust evidence and governance, and informed by patient and public participation. Other areas mentioned included major trauma care, anticipatory care planning and workforce development, training and skills. Finally, we talked about the good work that has been ongoing in relation to the management of medicines, in particular the engagement with territorial boards and the work on antimicrobial prescribing.

Meeting with Partnership Forum I started the meeting by extending my thanks for the contribution

and effort that enabled a solution to the rest breaks issues to be reached. Good progress is being made to transition staff to the reduced working week, and the challenges that have arisen have been worked through as a management I staffside team. I do not underestimate the significance of what is being implemented here, and support the underpinning principles of safeguarding patient safety, staff welfare and service delivery. We talked about the allocation of rest breaks and, while the system can never be perfect, standard operating procedures have been put in place to allow rest breaks to be managed effectively. There is no evidence to suggest staff are not getting rest breaks, and occasions where the breaks are outwith the optimal window are being minimised as far as possible.

We recognise the importance of getting the right skills mix on the range of ambulance resources, and I was pleased to hear of the partnership approach to addressing some of the operational challenges that might be a barrier to this. We spoke about the opportunities that exist to utilise ambulance crews more effectively within the wider NHS and I agree that the more this can be developed the more benefits can be realised for patient care and for the wider healthcare system.

More generally, I was told that partnership working is in good shape but that it is acknowledged that there is more to be done to support local partnership arrangements, in particular to engender the enthusiasm and commitment that will be essential through this period of significant change. I noted the commitment to reviewing partnership structures over the coming months to ensure they remain fit for purpose.

I share the concerns of staff around the potential impact of pension changes, as we discussed we want to take a different approach in Scotland and engage in a partnership process to agree the details of a new scheme. The ambulance service input and perspective will be important in taking forward these discussions. Finally, we touched on the significant change management process that has been required to underpin the scheduled care improvement programme. I am sure there have been many challenges given the impact on staff and it will be important to continue to manage these sensitively.

Please pass on my thanks to those who gave up their time to attend the meeting.

Meeting with Patient Representatives

I had an interesting and informative meeting with patient and public representatives, and I would ask that you pass on my best wishes and thanks to those involved. I was given a strong

sense of the way that patient experience is captured and learned from, this was illustrated really powerfully by some of the personal stories I heard. Throughout those stories there was a strong sense of how much patients and carers value the professionalism, calmness and patience of ambulance crews and the way they instil trust and confidence.

I was also pleased to be told that the service is inclusive, and committed to listening to patients and working with them to improve care. It was good to get the patient perspective of the extensive consultation and engagement exercise undertaken to support the air ambulance reprocurement, in particular the efforts to go out and speak to communities about what matters to them. Even though this was a complex project, the ambulance service were clear that patient care was at its heart. This type of approach has also been applied to the work to improve the patient transport service, allowing decisions to be informed by patient experience and input.

We touched on a range of other topics, including the challenges of delivering ambulance care in some of our remote, rural and island communities, the valuable contribution of volunteer car drivers and community first responders, and the efforts of the service to treat patients at home where that is most appropriate for them.

Annual Review Meeting

Following the report back from my morning programme you provided a summary of the year under review, touching on various aspects of performance, achievement and challenge that would be picked up as we moved through the agenda. You continue to make progress in delivery of your strategic framework ‘working together for better patient care’ which seeks to drive continuous improvement across the ambulance service. You also put on record your thanks to your Board, to the Scottish Government and, most importantly, to the staff of the Scottish Ambulance Service for their hard work over the year.

Everyone has the best start in life and is able to live longer healthier lives

Overall accident and emergency incidents increased by 4% in 2011-12, with the service responding to 474,324 incidents over the year. In relation to HEAT I LDP standards and targets the ambulance service has returned the following performance:

• Against a HEAT standard of 75% in 2011-12 the service reached 73% of Category A calls within 8 minutes. This is up from the 72% achieved in the previous year. This continuous improvement is to be welcomed. The service also achieved an average Cat A response time of 6.7 minutes (slightly faster than the 6.9 minutes achieved in 2010-11). The number of Category A incidents reduced by 4.4% from the previous year.

• Category B performance (against a target of 95%) for 2011-12 was 92.4%, down from 92.6% in 2010-11 and 93.7% in 2009-10. Emergency performance across the Island Boards improved to 54.5% of all incidents responded to within 8 minutes (against a target of 55% and up from the 54% achieved in the previous year). The final unscheduled response time target for the service relates to urgent requests from GPs and other clinicians, the service reached 86.3% of patients within the 1 hour timeframe agreed against a target of 93%. This is down from the 91.2% achieved in the previous year.

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Q&A Session The question and answer session gave us the opportunity

to touch on a few interesting issues such as mobile phone coverage and the potential impact on patients of reducing local bus services. Most substantively, we discussed the challenges around evacuating patients from some of our small islands, in particular those affected by the ongoing ferries review by Shetland Islands Council. While the service are actively looking at how the air ambulance, coastguard and Super Puma Jigsaw can ensure effective air evacuation if required on a 24/7 basis, it was acknowledged that land and ferry evacuation remains the preferred option in many cases. As such it is crucial for there to be effective input and engagement between Shetland Islands Council and partners including the health service, other emergency services and the utility companies to inform any future decisions.

Conclusion 2011-12 has been a year of continuous progress and

improvement for the Scottish Ambulance Service and I know you will continue to build on this in the coming months. At a time of significant development and change the service continues to deliver a high quality and valued service to people across the country. I would extend my thanks and best wishes to you and your board, to the clinical advisers and patient representatives who work with you, and to all of the staff of the Scottish Ambulance Service.

The attached annex sets out the main action points from the review.

In delivering the scheduled care improvement programme it will be important to ensure the full benefits are realised for the healthcare system, the ambulance service, for staff, and most importantly for patients. The ongoing evaluation and performance management of the service will support that, as well monitoring other factors such as hospital ‘Did Not Attend’ rates, patient appeals and complaints. While some further reduction in activity might be anticipated, it is not possible to quantify it at this stage and, as I have said in the past, no patient should be left unable to attend their appointment. I fully recognise the role and contribution that must be made by others, including regional transport partnerships and territorial health boards, to support transport for those patients who do not have a need for ambulance service care, and I think as a national service you are ideally placed to identify variations and disseminate examples of good practice.

It is critical for the service to respond appropriately and sensitively when caring for patients at the end of their life and it was helpful to learn more about the specific work you are undertaking, both to ensure patients are not unnecessarily taken to hospital but also to take patients home to die if that is their wish.

I was given a useful update on the development of the Single Common Triage Tool, a programme being taken forward jointly with NHS 24 and in partnership with other stakeholders. The three strands of clinical content development, technical build, and implementation planning are progressing well and you feel the organisation is where it needs to be at this point.

We concluded this section by reflecting on the importance of gathering patient experience and perspectives and learning from those across the organisation. The service has made some progress in the way it manages complaints, improving the timeliness and quality of responses and developing a structured approach to applying lessons learned, and will continue to make this a priority.

Staff feel supported and engaged As discussed in some detail at the earlier meeting with the

partnership forum, my thanks go to those involved in reaching the agreed solution. Against the original timescale of 18 months for implementation the service is on track, with over 1000 staff transitioned to the shorter working week and active recruitment ongoing to increase staffing numbers. Implementation is being achieved in a managed way, supported by robust evidence around service demand and resource requirements. As you know, I retain a close interest in the implementation of the solution and I will continue to monitor this carefully.

As with all parts of the NHS, the Scottish Ambulance Service continues to change and develop and it is critical to ensure that staff are appropriately trained and skilled to deliver the best possible patient care. This will require a real focus on evidence based clinical practice, and on implementing your career framework across the service. Ensuring the right skills mix across the service, delivered flexibly to meet the changing needs of patients, can only be achieved in partnership with staff and their representatives and as a board you will want to be assured that this is the case.

Finally on this item we talked about the ongoing commitment of the service to ensure that single crewing of traditional ambulances only occurs in exceptional circumstances, and about the increased levels of sickness absence, particularly long-term absence. It is clear that efforts are ongoing to tackle this, in

particular to ensure effective and supportive occupational health services and counselling services, as well as action plans in each division to deliver reduced absence levels.

People are able to live well at home or in the community The discussion under this item was around how the Scottish

Ambulance Service will support the realisation of our 20:20 vision for healthcare, enabling more people to be supported at home or in a homely setting. You are doing this in a range of ways, including through your target to treat more people at scene, thus avoiding unnecessary journeys to hospital where that is appropriate. Against a target of 12% you achieved 12.2% of emergency incidents treated at scene, this translates to 57,977 patients. This target is, of course, only a measure of success if the decision to leave the patient at home is the right one and that is why robust clinical governance and evaluation, extending the range of professional to professional support, and ensuring effective information sharing, are all required to support this model of care.

Best use is made of resources I was pleased to record that the Scottish Ambulance Service

met its financial and efficiency savings targets for 2011-12 and that the savings realised had been reinvested in patient care. I recognise that this is achieved through ongoing hard work and commitment, particularly within an increasingly challenging economic environment. I was pleased to hear that you are on track to achieve your 2012-13 targets and have defined plans in place to deliver the full £7.318m efficiency savings, on a recurring basis, that will be required to achieve this.

The award of the £120 million contract for the next generation of the air ambulance service was the result of a complex and extensive consultation and procurement project. As discussed in some of the morning meetings, the scale of input and engagement with NHS Boards, local communities, patients and other partners has been impressive and the contract has secured some real improvements in the way the air ambulance service will be delivered.

As in previous years, the service has adopted a systematic approach to identifying efficiency savings in partnership with staff and using learn and improve programmes. As noted, often staff are best placed to identify waste and to recognise opportunities for efficiency. It is evident that work continues on shared services, particularly in the collocation of your Headquarters with NHS National Services Scotland and the collaborative work on procurement and ICT services, and I would encourage you to take every opportunity to demonstrate best value of resources through sharing services in this way.

Nicola Sturgeon MSPDeputy First Minister & Cabinet Secretary for Health and Wellbeing

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Equal Opportunities PolicyThe Scottish Ambulance Service firmly believes that all employees should be treated equally and fairly. The Board opposes all forms of discrimination on grounds of age, disability, gender reassignment, marriage & civil partnership, pregnancy & maternity, sex, sexual orientation, race and religion & belief. Information about the Service, the full financial accounts for 2008/09 and details of the organisation and operation of the Service can be obtained from:

Secretary to the Scottish Ambulance Board,National Headquarters, Gyle Square,1 South Gyle Crescent, Edinburgh EH12 9EBT: 0131 314 000 E: [email protected] www.scottishambulance.com

A full Annual Report will also be available on our website. A summary is available in other languages and formats on request. Please telephone the Interpretation and Translation Service on 0131 242 8181 and quote reference number 08571.

Gheibhear an athaisg bhliadhneil ann an cànain neo dreach eile ma tha’ar ga iarraidh. Cuiribh fòn chun an t-seirbheis eadar-theangachaidh air 0131 242 8181 agus thoiribh seachad an àireamh iuil seo 08571.

Un résumé est disponible en d’autres langues et autres formats sur demande. Veuillez téléphoner au Service d’Interprétation et de Traduction au 0131 242 8181 et indiquez le numéro de référence 08751.

Краткое содержание на других языках и в других форматах предоставляется по просьбе. Пожалуйста, звоните в Службу устных и письменных переводов (ITS) по тел. 0131 242 8181 и указывайте исходящий номер: 08751.

Paprašius santrauką galima gauti kitomis kalbomis ir formatais. Skambinkite vertimo tarnybai (Interpretation and Translation Service) telefonu 0131 242 8181, nurodykite kodą 08751.

Streszczenie dostępne jest na życzenie w innych językach lub formatach. Proszę skontaktować się telefonicznie z Biurem Tłumaczeń Ustnych i Pisemnych (ang. Interpretation and Translation Service) pod numerem telefonu: 0131 242 8181 i podać numer referencyjny: 08751.

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