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ANNUAL REPORT ACCOUNTS
SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST ANNUAL REPORT & ACCOUNTS 2015/16
Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006.
© South Central Ambulance Service NHS Foundation Trust
CONTENTS 02
WELCOME FROM CHIEF EXECUTIVE AND CHAIRMAN
08
PERFORMANCE REPORT
10
OVERVIEW
28
PERFORMANCE ANALYSIS
36
ACCOUNTABILITY REPORT
38
STAFF REPORT
56
GOVERNORS
68
MEMBERSHIP
90
DIRECTORS’ REPORT
102
REMUNERATION REPORT
176
QUALITY REPORT
268
GLOSSARY
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Annual Report and Accounts 2015/16
Will Hancock Chief Executive
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WELCOME This time 12 months ago, we highlighted the unprecedented level of demand facing the NHS as a whole. Little did we know then, that such levels hadn’t peaked; in fact over the last year they have continued to rise. In the case of our Trust, not only have we taken more emergency calls and attended more emergency incidents than ever before, the proportion of life-threatening incidents we attend continues to grow. As a result we are not only facing a greater volume of calls to respond to, but the percentage of those incidents that involve patients in life-threatening emergencies is increasing too. We have unfortunately not met the 75% target time of eight minutes for Red 1 and Red 2 calls this year, but we are very close to it. Indeed, our average response time to getting to all such patients is under seven minutes. This means that when we do miss the target time, it is usually by a matter of seconds.
It is a great source of pride that our staff have continued to deliver high standards of patient care again this year in very difficult circumstances. We are very grateful to every single member of staff and volunteer without whose support we would not have been able to provide such safe, effective and responsive services over the past 12 months.
Whilst we have been working hard over the last year to get our response times back to achieving the Government standard which all ambulance trusts are measured against, we remain focused on delivering a fast, safe and clinically appropriate service to those people who need us the most.
Since 2012 the volume of Red calls we receive has increased by 60% and that demand shows no signs of slowing down. This year alone we have seen Red 1 calls, our most serious lifethreatening calls, increase by over 6% and Red 2 calls by 12.5% compared to last year.
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Annual Report and Accounts 2015/16
On average, we take 1,866 calls every day from members of the public and on some days that can be as high as 3,000 calls. This variability brings additional challenges in terms of focusing the resources we have where they are needed most; i.e. to those patients with life-threatening conditions - the Red 1 or Red 2 calls. At any one time across the SCAS region we have between 120 and 140 rapid response vehicles and ambulances operating to serve a population of over 4 million. The challenge we have is to ensure that we have those vehicles and staff available whenever and wherever a 999 call comes in – and that is a challenge we get right in the vast majority of emergencies.
The Trust has faced some significant challenges in meeting its financial targets for the year and ended the year with a ÂŁ3.7m deficit from continuing operations. This has arisen from the additional investment required in front line response to meet the challenge of achieving operational performance. The Trust put itself into internal turnaround in 2015/16 and has a robust plan to improve financial performance in 2016/17 with additional focus on financial efficiency. Whilst our core purpose always has been to save lives, we have adapted to the changing healthcare landscape by expanding some of our existing services, and developing new ones, to meet the changing needs of the commissioners and communities we serve. Thanks to the efforts of people across our commercial division, we have continued to win new tenders for non-emergency patient transport services and over the last 12 months have seamlessly launched new services. The year began on 1 April 2015 with the launch of improvements to non-emergency patient transport services in Milton Keynes, and concluded with the launch of a new, simplified non-emergency patient transport service across the Thames Valley on 1 April 2016.
We know this because behind the headlines of the performance against the 75% target time we are saving more lives today, than ever before. SCAS has the highest percentage amongst any ambulance trust in England of cardiac arrest patients who survive to leaving hospital. In South Central, just under 14% of patients suffering a cardiac arrest have survived to hospital discharge against a national average of under 9%. Our performance in getting patients suffering a heart attack or suspected stroke to specialist units that can provide the urgent care they need is also above the national average for all ambulance trusts.
This year we have also launched South Central Fleet Services Ltd, a standalone business that has allowed us to bring back more of our vehicles to be maintained by our own engineers and technicians. As well as reducing our annual expenditure on vehicle maintenance, this initiative has also enabled us to keep more of our vehicles on the road for longer.
Independent research conducted last year by the Trauma Audit and Research Network, found that patients who suffer a major trauma now have a 63% better chance of surviving than they did in 2008/09. That significant increase has been achieved thanks to the skills, speed and expertise of our staff that work in our clinical co-ordination centres, on our vehicles and on the local air ambulances, as well as the staff working in emergency departments at local hospitals.
We are also trialling and implementing new technologies across SCAS that will make us more efficient and deliver a better clinical experience for patients.
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Trevor Jones Chairman
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Annual Report and Accounts 2015/16
The Electronic Patient Record (ePR) system has been rolled out across our local hospital partners with the aim of improving the speed and efficiency with which our staff can handover to A&E staff in hospital. Over the next 12-18 months, further technical innovations both on our ambulances and response vehicles, as well as in our clinical co-ordination centres, are going to transform the level of care we can provide to patients at the scene of incidents.
In March 2016 the enhanced night flying service provided by the Thames Valley and the Hampshire and Isle of Wight Air Ambulances was launched. People in our region now benefit from an additional seven hours of night time flying every day, all year long, with the helicopters able to attend any emergency between 06.00 and 02.00. The quality of SCAS’ paramedics and the rest of the air ambulance team was perhaps best epitomised earlier in the year when Paramedic, Gerry Lea, won the Air Ambulance Paramedic of the Year Award at the national Air Ambulance Awards of Excellence 2015.
Other initiatives and achievements that we are particularly proud of over the last few months include the CQC’s focused inspection of our NHS 111 service that found it was both safe and effective. For a service that takes over 1.2 million calls a year, and this year had 100 complaints (a record low), it is good to know that the CQC inspectors came to the same conclusion that staff who work on the NHS 111 service, and the vast majority of patients who use it, already knew.
Despite the challenges and some of the negative press you may have read over the past 12 months, we would like to reassure everyone living and working within the South Central region that when you need us, we will be there. That confidence comes from knowing we proudly lead an organisation with dedicated, committed and hard-working staff and volunteers. We will continue to focus our efforts to make the best use of the financial and physical resources we have and we are working closely with our partners across the NHS to minimise the impact of pressure elsewhere in the system that can impact on the availability of our services.
Another strategy that has been successfully deployed this year to help us cope with the continuing increase in demand is to make our communities more resilient. We have increased the number of Community First Responders and Co-Responders by 24% in the last 12 months. Together, these valuable members of the SCAS team attended over 54,500 incidents. We have also installed a further 300 additional public access defibrillators (PADs) across the South Central Region in 2015/16, and we are committed to installing more. In the UK the survival rate for patients surviving a witnessed cardiac arrest outside of the hospital environment is only 1 in 10. Those odds must improve and we are determined to ensure that they will.
Will Hancock Chief Executive
Trevor Jones Chairman
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VICKY ROCK Clinical Support Desk Practitioner Southern House, Otterbourne Having worked as a paramedic for 10 years, Vicky took on a new role and challenge as a Clinical Support Desk Practitioner in September 2015. As a qualified clinician, Vicky works in our Clinical Coordination Centre and speaks to callers who have dialled 999. She carries out sometimes complex clinical triage over the phone, provides assessments of patients, or refers them to care pathways other than an ambulance if more appropriate for their needs. In addition, she can also be contacted by paramedics and emergency care assistants who are with patients at incidents if they want a second opinion or want to check any patient information, such as details of a care plan. “When I was working on the road, I dealt with one patient and then moved on to the next. I might only see a handful of patients every shift. In my new role, I often speak with and help 20 or 30 patients every shift, as well as supporting the SCAS crews on the frontline. I like the fact I feel I now have a wider impact on the Trust and our patients.�
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Annual Report and Accounts 2015/16
PERFORMANCE REPORT
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Annual Report and Accounts 2015/16
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Annual Report and Accounts 2015/16
ABOUT US Over the last six years, South Central Ambulance Service NHS Foundation Trust (SCAS) has transformed itself from being a traditional ambulance provider to a dynamic and innovative organisation that delivers a holistic healthcare service to the population of over 4 million people.
We will achieve our vision by: èè helping people access appropriate care by assessing individual needs and directing people to the most relevant service èè dispatching emergency clinicians to treat people with life-threatening injuries or conditions and providing specialist care whilst transporting those people to the most appropriate healthcare facility èè enabling people to stay safe and well in their own communities by providing mobile healthcare closer to home èè supporting whole system healthcare by working with partner organisations to assess needs and plan care for local communities and individual needs.
Our role has gone far beyond simply transporting people to the nearest hospital. Today, we provide a single point of access for people, predominantly, in Berkshire, Buckinghamshire, Hampshire and Oxfordshire, and in the last 12 months including Luton and Bedfordshire for NHS 111 services, who are ill, injured or concerned about their health. As well as clinical assessment, signposting and advice services, SCAS also works closely with clinical networks and trauma teams to provide the best possible care for those with critical or life-threatening conditions.
We deliver our services from: èè our headquarters in Bicester, Oxfordshire, and a regional office in Otterbourne, Hampshire. Each of these sites also houses a Clinical Co-ordination Centre where 999 and NHS 111 calls are received, clinical advice provided and emergency vehicles dispatched if needed. The Non-Emergency Patient Transport Service is also coordinated from control rooms within these buildings. èè 78 sites including resource centres, standby points, PTS bases and air ambulances bases èè 287 frontline vehicles èè 2 air ambulances
SCAS became an NHS Foundation Trust on 1 March 2012 and now has a foundation trust membership of more than 13,400 people. Despite a number of densely populated urban cities such as Southampton, Portsmouth, Reading, Oxford and Milton Keynes, our operational area is classified as predominantly rural. High levels of demand for our services continues to put significant pressure on us and requires us to continually review and improve the services we offer.
OUR VISION
We rely on the support of: èè 3,128 members of staff èè 1,271 Community First Responders (CFRs) and Co-Responders èè 107 volunteer drivers èè 26 governors èè 13,407 Foundation Trust public members.
Towards excellence saving lives and enabling you to get the care you need. //12
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Annual Report and Accounts 2015/16
WHAT WE DO As well as responding to emergency 999 and urgent GP calls that you would expect from a traditional ambulance service, the expansion of our nonemergency NHS 111 service means that SCAS now provides a much more integrated clinical assessment, signposting and advice service too.
This comes at a time of a national shortage of paramedics. As well as supporting staff from within the Trust to train to become qualified paramedics, we have also been working with Oxford Brookes and other local universities to ensure that we are building the required capacity within the higher education sector to increase the volume of graduate paramedics entering the job market in future years. In addition, our recruitment teams have been working relentlessly to attract qualified paramedics from across the UK and internationally to SCAS.
Our two clinical co-ordination centres based in Bicester, Oxfordshire, and Otterbourne, Hampshire, have allowed us to co-locate our NHS 111 and emergency operations centres where our ethos is two numbers, one service. We can now provide simplified access to healthcare across the four counties we serve, whether someone has telephoned 999 in a crisis situation, contacted NHS 111 with an urgent query, requires advice and support or needs to access a GP or out-of-hours service.
999 Our clinical coordination centres are based in Bicester and Otterbourne and receive on average over 1,800 emergency calls every day, which are handled by over 500 call centre staff who work 24/7.
During the past 12 months our focus has been on developing from an emergency point of contact to become more of a single point of contact for patients needing access into local healthcare services. As we build this capability, the Trust will also become a provider of more mobile healthcare services, providing advice and support over the phone and inperson that allows more people to be supported in their own homes and local communities.
To meet this demand we have more than 1,500 paramedics, technicians and emergency care assistants on the road delivering excellent front line care. We have a fleet of 279 specially-equipped emergency vehicles from over 30 sites across the region. Our specialist paramedics and nurses have additional skills such as being able to treat minor injuries, supply medication for a range of minor illnesses and chronic conditions, and provide advanced care for long term conditions with a focus on preventing unnecessary attendances at hospital. We are rapidly expanding this service by training more frontline staff to be able to be deployed with these specialist skills.
The record number of 999 calls received in 2014/15 has increased slightly again over the last 12 months creating further challenges to meet demand.
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Annual Report and Accounts 2015/16
During the last 12 months we have developed a new role for paramedics who wish to develop their skills further. The enhanced paramedic role is a step between a paramedic and a clinical mentor, and has been developed to provide paramedics with the opportunity to support student paramedics, new staff and existing staff by developing their skills in a supported environment. This has been a positive development opportunity for paramedics and attracted internal and external applications as well as improving our retention of paramedics.
Such resources include:
HAZARDOUS AREA RESPONSE TEAM (HART) HART is a team of paramedics specifically trained and equipped to deliver first class care to patients who are injured or ill in hazardous environments. Previously the ambulance service was unable to work in these areas as it would have been unsafe for ambulance staff to do so. By ensuring ongoing specialist training with partner agencies such as Police, Fire Service and Maritime & Coastguard Agency, and by having the correct specialist equipment and procedures, we are able to provide the public with greater reassurance that we can respond to challenging, complex incidents where they need help.
As an ambulance service we regularly work in close partnership with other blue light and emergency services in response to a wide range of incidents. As well as working together routinely, we also train together regularly in order that we can be prepared for emergency situations. An example of such training this year was the participation of SCAS paramedics from the Trust’s Hazardous Area Response Team (HART) in Exercise Unified Response; the biggest training exercise in UK history that took place over four days in London at the end of February and into March 2016. Such cooperation and interoperability ensures the public receives a joined up, coordinated and comprehensive service in crisis situations. The implementation of the Joint Emergency Services Interoperability Programme (JESIP) provides us a framework to work closely with other emergency services and responders.
Incidents where HART has been deployed to in the last 12 months include major incidents, such as the tragic building collapse in Didcot in February 2016, chemical incidents, flooding, inland river incidents, patients injured while at height and complex road traffic accidents. HART also supports Trust operational staff daily by sharing the team’s knowledge, experience and unique use of equipment in other incidents that thankfully are not deemed hazardous in nature but can still be challenging for the Trust. By providing excellent clinical care in these hazardous areas, we can ensure that our patients receive the best appropriate clinical treatment and management at the earliest opportunity.
In addition, we are able to rely on a number of in-house, partner and voluntary resources in dealing with emergencies which not only helps us save time and lives, but also helps free our core resources to respond to emergencies elsewhere.
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TRAUMA RESPONSE
The air ambulances are now available for far longer than they were just a year ago; they are now available for an additional seven hours of coverage every night and operate from 06.00 to 02.00.
Patients with major trauma are no longer taken to their nearest hospital for treatment: patients are transported to Major Trauma Centres where expert trauma teams treat them for their injuries.
When bad weather prevents the helicopters from flying, the Helicopter Emergency Medical Service (HEMS) teams for the Thames Valley and Hampshire respond using a car. We also deploy a HEMS Paramedic and Doctor in the ECRU at peak demand periods across the Thames Valley.
Transporting major trauma cases further across the Trust places additional pressure on our crews, but they have been extensively trained to deliver life-saving interventions en route to hospital. SCAS has a team of highly experienced doctors who respond to emergencies to support crews. We also have an Enhanced Care Response Unit (ECRU) covering the Thames Valley, and two air ambulances to take the care, once only available in hospital, to the patient’s side. The air ambulances are staffed by experienced doctors and paramedics who have additional skills to deal with trauma. There is evidence that trauma networks are having a dramatic impact on death rates. Following a national audit by the Trauma Audit and Research Network released in July 2015, patients suffering major injuries are now 63% more likely to survive than they were in 2008.
AIR AMBULANCES Where speed is vital because of the severity or nature of a patient’s injuries, or if the emergency cannot be reached easily by road, we rely on our air ambulance partners, Thames Valley and Chiltern Air Ambulance (TVCAA), and Hampshire and Isle of Wight Air Ambulance (HIOWAA), to deliver paramedics and doctors to the patient as quickly as possible. The team takes dedicated physician care to the patient to ensure the most critically injured patients receive the care and treatment they need.
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Annual Report and Accounts 2015/16
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NHS 111
We have seen improvements to the way new staff are recruited, trained and coached in the live environment. In October 2015, SCAS’ Emergency Operational Control / 111 Education and Audit Team introduced Quality Assurance Coaches to support new staff, ensure we maintain the high standards set for patient safety and reduce clinical risk in the live environment. The audit team continues to meet monthly target and within SCAS we see high audit compliance in comparison to the national figures.
Over the last year, SCAS’ NHS 111 service has continued to deliver urgent care telephone assessment across the six contracts covering Oxfordshire, Berkshire, Buckinghamshire, Bedfordshire, Luton and Hampshire. The NHS 111 service is provided using NHS Pathways trained call handlers and clinicians (nurses/paramedics). SCAS NHS 111 also provides health information and responds to medication enquiries via specially trained health information advisors, as well as providing a dental advisory service to callers in Hampshire.
In November 2015, the NHS 111 service received a focussed inspection by the Care Quality Commission (CQC) following the concerns raised in a Daily Telegraph article in July 2015. The subsequent report published by the CQC following the inspection recognised SCAS as being a very safe and effective provider of NHS 111 services, confirming such services were both responsive and well led. The CQC did not award SCAS a rating on this occasion as the inspection was focussed on particular aspects, rather than a general review. The service will be rated in 2016 when the CQC returns to inspect the Trust.
This year, our NHS 111 service answered over 1.25 million calls with SCAS now the largest NHS supplier of NHS 111 services. Modelling for an increasing demand has proved a challenge this year, as has retaining and recruiting staff to meet the varying demand. We have been challenged towards the end of this year to meet key performance indicators (KPIs): working to ensure that 95% of calls are answered within 60 seconds, and that call abandonment rate is below the 5% target. Our transfer to 999 remains consistently lower than the national average for all NHS 111 services.
Regular surveys undertaken over the past year confirm that patients are generally satisfied with the NHS 111 service that SCAS provides.
This year we have added the Milton Keynes call centre onto the virtual SCAS platform, enabling call handlers to answer calls from all contracts across three call centres whilst building resilience. Work continues to align operational processes across the call centres and contracts. During the last year, we have also operationalised the home working clinician project, enabling experienced clinicians to support the service from home as if working in the call centre.
We continue to work with partners to undertake a number of innovative developments and pilot projects to further develop and enhance our high quality non-emergency service and improve the patient experience.
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Annual Report and Accounts 2015/16
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COMMERCIAL SERVICES NON-EMERGENCY PATIENT TRANSPORT SERVICE (NEPTS)
An additional range of services, including Non-Emergency Patient Transport Services (NEPTS), Logistics & Courier Services and First Aid and Clinical Training, is provided by the Trust and managed within the Commercial Services Division. These markets are open to any company or organisation, both public and private sector, and are highly competitive.
The NEPTS service is for NHS nonemergency patients and their escorts who meet the eligibility criteria as defined by the Clinical Commissioning Group’s application of the Department of Health’s Eligibility Criteria for Patient Transport Services. Over 2015/16 SCAS has tendered and been awarded NEPTS contracts for both Thames Valley and Oxford Health and, in addition, successfully implemented the second phase of the established SHIP NEPTS contract. The NEPTS team has worked with commissioners to develop the services to meet the 24/7 service requirements.
SCAS’ Commercial Services Division has made huge leaps forward with its quality agenda during the 2015/16 financial year and 2016/17 brings with it additional plans and opportunities to further improve patient safety, patient experience and our clinical effectiveness. SCAS successfully tendered for the Thames Valley Patient Transport and Oxford Health Patient Transport and Logistics Contracts for which the ‘Go Live’ dates were 1 April 2016.
The NEPTS service is provided by over 400 team members comprising managers, ambulance care assistants and contact centre functions which are split between Bicester and Otterbourne. During the last 12 months we undertook over 500,000 NEPTS journeys which will increase in 2016/17 by around another 200,000; the increase due to the new contracts going live 1 April 2016. We are very proud of our pool of dedicated volunteer car drivers who undertake approx 15% of our walking patient activity and our volunteers build fantastic relationships with our regular patients.
These new contracts went through a highly competitive procurement process and are underpinned by the NHS Standard Contracts which includes clear KPIs and detailed information schedules, containing quality, safeguarding and Patient Experience (PE) elements. The contracts are similar in structure and contents to the ones already in use for the SHIP (Southampton, Hampshire, Isle of Wight and Portsmouth) and Milton Keynes NEPTS areas, the reporting for which has been constantly improved since their launches in September 2014 and March 2015 respectively. In addition to these contracts, the second phase of the SHIP contract went live on 1 March 2016 to include North Hampshire Hospital; again this was a successful and well received launch.
Satisfaction amongst patients with the service provided by SCAS remains high and we continually strive to further improve quality reporting formats, quality schedules and processes which facilitate data collection and analysis around patient experience.
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Annual Report and Accounts 2015/16
Multiple action plans have guided the quality improvements within the Commercial Services Division during 2015/16, including those arising from the Trust-wide CQC action plan, the Internal NEPTS Review, quarterly inward delays audits, a medicines audit, an aborts review overseen by the PERG, and a DoC case action plan. Works are ongoing and most outstanding actions have now been collated in to the NEPTS CQC Readiness action plan which is in progress at present.
These numbers are enormously encouraging and directly reflect the impact of the face to face training that all NEPTS staff have benefitted from since April 2015. However we are not complacent and despite these improvements further work is required to bring NEPTS reporting levels in line with those of other SCAS services, and further staff communications around these processes will be undertaken in 2016/17.
HEALTHCARE LOGISTICS & COURIER SERVICES
Some elements of these plans, which we are extremely proud of, are:
South Central Ambulance Service NHS Foundation Trust (SCAS) provides a Healthcare Logistics delivery and collection service for internal post, specimens and parcels across Oxfordshire, Buckinghamshire and Wiltshire.
èè The delivery of a bespoke NEPTS two-day face to face training course for all staff incorporating safeguarding, the Mental Capacity Act and incident reporting procedures, as well as other statutory and mandatory training aspects èè Design and implementation of a fully accredited course which gives new ACAs a recognised qualification through Future Quals èè Engagement in a Trust-wide campaign approach which educates staff in areas of strategic importance such as infection prevention, month on month èè All staff have been offered a place on a modern apprenticeship program to contribute to their continued professional development
During the past year, SCAS has successfully tendered for and been awarded the Oxford Health NHS Foundation Trust Logistics contract but also an element of the business was transferred over to another provider resulting in TUPE of some of the Logistics team members; this was a sad time for the service to lose such committed team members. We have worked hard over 2015/16 to transform the service and our approach ensuring we optimise vehicles and routes, analysing/managing activity levels and working towards implementing a track and trace system for greater efficiency.
We have created a highlight report format to share patient survey results with staff and introduced new guidance on leaving patients unattended and oxygen administration has been released so risk is minimised for all.
Our philosophy for all of our logistics operations remains the same: to provide the right vehicle, at the right time, in the right location. This, combined with our investment in innovative IT solutions for booking, tracking and reporting, means that all our service users can be confident that SCAS continues to provide the most efficient, capable logistics service in the marketplace today.
DATIX reporting has increased within Commercial Services by 240% from calendar years 2014 to 2015, and safeguarding reporting has increased in the order of 600%.
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SCAS LOGISTICS IN NUMBERS:
11,035,802 Goods transported
316,237 Specimens transported
53,129
Passengers transported
6 7 9 , 3 1,01 elled
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Annual Report and Accounts 2015/16
FIRST AID AND CLINICAL TRAINING (FACT)
Over the last 12 months we have further developed our course portfolio to include:
The First Aid and Clinical Training (FACT) department is a dedicated division of SCAS with over 15 years’ experience of training delivery. We have a dedicated, experienced and professional training team who have the skills, clinical knowledge and professional status that ensure all trainees get the most out of their training. In 2015/16 we have continued to raise the awareness of SCAS as a competitive and high quality training provider through communicating and marketing this provision effectively to target customer groups.
èè Level 2 Emergency First Aid and Level 3 First Aid at Work, Basic Life Support èè Moving and Handling People, Moving and Handling Inanimate Objects èè Automated External Defibrillation; Initial & Refresher, Medical Gases èè First Person on Scene, First Bike on Scene èè Paediatric First Aid, Sports First Aid Whilst introducing these courses we have ensured all legislative requirements are met and introduced on our FACT website a First Aid Requirements Calculator which is designed to accurately calculate the cover required for first aid in the workplace.
Our rebranding as FACT has made an impact as now we are being seen as a modern and forward thinking training provider who has trained 5,700 delegates in 2015/16. We offer a diverse portfolio of training through the Future Quals framework and we engage directly with community projects such as First Aid for Schools. Over the past year FACT retained membership of the NHS Ambulance Service First Aid Training consortium (NASFAT). NASFAT is a partnership of NHS Ambulance Services that are working together to promote a full range of high quality first aid training services that we can provide both locally and nationally. FACT has in addition supported other NHS Trusts in the provision of Basic Life Support including use of Automated External Defibrillators (AED).
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RISKS The Trust has developed a risk management culture to empower all staff to make sound judgements. This forms part of the Trust’s Risk Management Strategy. We are committed to continuous improvement of those processes.
Each risk is entered in a risk register which is reviewed on a periodic basis by the Trust Executives at the Risk Assurance Compliance Committee (RACC) and also by the Audit Committee. These form the basis of the Trust Board’s Assurance Framework which is reviewed periodically by the Board as well as the Audit Committee.
, THE TRUST S MAIN POTENTIAL STRATEGIC RISKS HAVE BEEN IDENTIFIED AS FOLLOWS: èè Inability to recruit and retain staff in high enough number to deliver operational performance èè Operational response time targets are not consistently met èè Failure to achieve financial targets and CIPs èè Poor IT/telephony resilience èè Hospital handover delays resulting in delays in reaching patients There are several risks of an external nature that may impact on the Trust, including an ageing population and the challenge of meeting performance targets in a predominantly rural area.
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Annual Report and Accounts 2015/16
SERVICE DEVELOPMENTS èè Access available to Mobile Directory [of Services] for all clinicians to assist with care pathway decisions èè Capability to transmit information and photos directly from scene to hospitals, particularly valuable for time critical patients and those in life-threatening conditions èè Development of live video link capability, with work underway to assess its use in a clinical setting and strong interest from key partners èè Investment to recruit and develop Specialist Paramedics/Nurses. These specialists are helping to contain the numbers conveyed to Emergency Departments (ED), despite growing demand and rising acuity èè We, along with other ambulance services, have adapted our operational processes, resourcing levels and deployment model to respond to some changes in the National Ambulance Quality Indicators. There has been a negative impact on the red call performance exacerbated by the pressure from the increasing number of life-threatening (Red) calls èè Subsidiary Fleet Company set up and we hope to realise the associated financial advantages soon èè Mobilised the second phase of the Hampshire NEPTS contract èè Piloting of dynamic vehicle scheduling
The Trust continues to evolve to meet the new health and social care challenges and we pride ourselves on being adaptive to the changing arena. Our key position in the care setting enables us to develop our signposting and advice services for urgent, emergency and social care. We are developing our technical capabilities to increase our access to a wider range of expertise, working towards greater integrated care between providers. There is an ambitious transformation programme and also a development programme for our leadership team to make further improvements in the organisational culture and behaviours. Our operational management structure is under review to meet changing requirements and continue its effectiveness.
KEY SUCCESSES èè Improvements in the virtual telephony platform bringing greater resilience and realising economies of scale across our Clinical Coordination Centres (CCC) èè Subset of staff working across both 999 and NHS 111 services to help adjust staff resources to meet fluctuating demand èè Summary Care Records visible to staff in the CCCs and to operational clinicians. National work will spread the use of enhanced Summary Care Records, further improving the information available for clinicians’ decision making about care pathways èè Up-to-date care plan information available to CCCs
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FUTURE:
èè Develop partnerships with the voluntary third sector and local authority organisations in order to offer a more cost-effective service
To enable people to identify and access the care that they need first time, we will:
To ensure people travel safely between home and care settings, we will:
èè Further improve links with mental health crisis helplines thereby avoiding the default of emergency dispatch èè Book appointments, rather than just provide advice for patients to call other services, such as their GP or other services èè Expand indirect care and faller arrangements èè Introduce paramedic rotations to help SCAS retention and to help local care systems ÒÒ Early Bird GP schemes ÒÒ Support to Night community ÒÒ Rotations through GP practices, ED and Minor Injuries Units ÒÒ Paramedic Demand Practitioners working with partners (GPs, social care) to develop management plans for high intensity users of 999, 111 and other NHS services èè Explore virtual working from home or other health settings plus other cost effective ways of getting clinical expertise to advise callers
èè Improve demand predication and improve the scheduling of resources in response èè Explore ways to get more value from our technical infrastructure such as hosting other partners’ call services and technical integration between organisations èè Reduce reliance on private providers by improvements in forecasting, recruiting, developing and retaining the workforce To support efficient and effective patient flow around systems of care, we will: èè Move to Adastra for NHS 111 which will facilitate greater interface with GP out-of-hours services èè Ongoing contractual bids to renew as the ‘provider of choice’ for those we already have and to widen our footprint of appropriate new business èè Explore other technology – mobile data transfer, electronic records, care plan access èè Ensure our current and future estate has the capacity to meet the demand for our services èè Common computer system, enabling virtual and streamlined services across the two clinical coordination centres èè Improve data quality and analytical ability so we can better exploit our position as ‘data rich’ with the ability to take an overview of health systems
To enable more people to stay safely in their own home or community setting, we will: èè Work with commissioners to enhance the content on the Directory of Services for our clinicians to signpost patients along appropriate pathways èè Work underway to support people in their own homes and local communities through better pathways, processes and practices èè Assess the feasibility of introducing mobile screening and diagnostic services
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Annual Report and Accounts 2015/16
ANALYSIS //28
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PERFORMANCE: A REVIEW TARGET
NATIONAL TARGET
2015/16
2014/15
2013/14
RED 1
75%
71.9%
75.0%
79.2%
RED 2
75%
72.7%
74.5%
75.7%
RED 19
95%
94.4%
95.5%
95.4%
The final target is designed to measure the percentage of Red 1 and Red 2 calls where a fully equipped ambulance vehicle arrives within 19 minutes that is able to transport the patient in a clinically safe manner. Known as the 19 minute transportation time, the target is to achieve this in 95% of cases.
National targets are set by the Department of Health and they apply to every ambulance service in England. These standards are amongst the most challenging standards set for ambulance services in the world. The targets ensure the Trust is measured against the percentage of calls responded to in 8 or 19 minutes depending on the priority of call with Category A calls measured as the highest priority. This data is extracted from the Trust’s Computer Aided Dispatch (CAD) systems.
Since 2011/12 the volume of red calls has increased by 60%. Red call demand continues to rise and is now a greater proportion of total calls than last year. This has been a significant factor in SCAS not achieving the national performance targets this year.
Category A calls are subdivided into Red 1 calls covering response to patients in a condition which may be immediately life-threatening, such as a cardiac arrest, and Red 2 calls where patients may still be in a life-threatening condition but less time critical. The national target for both Red 1 and Red 2 calls is to receive an emergency response within eight minutes irrespective of location in 75% of cases.
However, our response times to patients in life-threatening conditions remains good. On average we get to all Red 1 and Red 2 patients in less than seven minutes. This means that when we do miss the eight minute target, it is usually by a matter of seconds.
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Annual Report and Accounts 2015/16
KEVIN LETCHFORD HEMS Paramedic RAF Benson Kevin has spent the last six years working on the Thames Valley Air Ambulance as a Helicopter Emergency Medical Service (HEMS) Paramedic. As a HEMS Paramedic, Kevin will team up with a doctor on board and be flown to treat the most severely injured and ill patients anywhere across Berkshire, Buckinghamshire, Oxfordshire and sometimes further afield. He works a shift pattern of either 07.00-19.00 or 14.00-02.00 and when poor weather prevents the helicopter from flying can still attend incidents in the ECRU (Enhanced Care Response Unit) Car. “It’s a great role to have – a tough role and not easy by any stretch as we’re dealing with very ill or seriously injured patients where speed and treatment can be absolutely critical to their survival. We have lots of equipment, blood products, medication and techniques that we can use that road crews don’t have, so we give those patients the best possible chance of surviving by treating them at the scene and then flying them to specialist major trauma centres. Many people do recover and it’s very special when those patients come back and see us.”
//30
//Performance Report
Compared to all other ambulance trusts in the country, where only one or two ambulance trusts have met the national performance targets this year, SCAS’ performance is in, or close to, the top performing half of trusts.
RED 1
%
RED 2
%
19 MINUTE
%
West Midlands
78.5
West Midlands
75.1
West Midlands
97.2
North West
74.8
Isle of Wight
74.2
Yorkshire
95.0
South Western
73.7
South Central
72.7
Isle of Wight
94.9
South Central
71.9
Yorkshire
71.4
South Central
94.4
South East Coast
71.6
North West
70.4
South East Coast
93.8
East of England
71.3
North East
68.6
London
93.4
Isle Of Wight
71.3
South East Coast
67.3
North West
92.6
Yorkshire
70.8
London
63.7
North East
92.0
East Midlands
69.1
South Western
63.6
East of England
89.8
North East
68.1
East Midlands
60.8
South Western
89.4
London
68.1
East of England
60.4
East Midlands
87.4
With demand expected to continue to rise, as the population we serve increases in number and the proportion of elderly people and those with complex medical problems grows, we are working hard to improve our response and keep delivering a high quality service to all patients who require our assistance.
Action plans have been implemented during the year in order to assist us in making those improvements in 2016/17.
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Annual Report and Accounts 2015/16
SUSTAINABILITY REPORT The Trust was in its last year of the Sustainable Development Management Plan (SDMP) in 2015/16 and a revised strategy will be produced in 2016/17. The Trust continues to take an active part in the GREAN (Green Environmental Ambulance Network) and is an active member of the Oxford Sustainability Network which comprises health and other public sector bodies. These groups allow the Trust to keep up to date with latest initiatives and engage in joint projects that will allow the Trust to lower its carbon emissions.
Amongst some of the initiatives that continue to have direct impact in the reduction of our carbon footprint include: èè all new ambulance vehicles met euro 6 standards using less fuel èè video conferencing launched within the Trust which is saving travel time èè electronic timesheet project launched saving paper and e-expenses solutions being actively investigated èè new waste disposal contract agreed with the aim of increasing waste that is recycled èè all rapid response vehicles now have solar panels on roof èè all new ambulances have solar panel connection points on roof for ease of installation of panels èè second tranche of cycle to work scheme to be launched in 2016/17 èè active role in the NHS Forest Campaign including broadening of NHS Forest community schools project initiative èè installation of waste management facilities front line ambulances and PTS vehicles
The Trust has a dedicated Green Coordinator who is supported internally by a network of volunteers from within the Trust who are known as the green team. A regular newsletter is produced which updates all Trust staff of the latest green initiatives. The Trust has an overseeing Green Committee that meets three times a year and monitors progress against the strategy. The Committee is chaired by the Director of Finance, who is also the Board sponsor, and comprises all of the main functional heads. The Green Coordinator undertakes regular site visits identifying any areas of improvement from an environmental perspective.
The Trust continues to work towards Department of Health initiative towards reducing its CO2 emissions and has achieved a reduction over its 2008/09 baseline in spite of increasing activity and business. Function
2008/9 Actual CO2
2015/16 Forecast CO2
Fleet Estates related Total
10,009 5,034 15,043
11,216 3,203 14,419
//32
//Performance Report
SCAS IN THE COMMUNITY As well as playing a vital part in providing healthcare and other services for the communities we serve, the Trust is committed to investing in our local areas to help build a better, more resilient society.
The demand for SCAS ambulance services to attend life-threatening incidents (Red calls) has increased by 60% from 2011/12 to 2014/15. This comes at a time when fire crews nationally are attending around half the call outs for fires that they used to ten years ago. At the end of March 2016, SCAS had trained 423 Co-Responders.
We have continued to invest in the local communities by recruiting, training and developing a diverse team of community based volunteers who work side by side with our frontline staff to deliver care in medical emergencies. SCAS has 394 schemes and there are now 848 active Community First Responders (CFRs) who generally respond within a three mile radius of their location.
In 2016/17, we will also be rolling out an accredited course, “Level 3 Certificate in Community First Responding”. This is a national qualification and will enhance the knowledge and excellent patient care our CFRs provide for their local communities’ needs. Our co-responders, who can sometimes be first on scene to major trauma incidents, such as road traffic collisions and drownings which CFRs are not sent to, will also in 2016/17 undertake the Intermediate Emergency Care Course. This will ensure that when our coresponders are first on scene to major trauma events, they all have the same additional skills and can consistently provide more specialised first aid care in those few minutes before our paramedic teams arrive at the scene.
As well as CFRs, the Trust has also strengthened its partnerships with Fire and Rescue Services in Buckinghamshire, Oxfordshire, Berkshire and Hampshire and expanded the Co-Responder Schemes in these counties. New and expanded schemes utilising firefighters from some of the full time stations across the four counties ensures that SCAS-trained firefighters with enhanced first aid skills and medical equipment can be called upon for specific medical emergencies where there is an immediate threat to life prior to an emergency ambulance arriving on scene.
Over the last 12 months, SCAS has increased the total number of community first and co-responders by 24% - a significant increase that is making a life-saving contribution across the many communities we serve. Together, our CFRs and co-responders have been called out to and attended 54,621 incidents – an increase of 6% above the 51,756 incidents they attended in 2014/15.
The co-responder schemes, not just with the region’s Fire and Rescue Services, but also with local military services, provide patients in lifethreatening emergencies with a greater chance of survival and full recovery by getting appropriate, qualified and emergency first aid trained personnel to the scene as quickly as possible.
//33
Annual Report and Accounts 2015/16
During 2015/16, we have installed over 300 additional public access defibrillators (PADs) across the SCAS region. This brings the total number of life-saving PADs to over 700 and is a significant increase on the 99 PADs that had been installed at the end of 2013/14. We are committed to continuing to support the installation of more PADs, along with advice and guidance for local communities, to strengthen this network of life-saving devices across the region. Over 1,800 automatic external defibrillators (AEDs) and PADs can be found on SCAS’ AED Locator App. A new, improved App is currently being developed by SCAS in partnership with O2 and will be launched in the next few months.
700
Our groups of volunteers continue to assist us in raising awareness amongst our local communities about the lifesaving benefits such installations can bring as well as how beneficial CPR (cardio pulmonary resuscitation) can be. Some of our communities are involved in the national Heart Start programme which encourages residents to learn basic life support. Over the last 12 months, our CPR and safe use of defibrillator awareness sessions were given to more than 4,000 people across the SCAS region and we will continue to offer these sessions in 2016/17. Statistics show that in cases of sudden cardiac arrest outside hospital, only 1 in 10 people survive. However when bystanders provide CPR and use such defibrillators before emergency services arrive, as many as 4 in 10 victims survive.
PADs across SCAS
1,800
The Trust can provide training and advice for anybody interested in installing a PAD as this important adjunct compliments the already valuable service our volunteer Community First Responders provide.
AEDs on the SCAS locator app
//34
//Performance Report
Will Hancock Chief Executive Date: 25 May 2016
//35
AC
CO
UN TA
BIL
ITY
RE PO RT
Annual Report and Accounts 2015/16
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//Accountability Report
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Annual Report and Accounts 2015/16
//38
//Accountability Report
OUR WORKFORCE Our workforce remains our priority and we continue to invest in the workforce at all levels. Our key priorities during 2015/16 remained recruitment and retention, the development of the recruitment team, working practices and the launch of our first, dedicated recruitment website. This helped increase in-fill rates for all core programmes during quarters 2, 3 and 4.
Following the success of our first visit to Poland, paramedics from that country began their training with SCAS in March 2015. We have gone on to recruit 38 frontline members of staff from Poland over the past 12 months, part of a workforce of 68 international recruits from Poland, Australia, South Africa, Hungary, Ireland and Romania who have joined or are currently awaiting to start with SCAS this year.
NATIONALITY
TOTAL
Polish
38
Australian
25
Hungarian
2
Irish
1
Romanian
1
South African
1
Total
68
//39
Annual Report and Accounts 2015/16
KURNEL TUCKER Logistics Driver Oxford City Ambulance Station Kurnel, or ‘Marshal’ as he is affectionately known by his colleagues in the SCAS Logistics Division, has been in his current role for over 10 years. As well as help sorting the initial deliveries and mail for the day, Kurnel will ensure that the packages for each route are correctly prepared, ready for collection for the morning and afternoon rounds. He himself knows all the different routes inside out, having driven for over a decade across Oxfordshire, Berkshire, Wiltshire, Buckinghamshire and Northamptonshire. “The people I work with are great – it’s a good team. Every day it’s a different job and every day it’s varied. I could be taking records or mail to hospitals, taking supplies to local GPs or making sure the blood deliveries get to the air ambulance at RAF Benson on time. It’s good to know that whatever I’m doing, wherever I’m driving, I’m helping people further down the line.”
//40
//Accountability Report
STAFF SURVEY
The investment in the development of our existing workforce, with the launch of the specialist paramedic and enhanced paramedic programme, provided career development opportunities for over 150 staff. In addition, the launch of our associate ambulance practitioner programme aims to develop a more vocational route to qualification through to our fasttrack paramedic programmes. Attrition within our Urgent and Emergency Care Directorate dropped from a 16% high in year to 13% by year end for 999 frontline staff. Developing our understanding for what motivates our staff at work and factors which may influence their decision to leave will continue through 2016/17.
Feedback from our staff is very important and we encourage all staff to share their opinions through our staff surveys. During 2015/16 all staff were invited to share their views through the Friends & Family Test in addition to the annual staff survey. This year, all staff were invited to complete the survey online. Response rates were slightly less than the previous year at 56%, with some departments achieving over 90% returns. Our response rate was again the highest of all English ambulance trusts, the average being 35% (for ambulance trusts) and 41% across all NHS trusts.
In addition to our frontline 999 workforce, we have continued to recruit within our EOC and NHS 111 control rooms and across our Non-Emergency Patient Transport Service (NEPTS), all of which continue to grow. During 2015/16, we developed our approach to integrated workforce plans for each of these directorates, including the development of focused recruitment initiatives such as two successful open days at our HQs within Bicester and Otterbourne.
The 2015 survey consisted of 92 questions, with the results reported against 29 key findings, which were clustered around four of the seven staff pledges within the NHS Constitution, and additional themes of staff satisfaction, equality and diversity and patient experience measures. A total of 86 questions were used in both the 2014 and 2013 surveys, reported against 27 key themes.
Recruitment and retention will remain a key priority during 2016/17. Our recruitment plan includes offering flexible contracts and support to qualified paramedics who may not be currently in work but considering a return to the profession, improving our links with schools and colleges, attracting more applicants from under-represented communities and continuing to develop our overseas recruitment from EU countries.
//41
Annual Report and Accounts 2015/16
RESPONSE RATE TRUST
NATIONAL AVERAGE
2011/12
41%
54%
2012/13
32%
50%
2013/14
60%
49%
2014/15
59%
42%
2015/16
56%
41%
//42
//Accountability Report
The staff engagement score was similar to the national average when compared against other ambulance trusts, but had improved considerably since 2014.
OVERALL STAFF ENGAGEMENT
Trust score 2015
3.37
Trust score 2014
3.30
National 2015 average for ambulance trusts
3.39 1 Poorly engaged staff
3
5 Highly engaged staff
Of the 27 comparable key findings, four showed significant improvement from 2014. These were:
2014
2015
Percentage of staff believing that the organisation provides equal opportunities for career progression or promotion
66%
71%
Staff motivation at work
3.48
3.59
Percentage of staff feeling pressure in the last three months to attend work when feeling unwell
66%
61%
Support from immediate managers
3.60
3.69
2014
2015
Percentage of staff experiencing physical violence from patients, relatives or the public in the last 12 months
28%
32%
Staff confidence and security in reporting unsafe clinical practice
3.56
3.48
Two had significantly deteriorated since last year, continuing that trend from 2014:
//43
Annual Report and Accounts 2015/16
In comparison to other ambulance trusts, SCAS’ scores were significantly higher in seven key findings. The top five ranking scores, compared to the average, were:
KF10. SUPPORT FROM IMMEDIATE MANAGERS
3.69
Trust score 2015 National 2015 average for ambulance trusts
3.39 0
1
3
4
Unsupportive managers
KF5. RECOGNITION AND VALUE OF STAFF BY MANAGERS AND THE ORGANISATION
3.10
Trust score 2015 National 2015 average for ambulance trusts
2.96 0
1
2
Low recognition / value
KF.19 ORGANISATION AND MANAGEMENT INTEREST IN AND ACTION ON HEALTH AND WELLBEING
KF12. QUALITY OF APPRAISALS
3
4
3.33
National 2015 average for ambulance trusts
3.15 0
1
2
3
4
5
High interest in health
3.40
Trust score 2015 National 2015 average for ambulance trusts
3.28 0
1
2
3
Ineffective / unfair procedures
4
5
Effective / fair procedures
2.75
Trust score 2015 National 2015 average for ambulance trusts
2.61 0
1
Low quality appraisals
//44
5
High recognition / value
Trust score 2015
Low interest in health
KF30. FAIRNESS AND EFFECTIVENESS OF PROCEDURES FOR REPORTING ERRORS, NEAR MISSES AND INCIDENTS
5
Supportive managers
2
3
4
5
High quality appraisals
//Accountability Report
SCAS was only significantly lower than average for all ambulance trusts in two key findings (lowest five areas are shown):
KF17. PERCENTAGE OF STAFF SUFFERING WORK RELATED STRESS IN LAST 12 MONTHS
KF2. STAFF SATISFACTION WITH THE QUALITY OF WORK AND PATIENT CARE THEY ARE ABLE TO DELIVER
KF4. STAFF MOTIVATION AT WORK
Trust score 2015
50%
National 2015 average for ambulance trusts
49% 0
25
50
75
Trust score 2015
3.73
National 2015 average for ambulance trusts
3.79 0
1
2
3
Unsatisfactory delivery of work/ care
3.59
National 2015 average for ambulance trusts
3.69 1
2
3
Not enthusiastic / absorbed
KF14. STAFF SATISFACTION WITH RESOURCING AND SUPPORT
4
4
87%
National 2015 average for ambulance trusts
88% 25
50
75
Trust score 2015
2.97
National 2015 average for ambulance trusts
3.02 0
1
Unsatisfactory resourcing / support
//45
2
5
Enthusiastic / absorbed
Trust score 2015
0
5
Highly satisfactory delivery of work/ care
Trust score 2015
0
KF3. PERCENTAGE OF STAFF AGREEING THAT THEIR ROLE MAKES A DIFFERENCE TO PATIENTS / SERVICE USERS
100
3
4
100
5
Highly satisfactory resourcing / support
Annual Report and Accounts 2015/16
ACTIONS TAKEN FOLLOWING THE 2014 RESULTS The three areas which were of concern from the 2014 survey were:
2013
2014
2015
Staff reporting work pressures
3.19
3.32
N/A
Staff motivation at work
3.72
3.57
3.59
Percentage of staff being appraised
79%
74%
75%
Since the 2014 survey results there have been a number of actions which have taken place:
èè A “You Said, We Did” action plan has been developed which highlights areas where staff have raised issues and monitors the progress against each area.
èè Face-to-face equality and diversity training has been arranged for most corporate departments èè Commercial Services offered modern apprenticeships to all staff and they are being incorporated into the Band 2-3 progression èè Career development opportunities within our Urgent and Emergency Care Directorate have also been developed with the roles of specialist paramedic and enhanced paramedic èè “Stay interviews” focusing on reducing attrition by identifying what will make team leaders stay with SCAS are being piloted amongst team leaders in Oxfordshire and North East Hampshire, and action plans will be devised accordingly èè A review of recruitment processes has been undertaken which allows new staff to start quicker than previously
ACTION PLANS – 2015 SURVEY Local action plans and pledges in a consistent format are being developed by managers and will be monitored by the executive team. A series of communications will provide further feedback to staff on progress against key findings and pledges, both at a Trust and a local level. Action plans will include items to improve the two key findings of concern, alongside the bottom five ranking scores, where the Trust was lower than average across all ambulance trusts. This will be achieved by ensuring each local action plan has a specific local action to address this.
//46
//Accountability Report
STAFF ENGAGEMENT
èè discover what steps individuals can take to improve their health and wellbeing
Our formal routes for staff engagement remain our Joint Consultative Committee and local staff forums, with staff side representatives joining managers on major committee and project boards.
Staff from Team Prevent are invited to Trust meetings in order to provide expert advice in their field. Optum, our confidential Employee Assistance Programme and counselling service is available to staff and their families. Optum offers a wide range of advice and help both in person and online, and the service works with Occupational Health to promote healthy lifestyles and health choices.
Our staff side representatives have been fully engaged and committed to work in partnership with the Trust in our bids for commercial contracts. All operational and HR policies are developed in partnership through joint working groups. Informal routes for staff engagement exist in a variety of ways.
We have expanded the team of trained Trauma Risk Management (TRiM) practitioners to support staff who may experience stress in the workplace. The team will provide advice on coping strategies and signposting to other services if required.
These include access to Chief Executive and members of the Board through CEO meetings and leadership walkarounds, feedback to the Chief Executive through a dedicated confidential email address, and staff and station meetings.
The team follow established protocols to support staff in the early stages after dealing with distressing or traumatic incidents, and assess whether there is a need for further intervention.
SUPPORTING STAFF HEALTH AND WELLBEING
All TRiM practitioners are volunteers and receive training and support to fulfil this difficult but essential role.
We continue to provide support to our staff through our Occupational Health service provider Team Prevent. The Team Prevent ‘Wellbeing’ website is a well-supported resource that is used by our managers and staff. The site aims to help anyone:
Our TRiM managers who support the TRiM team have also this year qualified as trainers, so we can train more practitioners as and when needed in house in order to maintain the numbers of practitioners needed for the optimum ratio between practitioners and number of staff.
èè understand more about the role of Occupational Health through the information provided in the Manager and Employee Zones èè find out how to get the best from the Occupational Health service èè complete an individual confidential health risk assessment and download a personalised health report
SCAS has this year introduced a Health, Wellbeing and Attendance team who provide extra support and advice to staff on maintaining good health.
//47
Annual Report and Accounts 2015/16
This support is in addition to the access all staff have to online stress training as well as actively promoting health and wellbeing through: èè work out at work days èè physiotherapy at work sessions èè Fruity Fridays èè cycle-to-work scheme èè promoting Dry January and other NHS and national programme initiatives such as stopping smoking èè weekly health and wellbeing tips èè health and wellbeing promotion days The Trust has also this year signed the Blue Light Pledge (Time to Change), a scheme supported by MIND which promotes mental health support for ‘blue light’ employees and recognises the unique stresses this staff group works with. The Trust will continue to support national schemes throughout 2016/17 as well as managing attendance and attraction schemes.
MODERN SLAVERY The organisation has taken no steps to confirm the existence of slavery or trafficking.
//48
//Accountability Report
WORKFORCE STATISTICS
Over the last 12 months, SCAS has employed 622 new staff, including 169 staff to help manage the increased demand within our NHS 111 and 999 clinical coordination centres. As a result of continued expansion and successful bidding for commercial contracts within the Thames Valley and Hampshire, the Trust employed 64 additional NEPTS staff.
622
new staff employed in the last 12 months
49%
51% The Trust’s gender balance is fairly equal, with 49% of staff female and 51% male.
//49
The ongoing development of our workforce and the recruitment of additional resources within our 999 frontline services has been a top priority for SCAS in 2015/16. Over the past 12 months, SCAS has welcomed 313 new 999 frontline recruits in clinical, non-clinical and clinical-student positions. The Trust has continued to recruit paramedics both from abroad and within the UK to meet increasing demand for our emergency services. This work continues in 2016/17 where we will expand our workforce, whilst seeing the benefits of two years of extensive internal staff development through increased clinical workforce numbers. The following tables show a breakdown of the Trust’s workforce by age, ethnicity and gender, as well as disability information, for 2014/15 and 2015/16 respectively.
Annual Report and Accounts 2015/16
ETHNICITY
2014/15
2015/16
SIP
FTE
SIP
FTE
2,530
2,288.04
2,708
2,453.11
B White - Irish
12
10.04
18
16.06
C White - Any other White background
51
44.91
104
96.88
C3 White Unspecified
7
6.61
8
7.61
CA White English
43
41.24
36
33.71
CB White Scottish
3
2.51
1
1.00
CC White Welsh
4
3.80
3
2.80
CD White Cornish
2
1.51
2
1.51
CK White Italian
1
1.00
1
1.00
CP White Polish
1
1.00
2
2.00
CY White Other European
1
1.00
1
1.00
D Mixed - White & Black Caribbean
1
0.31
4
3.32
E Mixed - White & Black African
3
3.00
3
3.00
F Mixed - White & Asian
7
7.00
8
7.53
G Mixed - Any other mixed background
10
9.55
8
7.55
GD Mixed - Chinese & White
1
1.00
1
1.00
H Asian or Asian British - Indian
9
7.91
8
7.33
J Asian or Asian British - Pakistani
6
3.97
5
4.33
L Asian or Asian British - Any other Asian background
9
7.72
9
7.27
LH Asian British
1
0.93
1
0.93
LK Asian Unspecified
1
1.00
1
1.00
M Black or Black British - Caribbean
12
9.43
12
10.11
N Black or Black British - African
9
7.35
9
7.91
P Black or Black British - Any other Black background
2
2.00
1
0.27
R Chinese
1
1.00
1
1.00
S Any Other Ethnic Group
2
1.72
2
1.80
SE Other Specified
1
1.00
1
0.92
Z Not Stated
242
205.73
217
182.61
SCAS Total
2,972
2,672.26
3,128
2,864.62
A White - British
//50
KEY: SIP = Staff in post
FTE = Full time equivalent
//Accountability Report
2014/15
AGE
2015/16
SIP
FTE
SIP
FTE
<20
15
12.44
16
13.72
20 - 29
643
588.05
707
655.65
30 - 39
696
610.97
743
655.63
40 - 49
840
754.61
855
766.92
50 - 59
595
559.77
654
607.99
60 - 69
167
144.56
179
151.79
>70
16
9.83
21
12.91
SCAS Total
2,972
2,827.94
3,175
2,864.62
2014/15
GENDER
2015/16
SIP
FTE
SIP
FTE
Female
1,477
1,261.01
1,565
1,341.16
Male
1,495
1,411.25
1,610
1,523.46
SCAS Total
2,972
2,672.26
3,175
2,864.62
2014/15
DISABILITY
2015/16
SIP
FTE
SIP
FTE
Yes
130
116.58
142
127.98
No
2,119
1,910.73
2,329
2,108.24
Non disclosure
723
644.95
704
628.40
SCAS Total
2,972
2,672.26
3,175
2,864.62
KEY: SIP = Staff in post FTE = Full time equivalent
//51
Annual Report and Accounts 2015/16
MANDIE CHAPLEN NHS 111 Clinical Advisor Clinical Coordination Centre (CCC) Hampshire Following a 16 year career working on the frontline for the ambulance service, starting as a trainee technician and finishing as a specialist paramedic, Mandie took the opportunity for a career change with the launch of the NHS 111 service in 2013. NHS 111 is available 24 hours a day, 365 days a year, and should be used by patients who urgently need medical help or advice but it’s not a lifethreatening situation. As a NHS 111 Clinical Advisor, Mandie provides over the phone assessment through careful and considered questioning. This, along with her clinical qualifications, enables her to really get to the heart of what is ailing the patient and ensures she can arrange the right help for them. “When I was seeing patients face-toface as part of an ambulance crew, I was able to see how they were doing and do a full range of observations. The challenge as a NHS 111 Clinical Advisor is to do a similarly thorough assessment over the phone. Quite often patients call in quite a panicked situation and so it is especially satisfying when we can talk it through with them and really put their minds at rest about a problem they might be having.”
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//Accountability Report
CELEBRATING DIVERSITY EQUALITY DELIVERY SYSTEM 2
It demonstrates to disabled people which employers will be positive about their abilities. In achieving the disability symbol status SCAS has demonstrated that it will:
The Trust has recently renewed its four years of the Equality Delivery System designed to support NHS commissioners and providers to deliver better outcomes for patients and communities and better working environments for staff, which are personal, fair and diverse.
èè Interview all disabled applicants who meet the minimum criteria for a job vacancy and consider them on their abilities èè Ensure that there is a mechanism in place to discuss, at any time but at least once a year, with disabled employees, what both parties can do to make sure disabled employees can develop and use their abilities èè Make every effort when employees become disabled to make sure they stay in employment èè Take action to ensure that all employees develop the appropriate levels of disability awareness needed to make sure these commitments work èè Review these commitments each year and assess what has been achieved, plan ways to improve on them and let employees and JobCentre Plus know about the progress and future plans.
The grading was carried out by our community engagement panels and staff and covers: èè Goal 1 > Better outcomes for all èè Goal 2 > Improved patient access and experience èè Goal 3 > A representative and supported workforce èè Goal 4 > Inclusive leadership There were a total of 18 outcomes to be considered and graded. Overall, the feedback was positive with 16 graded green (achieving) and two graded amber (developing). The amber (developing) will be set as objectives for EDS 20162020. The Trust is assessed at 89% achieving.
THE DISABILITY SYMBOL SCAS has for the sixth year running achieved the disability symbol awarded by Jobcentre Plus to employers who show their commitment to employing disabled people.
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Annual Report and Accounts 2015/16
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Annual Report and Accounts 2015/16
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COUNCIL OF GOVERNORS BACKGROUND
èè five elected staff governors èè three appointed Local Authority governors èè two appointed Clinical Commissioning Group governors èè one appointed partner governor (the Air Ambulance charities)
The Trust’s Council of Governors (CoG) plays an essential role in the governance of South Central Ambulance Service NHS Foundation Trust, providing a forum through which the Board of Directors is accountable to the local community.
The CoG elects a lead governor and Robert Duggan served in this position during 2015/16 (and has since been reelected for 2016/17).
The Trust’s Constitution sets out the key requirements in respect of the functioning of the CoG. Its general functions are to:
The CoG started the year with twenty four governors in place, with the two vacancies relating to the Hampshire public governor constituency. It ended the year with twenty two governors in place and therefore four vacancies (one governor in each of the Oxfordshire, Berkshire and Buckinghamshire public governor constituencies, and the PTS and Logistics Field staff governor).
èè hold the non-executive directors individually and collectively to account for the performance of the Board of Directors èè represent the interests of the members of the Trust as a whole and the interests of the public The period 1 April 2015 to 31 March 2016 represents the fourth full year of working for the CoG and the delivery of its statutory duties.
During 2015/16, there have been the following changes to the composition of the CoG: èè four of the fifteen elected public governors – two from Buckinghamshire and one each from Berkshire and Oxfordshire - resigned èè three elected public governors – two from Hampshire and one from Buckinghamshire – joined the CoG under the Trust’s constitutional ‘reserved candidacy’ rules èè the elected staff governor for the PTS and Logistics Field Staff constituency resigned in March 2016.
MEMBERSHIP AND MEETINGS MEMBERSHIP OF THE COUNCIL OF GOVERNORS The CoG is chaired by the Trust Chairman, and the full composition of governors numbers twenty six as follows: èè fifteen elected public governors across four constituencies (Hampshire, Berkshire, Oxfordshire and Buckinghamshire)
Governor elections are due to be held in both late 2016 and 2017 and will aim to fill the governor vacancies at that time.
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Annual Report and Accounts 2015/16
DUTIES AND FUNCTIONS
Details about each governor, including biographies and declared interests, can be seen on the Trust’s website.
DELIVERY OF SPECIFIC STATUTORY DUTIES
FORMAL MEETINGS OF THE COG
The governors have a range of specific statutory duties, and all of the statutory duties relevant to 2015/16 were satisfactorily discharged.
Three formal meetings of the CoG have been held during 2015/16: in July 2015, October 2015 and January 2016, a fourth was scheduled to take place in May 2015; this was cancelled due to it falling within elections week. All meetings have been held in public, and fully in accordance with the Trust’s Constitution. An extraordinary formal meeting of the CoG was also held in January 2016 to approve new Non Executive Director appointments. All meetings were chaired by the Trust Chairman, with a good representation of Board members, including Non Executive Directors, in attendance. Appendix A reports on the attendance of governors at formal meetings of the CoG.
OTHER MEETINGS OF THE COG The CoG has had two formal subcommittees during 2015/16; the Nominations Committee, and the Membership and Engagement Committee. Details of their meetings and work programmes are explained below. Two governor workshops were held during the year; in June 2015, to consider the Trust’s commercial strategy, and in January 2016, to obtain the views of the governors on refreshing the Trust’s strategy.
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DUTY
COMMENTS
Receive annual accounts, auditor’s report and annual report
P
Received annual accounts and reports at the July 2015 meeting. Overview from KPMG (external auditors) of their approach to the 2015/16 audit programme at the October 2015 meeting.
Appoint and, if appropriate, remove the external auditor
n/a
The CoG approved the extension of the external audit contract (KPMG) in September 2014 for a further two years. No duties in respect of the external audit appointment were required in 2015/16.
Directors must have regard to governors’ views when preparing the forward plan
P
A specific workshop was held on 7 January 2016 to obtain the views of the governors, and these were taken into account in developing the 2016/17 annual business plan.
Appoint and, if appropriate, remove the Chair
n/a
The CoG previously reappointed the current Chairman for a period to 31 March 2017. During 2015/16 the governors were involved in work to establish a process for appointing a successor chair from 1 April 2017.
Appoint and, if appropriate, remove the other Non Executive Directors (NEDs)
P
During 2015/16, the CoG approved the appointment of three new NEDs, one of whom commenced his role on 1 March 2016.
Decide remuneration and terms of conditions for Chair and other NEDs
P
During 2015/16 the CoG accepted a recommendation from the Nominations Committee that remuneration levels for the Chairman and NEDs should remain unchanged
Approve appointment of Chief Executive
n/a
No new appointment was made in 2015/16
Approve significant transactions
n/a
No significant transactions required approval in 2015/16
Approve an application by the Trust to enter into a merger, acquisition, separation or dissolution
n/a
No such applications occurred in 2015/16
Decide whether the Trust’s non-NHS work would significantly interfere with its ‘principle purpose’
n/a
This was not required during 2015/16
Approve amendments to the Constitution
P
A number of minor constitutional amendments were approved by the CoG during 2015/16 (including changes to the quoracy rules for formal CoG meetings)
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Annual Report and Accounts 2015/16
During 2015/16, most of the Trust’s governors attended at least one of the Board meetings in public, and one of the six Board meetings in 2016/17 will be held in the evening to help facilitate greater governor attendance.
Delivery of other duties and functions of the CoG There are general duties for the governors in relation to holding the Board of Directors to account for the performance of the Trust via the Non Executive Directors, and representing the interests of the members and the public.
The work of the Membership and Engagement Committee (see below) has been key to the governors’ other general duty of representing the interests of the members and the public.
A range of mechanisms have been in place to support the governors with their holding to account role, including:
During the course of the year, governors have attended a range of membership recruitment and engagement events, and used other opportunities to meet with Trust members and members of the public to ascertain their views on the Trust.
èè six Board meetings in public have been held, and governor attendance at these has been strongly promoted. There has been good attendance at Board meetings, with an average of eight governors attending each meeting èè the Trust ensures that the governors receive the papers for Board meetings one week ahead of the meeting, and the minutes on a timely basis subsequent to the meeting having taken place èè governors have been invited to ‘buddy up’ with one of the Trust’s NEDs to help develop their understanding of how the NEDs seek assurance over the day to day running of the organisation èè all formal meetings of the CoG include an update from the Chief Executive on key strategic issues and operational performance, with an opportunity for governors to ask questions. In addition, the format of CoG meetings is such that governors can hear from the NEDs how they seek assurance and hold the Executive Directors to account for improving the performance of the Trust èè information is regularly circulated by the Company Secretariat office to keep governors up-to-date on key Trust issues and developments, with any questions and comments being responded to as appropriate
COG SUB-COMMITTEES NOMINATIONS COMMITTEE One of two formal sub-committees, and a statutory requirement, the CoG has established a Nominations Committee, which is chaired by the Trust Chairman and has four other governor members (the Lead Governor and one governor each from the categories of Local Authority, Staff and Public). The Nominations Committee has met formally on two occasions during 2015/16, and meeting attendance levels can be seen at Appendix A. Two additional committee teleconferences have been held to discuss emerging items of business.
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Annual Report and Accounts 2015/16
During the year, and with delegated authority from the CoG, the Nominations Committee has performed a range of tasks including:
èè surveyed all members of the CoG to gain their views on how membership engagement arrangements can be further strengthened.
èè considering NED succession planning arrangements, and agreeing a way forward with the CoG which will help facilitate the appointment of a new Chair, ViceChair/Senior Independent Director, and other NEDs over the next two years èè linked to the above, overseeing the process which resulted in a recommendation to the full CoG for the appointment of three new NonExecutive Directors (with the first joining the Board on 1 March 2016) èè developing processes for the 2015/16 Chair and NED appraisals.
GOVERNOR SUPPORT, TRAINING AND DEVELOPMENT The Trust has a formal duty to ensure that governors are equipped with the skills and knowledge they require to undertake their role, and during the course of the year the Trust has supported governors in this respect. In addition to the mechanisms outlined to support the general duties of governors, the Trust has: èè provided a comprehensive and tailored induction programme for all new governors; èè provided access to relevant external training as provided by Monitor and NHS Providers (for instance, NED recruitment training for governors on the Nominations Committee); èè further extended its informal ‘buddying’ scheme between individual governors and NEDs; èè provided the opportunity for governors to participate in Emergency Operations Centre tours, crew ride-outs, and ambulance station visits to help support their understanding of the Trust and its business; èè issued regular briefings and bulletins.
MEMBERSHIP AND ENGAGEMENT COMMITTEE The CoG has established a Membership and Engagement Committee, whose main role is to recommend strategies to the CoG for the recruitment of, and engagement with, Trust members. The Membership and Engagement Committee ended the year with eight members, comprising six public governors and two appointed partner governors. During the year, the Membership and Engagement Committee has: èè agreed a Foundation Trust Membership Plan for 2015/16, and monitored progress throughout the year èè contributed to the development of the Trust’s annual Member Satisfaction and Patient Care survey èè overseen the arrangements for the Trust’s fourth Annual Members Meeting in September 2015
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CONCLUSIONS AND PRIORITIES FOR 2015/16
èè contributing to the development of the Trust’s future strategic priorities and forward plans èè continuing to review the effectiveness of the Council of Governors to ensure that the governors are appropriately supported to deliver their roles, that value is added where appropriate, and the functioning of the CoG is delivered in the most cost effective way.
CONCLUSIONS The Council of Governors has overseen some major achievements during 2015/16 and helped contribute to the overall success of the Trust. Additionally, all of the relevant statutory duties have been effectively delivered. It is considered that the Council of Governors has a good working relationship with the Board of Directors, and directors regularly attend Council of Governors meetings to answer questions, participate in discussions, and help the governors deliver their statutory duties. In turn, the Trust has benefitted from the perspectives brought by a diverse group of governors, and this has been demonstrated in recent years by the governors’ input to the annual planning and CQC inspection processes. PRIORITIES FOR 2016/17 The CoG has identified the following priorities for 2016/17: èè with a continually growing membership that now stands at over 16,000 (public and staff), further developing arrangements for engaging with the Trust’s membership and ensuring that the interests of members are suitably represented and that their views are brought to the attention of the Trust èè given the challenges faced by the NHS, continuing the strong focus that the governors have in terms of holding the Board to account, via the Non Executive Directors, for the performance of the Trust; èè overseeing the appointment processes for the Chair and ViceChair/Senior Independent Director positions
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CONSTITUENCY
Public – Hampshire
Staff – 999 North
Partner – LA
Public – Hampshire
Partner – CCG
Partner - CCG
Public – Hampshire
Public – Hampshire
Public – Bucks/Lead
Staff – Contact centres
Public – Berkshire
Public – Berkshire
Partner – LA
Public – Bucks
Public - Hampshire
Staff - PTS
GOVERNOR
Andy Bartlett
James Birdseye
David Burbage
Paul Carnell
Sabrina Chetcuti
David Chilvers
Richard Coates
Jon Cotterell
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Bob Duggan
Michele Foote
Colin Godbold
Ian Hammond
Keith House
Dave Johnson 4
Barry Lipscomb
Katharine Naylor 5
1/3/2015 – 28/2/2018
20/7/2015 – 28/2/2017
1/3/2014 – 28/2/2017
1/3/2015 – 28/2/2018
1/3/2014 – 28/2/2017
1/3/2015 – 28/2/2018
1/3/2015 – 28/2/2018
1/3/2015 – 28/2/2018
1/3/2014 – 28/2/2017
20/7/2015 – 28/2/2017
1/7/2013 - 30/6/2016
1/8/2013 – 30/6/2016
1/3/2015 – 28/2/2018
1/10/2014 – 30/9/2017
1/3/2015 – 28/2/2018
1/3/2015 – 28/2/2018
TERM OF OFFICE
1/3
2/2
1/2
1/3
3/3
2/3
3/3
3/3
3/3
2/3
1/3
2/3
2/3
1/3
1/3
2/3
FORMAL COG MEETINGS
1/4
1/1
1/2
n/a
4/4
n/a
n/a
3/4
3/4
n/a
n/a
n/a
n/a
n/a
n/a
n/a
MEMBERSHIP AND ENGAGEMENT COMMITTEE
n/a
n/a
n/a
4/4
4/4
n/a
n/a
4/4
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
NOMINATIONS COMMITTEE
APPENDIX A: ATTENDANCE AT MEETINGS FOR GOVERNORS WHO SERVED DURING 2015/16 1
Annual Report and Accounts 2015/16
Public - Berkshire
Public – Oxfordshire
Partner – Charity
Martin Shea 5
Mike Shread 2
Sue Thomas
Public - Oxfordshire
Staff – Corporate/support
Debbie Scott
Tim Windsor-Shaw
Public – Hampshire
Ray Rowsell
Public - Oxfordshire
Public – Bucks
David Ridley 3
Emily Williams
Public – Bucks
Tony Peirson
Partner – LA
Staff - 999 South
David Palmer
Jan Warwick
CONSTITUENCY
GOVERNOR
//65 1/3/2014 – 28/2/2017
1/3/2015 – 28/2/2018
1/3/2015 – 28/2/2018
1/10/2014 – 30/9/2017
1/3/2014 – 28/2/2017
1/3/2015 – 28/2/2018
1/3/2015 – 28/2/2018
1/3/2015 – 28/2/2018
1/3/2014 – 28/2/2017
01/9/2015 – 28/2/2017
1/3/2015 – 28/2/2018
TERM OF OFFICE
3/3
2/3
2/3
3/3
0/2
2/3
2/3
3/3
1/2
0/2
3/3
FORMAL COG MEETINGS
3/4
1/4
2/4
4/4
0/1
n/a
n/a
n/a
1/2
n/a
n/a
MEMBERSHIP AND ENGAGEMENT COMMITTEE
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
3/4
NOMINATIONS COMMITTEE
//Accountability Report
1 This is a full record of the governors who served during 2015/16. Those highlighted in bold were in post at the end of the 2015/16 year (i.e. on 31 March 2016)
2 Resigned in June 2015 (term of office was until 28 February 2017)
3 Resigned in August 2015 (term of office was until 28 February 2017)
4 Resigned in September 2015 (term of office was until 28 February 2017)
5 Resigned in March 2016 (term of office was until 28 February 2018).
Annual Report and Accounts 2015/16
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Annual Report and Accounts 2015/16
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Annual Report and Accounts 2015/16
MEMBERSHIP REPORT SCAS has a total membership of 16,507 people as of 31 March 2016. We have 13,403 public members and 3,104 staff members.
SCAS membership is broadly representative of the area we serve with the exception of the Asian community where members remain underrepresented in comparison with the population of the South Central region.
MEMBERSHIP ELIGIBILITY PUBLIC CONSTITUENCY
The Trust continued to target and encourage participation by working with various groups such as the Asian community in Southampton, Hampshire, and Aylesbury, Buckinghamshire, together with attending multicultural festivals and encouraging more members of Black and Minority Ethnic (BME) communities to join our membership and become a governor.
Members of the public aged 14 and over are eligible to become public members of the Trust if they live in the area (or have a connection with) where SCAS provides services (Buckinghamshire, Berkshire, Oxfordshire and Hampshire). STAFF CONSTITUENCY
These activities will be expanded further in 2016/17.
Any SCAS staff member with a permanent contract or a fixed term contract of 12 months or longer is able to become a member of the Trust. Staff who join the Trust are automatically opted into membership and advised how they can opt out if they wish. ANALYSIS OF PUBLIC MEMBERSHIP AS AT 31 MARCH 2016 The profile of SCAS public membership is compared against the records held by the Office of National Statistics (ONS) to determine how representative the Trustâ&#x20AC;&#x2122;s membership is of the South Central population. The public membership breakdown by category on 31 March 2016 is shown on the right.
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PUBLIC CONSTITUENCY
NUMBER OF MEMBERS
POPULATION IN SOUTH CENTRAL
INDEX (%) (100 = IDEAL REPRESENTATION)
13,403
4,158,611
100.00
0-16
65
n/a
17-21
574
256,541
69
22+
12,579
3,038,561
128
Not stated
188
AGE
GENDER Unspecified
24
Male
5,504
2,041,644
83
Female
7,875
2,084,045
116
White
10,891
3,556,479
73
Mixed
186
85,182
69
Asian or Asian British
536
277,046
56
Black or Black British
261
86,155
95
Other Ethnic Group
79
24,636
92
Not stated
1,444
ETHNICITY
ACORN SOCIO-ECONOMIC CATEGORY Affluent Achievers [1]
3,904
1,340,169
82
Rising Prosperity [2]
1,751
570,291
103
Comfortable Communities [3]
3,457
1,038,607
115
Financially Stretched [4]
2,689
772,746
108
Urban Adversity [5]
1,321
448,801
92
Not Private Households [6]
204
Not available [NA]
77
Red: under-represented
151
Green: over-represented
//71
Amber: within correct tolerance
Annual Report and Accounts 2015/16
MEMBERSHIP BY COUNTY
2,879 OXFORDSHIRE
2,652 BERKSHIRE
5,168 HAMPSHIRE
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2,704 BUCKINGHAMSHIRE
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MEMBERSHIP AND ENGAGEMENT ACTIVITIES
Large events included: èè Various Pride days èè Your Health, Your NHS. Portsmouth, Hampshire èè Armed Forces Day. Fawley, Hampshire èè Hayling Island 999 Emergency Services Day. Hampshire èè Art in the Park. Milton Keynes, Buckinghamshire èè Hampshire 999 Emergency Show 2015. Bordon, Hampshire èè New Andover Show. Thruxton, Hampshire èè Bucks County Show, near Aylesbury èè Southsea Fire Station Open Day. Hampshire èè Wallingford BunkFest, Oxfordshire èè Heritage Open Day and Emergency Services. Waddesdon Manor, Buckinghamshire.
The Trust attends and / or organises a variety of events every year, sometimes in partnership with other organisations including other NHS Trusts. These include annual public events such as county shows, local community fairs, SCAS patient experience roadshows, careers fairs at local colleges and schools and recruitment open days. Information is provided with regard to the Trust’s services, membership and the wider and local health economy. Some event types and locations are selected when considering membership recruitment needs in terms of recruiting more members from under-represented categories.
PUBLIC ENGAGEMENT PUBLIC EVENTS
MEMBERSHIP SATISFACTION AND PATIENT CARE SURVEY
In 2015/16 the Trust continued its programme of delivering public health messages as well as raising awareness of the work done by SCAS in communities across its four counties.
The third annual membership survey was undertaken in May 2015 over a five week period. It was sent to all Foundation Trust public members who have supplied the Trust with an email address.
Representatives of the Trust attended events and summer shows where they met with members of the public, provided information about our services and listened to their views.
The survey was also posted on the SCAS website and to 1,204 members. These are members who have expressed an interest in taking part in surveys on their application form but do not have / or have not supplied the Trust with an email address.
In the summer alone SCAS organised and / or attended 47 events from June to September, some regional and some more local and smaller.
For the second year running we invited GP surgeries across our four counties to pass on our request to complete the survey to their Patient Participation Groups (PPGs) and other contacts so they could tell us about their experience of the care they receive from us.
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Annual Report and Accounts 2015/16
IN TOTAL WE RECEIVED 485 RESPONSES BROKEN DOWN AS FOLLOWS.
12
84
401
via post
via email
Last year we received 478 responses.
BELOW ARE SOME EXAMPLES OF FEEDBACK FROM SOME OF OUR RESPONDERS.
Q
Please tell us one thing that would most improve your experience of 999
èè “Couldn’t improve that experience, it was exemplary” èè “Not at the moment. I was treated the uttermost respect at a very high standard and great quality of care. Thank you.” èè “My young son broke his leg in a football accident, we were treated excellently throughout.” èè “Quicker response.” èè “Warmer ambulance.” èè “The ambulance was an old model and rather a hard ride, rattling a lot. Nobody’s fault.”
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Q
Please tell us one thing that would most improve your experience of Patient Transport Service
èè “I found the service very helpful. Didn’t think you can improve a top rate service.” èè “There is nothing I can add as the service is excellent.” èè “I can’t because my experience was very good.” èè “Given a warning when driver is going to be delayed.” èè “Bottle of water & tissues.” èè “Vehicle was extremely bumpy and made me nauseous.” èè “A more comfortable ride.”
Q
Please tell us one thing that would most improve your experience of NHS 111
èè “Great service, helpful.” èè “Never used 111 before but I cannot fault the service.” èè “Make the questions more relevant.” èè “I felt that the advice given (sent an ambulance) was a bit of an over-reaction, but it was felt necessary at the time.”
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Annual Report and Accounts 2015/16
PATIENT FORUMS Throughout the year SCAS continued to work with our four patient forums (one in each county) and its members had the opportunity to undertake the following activities: èè Take part in the Equality and Diversity Strategy (EDS2) assessment èè Visit to our HART (Hazardous Area Response Team) Resource Centre èè Make recommendations on: ÒÒ SCAS Standby Policy ÒÒ Duty of Candour Policy ÒÒ Present a personal experience of mental health as a patient story at a Board meeting Three of the patient forums are chaired by an existing public governor for the Trust. The Hampshire Forum is chaired by a former Trust public governor.
HAZARDOUS AREA RESPONSE TEAM 05/11/2015 Many thanks to the Hazardous Area Response Team (HART) for showing Sam around their base in Eastleigh. HART is comprised of specially recruited and trained personnel who provide an ambulance response to particularly hazardous or challenging incidents. Teams work alongside the police and fire and rescue services within what is known as the ‘inner cordon’ (or ‘hot zone’) of a major incident. The job of the HART teams is to triage and treat casualties and to help save lives in very difficult circumstances. Southampton, with its docks, industry and nearby refinery is identified as potential risk area for hazardous situations so it’s reassuring to know we have trained staff nearby who are able to respond.
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WE ARE LISTENING: YOU SAID, WE DID We are continually seeking to improve the care we provide to patients and the welfare of our staff. So, whether things go well or not so well, we actively encourage feedback to help us develop better practices and processes. Following our 2015/16 patient experience roadshows and patient forums we took some actions from the feedback received at the events as listed below.
CLINICAL CARE, QUALITY AND PATIENT SAFETY - END OF LIFE CARE You said “I had a negative experience when my grandfather, who was terminally ill with cancer, was dying. SCAS did not send an ambulance and did not give me any alternative care services for me to contact/be referred to.” We did We reinforced the training programme by constructing two presentations on ‘Introduction to End of Life Care’ and ‘Oncology Emergencies for CPD (Continuing Professional Development)’ to be delivered at workshops for NHS 111 and CSD (Clinical Support Desk) clinicians.
VOLUNTEER CAR DRIVERS
You said “Some volunteer car drivers did not carry any SCAS ID and there was no SCAS branding/identification on their vehicles”. NEPTS (Non-Emergency Patient Transport Service) user. We did The Volunteer Car Drivers (VCDs) have improved the signs they can place within their vehicles. VCDs all have SCAS IDs and as per the VCD handbook are instructed they must be worn at all times.
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Annual Report and Accounts 2015/16
JAMES CLARKE Managing Director, Hook Norton Brewery and Community First Responder Despite having significant working responsibilities as the Managing Director of Hook Norton Brewery in Oxfordshire, for the last three years, James has also found the time to become a Community First Responder (CFR) for SCAS. James already demonstrated plenty of community commitment having been a retained firefighter for 14 years. When his father passed away, James needed to take on more responsibility at the Brewery and had to give up his voluntary firefighter role. The death of a person in the village brought home to James and the small, rural community that there was no defibrillator in Hook Norton. It was the fundraising that he undertook with others to help raise enough money to install a public access defibrillator in the village that got James interested in doing more and ultimately becoming a CFR. “I’m able to offer on average around 5060 hours of cover a week, both when I’m at the Brewery in Hook Norton and when I’m at home in Banbury. It’s not just medical skills you learn as a CFR, but very valuable life skills too. The most satisfaction I get is when the patient or their family simply says thank you. It means you’ve done something that’s made a real difference to someone in your community.”
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Regulatory Rating This added two further measures to the pre-existIng capital service capacity rating and liquidity rating which comprised the replaced continuity of service rating. This comprised the income and expenditure margin and an income and expenditure margin variance from plan. These four rating have equal weighting of 25%.
As part of its regulatory regime, Monitor assigns risk ratings to each NHS Foundation Trust as an indicator of the Trustâ&#x20AC;&#x2122;s compliance with the conditions of its licence. South Central Ambulance Service NHS Foundation Trust (SCAS) was authorised as an NHS Foundation Trust on 1 March 2012 and has been assessed under this framework since that date.
SCAS achieved the following risk ratings for 2015/16 and 2014/15 based on assessment of its submissions:
Monitor amended the risk ratings slightly in quarter 2 replacing the continuity of risk rating with the financial sustainability risk rating.
2015/16
ANNUAL PLAN
Q1
Q2
Q3
Q4
Continuity of Service Rating
4
3
na
na
na
Financial Sustainability Risk Rating
4
na
2
2
2
Governance Rating
Green
Green
Green
Green
Green
ANNUAL PLAN
Q1
Q2
Q3
Q4
4
4
4
4
4
Green
Green
Green
Green
Green
2014/15 Continuity of Service Rating Governance Rating
The Trust achieved a 2 rating for Continuity of Service. The Trust achieved a green rating for governance.
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Annual Report and Accounts 2015/16
ANNUAL GOVERNANCE STATEMENT 1. SCOPE OF RESPONSIBILITY
The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of the policies, aims and objectives of South Central Ambulance Service NHS Foundation Trust (SCAS), to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in SCAS for the year ended 31 March 2016 and up to the date of approval of the annual report and accounts.
As Accounting Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of South Central Ambulance Service NHS Foundation Trust’s policies, aims and objectives, whilst safeguarding the public funds and departmental assets for which I am personally responsible, in accordance with the responsibilities assigned to me. I am also responsible for ensuring that South Central Ambulance Service NHS Foundation Trust is administered prudently and economically and that resources are applied efficiently and effectively. I also acknowledge my responsibilities as set out in the NHS Foundation Trust Accounting Officer Memorandum.
3. CAPACITY TO HANDLE RISK The Risk Management Strategy comprehensively sets out arrangements in respect of the accountability for risk management in SCAS.
2. THE PURPOSE OF THE SYSTEM OF INTERNAL CONTROL
LEADERSHIP èè as Chief Executive and Accounting Officer I have overall accountability for ensuring that the organisation has effective risk management systems in place. I have delegated specific areas of risk management activity to each of the Executive Directors; for example, as follows:
The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness.
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ÒÒ the Director of Patient Care has day-to-day responsibility for managing the strategic development and implementation of organisational risk management, clinical effectiveness and clinical governance. This includes acting as the designated lead for a range of responsibilities such as health and safety, security management, and infection prevention and control ÒÒ the Medical Director has responsibility for the management and development of clinical standards ÒÒ the Director of Finance has responsibility for financial risk management and, in the role of Senior Information Risk Owner, for risks relating to information ÒÒ the Chief Operating Officer has responsibility for managing the strategic development and implementation of clinical and non-clinical risk management (operational risks) associated with the provision of emergency ambulance services, NHS 111 and fleet management, as well as being the lead for emergency planning and business continuity activities ÒÒ the Director of Strategy, Business Development, Communications and Engagement has responsibility for managing the risks associated with the provision of non-emergency ambulance services, including patient transport services èè the Board, with overall responsibility for governance, considers the risks faced by the Trust on a regular basis. For example, it receives the Board Assurance Framework at each public Board meeting.
èè the Quality and Safety Committee, with delegated authority from the Board, monitors and reviews the Trust’s clinical governance arrangements èè the Audit Committee, also with delegated authority from the Board, receives the Board Assurance Framework and strategic risk register at every meeting, with the purpose of seeking assurance that effective risk management practice is in place èè the Executive Team, underpinned by the work of its various subcommittees, receives and reviews updates from all directorates relating to risk management, as well as the Trust’s Board Assurance Framework and strategic risk register èè the Executive Team has also established a Risk, Assurance and Compliance Committee. This committee, comprising the Executive Directors of the Trust and the Company Secretary, carries out a deep-dive review of the Trust’s biggest risks and ensures that appropriate mechanisms are in place to provide assurance over the management of those risks
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TRAINING
The key elements of our strategy are to:
èè officers involved in leading the Trust’s risk management processes (e.g. Head of Risk and Security Management, Clinical and Non Clinical Risk Managers) are suitably qualified and experienced governance and risk management professionals. A wide range of training has been delivered to staff to enable them to manage identified clinical and non-clinical risks effectively. This training has been informed by a detailed training needs analysis based on external training requirements outlined by the NHSLA and CQC, in addition to training needs identified internally by the Trust. Our corporate induction training programme for new staff covers health and safety, awareness of risk, and incident reporting. èè the Trust has a very positive culture of incident reporting. The team structure in place enables immediate raising of concerns with on duty team supervisors who are able to directly support the reporting of incidents and the actual investigation, and can apply actions to mitigate. Incidents are monitored and reviewed at different levels of the organisation, including by a Serious Incidents Requiring Investigation Review (SIRI) Group, to ensure trends and patterns are identified and responded to where appropriate.
èè integrate risk management into the Trust’s culture and everyday management practice by clearly defining the Trust’s approach and commitment to risk management, by raising staff awareness, and building knowledge and skills èè provide clearly documented responsibilities and structure for managing risk to ensure a coordinated, standard methodology is adopted by every directorate/ department èè encourage and support incident reporting in a culture to ensure that the Chief Executive and Board are provided with evidence that risks are being appropriately identified, assessed, addressed and monitored èè adopt an integrated approach to risk management, whether the risk relates to clinical, organisational, health and safety or financial risk, through the processes and structures detailed in the Trust’s Risk Management Policy èè accept that whilst the provision of health care is not risk free, the Trust will aim to minimise the adverse effects of any risks through management of risk via the Quality and Safety Committee and Audit Committee both of which are sub committees of the Board IDENTIFICATION OF RISK A range of tools are used to identify and control risks, including: èè the monthly Integrated Performance Report, including SIRIs èè review of adverse incidents and accident reports èè quarterly reviews of claims and complaints èè workforce engagement and leadership walkarounds èè annual fire safety inspections
4A. THE RISK AND CONTROL FRAMEWORK STRATEGY The Trust has a comprehensive Risk Management Strategy which is reviewed periodically (e.g. annually), and updated where required.
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èè health and safety risk assessments èè review of performance against the NHSLA Risk Management Standards èè self-assessments against the Care Quality Commission essential standards of quality and safety
These include internal checking mechanisms, internal and external audit reviews, and a comprehensive review of the monthly Integrated Performance Report by the Executive Team prior to being presented to the Board. KEY STRATEGIC RISKS
The risks are identified through careful triangulation of the themes across the above reporting mechanisms recognising issues that affect patient safety, treatment and experience as the most reliable indicators.
We have a range of key strategic risks, which we have identified and are proactively managing. The Board considers the Board Assurance Framework at every Board meeting in public, and at the final meeting of 2015/16 (in March 2016) the submitted BAF had seven red risks. The red rated risks related to the following categories: inconsistency in the delivery of responsive and clinically excellent services; risks to patient safety, patient confidence and Trust reputation arising out of issues in the South East Hampshire health economy; poor IT resilience; financial performance and delivery of cost improvement programme savings; managing sickness absence; and the recruitment and retention of staff.
APPETITE FOR RISK The Trust acknowledges that delivery of healthcare and, in particular, the provision of ambulance services, will always involve a degree of risk (potentially heightened during periods of demand and change management). However, the Trust is fully committed to taking all necessary actions to ensure that risk is both minimised and mitigated. We adopt a positive approach to risk management and are particularly cautious on matters affecting our reputation, or when pursuing new service developments.
Comprehensive action plans are in place for all of the risks reported in the BAF.
QUALITY GOVERNANCE ARRANGEMENTS
NHS FOUNDATION TRUST LICENCE CONDITION 4 – FT GOVERNANCE
The key elements of our quality governance arrangements are set out in the periodic self-assessments we undertake against the Monitor Quality Governance Framework, and report to the Board.
The Trust undertakes periodic reviews of its position against all of the conditions contained within its Monitor provider licence, and reports to the Board accordingly. No risks have been identified within 2015/16.
We are either compliant (mostly) or partly compliant for all elements. Performance information is key to ensuring delivery of quality, and we have rigorous processes in place to ensure the quality of performance data.
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In terms of condition 4 – FT governance, the Trust has undertaken a number of steps during 2015/16 to identify any potential risks, including:
4C. COMPLIANCE WITH NHS PENSION SCHEME REGULATIONS
èè it has carried out a high-level review of the Trust’s corporate governance arrangements against the Monitor Code of Governance, including a review of the Board’s sub-committees and Non Executive Director responsibilities; èè it assessed in detail the requirements of the Monitor Corporate Governance Statement declarations, presenting a selfassessment with supporting evidence to the Board in May 2015.
As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments into the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations.
INVOLVEMENT OF PUBLIC STAKEHOLDERS
4D. COMPLIANCE WITH EQUALITY, DIVERSITY AND HUMAN RIGHTS LEGISLATION
Public stakeholders are involved in the management of risks which impact on them through the work of the governors, public meetings of the Board, and our attendance at Health Overview and Scrutiny Committee meetings. Our engagement with our stakeholders produces an additional layer of scrutiny and challenge from broad representative areas of our population groups and therefore enables SCAS to remain grounded and responsive to the communities we serve.
Control measures are in place to ensure that all the organisation’s obligations under equality, diversity and human rights legislation are complied with. Equality impact assessments are integrated into the core business of the Trust by ensuring that all policies have an equality impact assessment completed. In addition all papers presented to the Board highlight any relevant equality and diversity issues and implications.
4B. COMPLIANCE WITH CQC REGISTRATION REQUIREMENTS The Foundation Trust is fully compliant with the registration requirements of the Care Quality Commission (CQC). The next CQC inspection of SCAS is taking place in May 2016.
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4E. COMPLIANCE WITH CLIMATE CHANGE ADAPTATION REPORTING TO MEET THE REQUIREMENTS UNDER THE CLIMATE CHANGE ACT
èè the Trust’s monthly Operational Performance Reviews are designed to review performance against key financial, operational, clinical and workforce targets as agreed at the start of the year. In addition, a programme of visits by directors across the service gives additional assurance on the management of the organisation èè the Trust routinely carries out benchmarking reviews of its performance and efficiency levels with other NHS bodies, including those in the ambulance sector. It also benchmarks sickness and recruitment and retention rates. èè the Board receives regular reports on the performance of the estate against a set of key performance indicators. These have been developed to report on criteria such as the physical condition, statutory compliance, functional stability, efficient utilisation and energy performance of the estate. èè the Trust has in place governance and financial policies which include standing financial instructions, standing orders and a scheme of delegation. These policies prescribe the Trust’s policy for the effective procurement of goods and services within the Trust. èè an annual programme of internal audits, monitored closely by the Audit Committee, allows further assurance to be given to the Board on the use of its resources.
The Foundation Trust has undertaken risk assessments and Carbon Reduction Delivery Plans are in place in accordance with emergency preparedness and civil contingency requirements, as based on UKCIP 2009 weather projects, to ensure that this organisation’s obligations under the Climate Change Act and the Adaptation Reporting requirements are complied with.
5. REVIEW OF ECONOMY, EFFICIENCY AND EFFECTIVENESS OF THE USE OF RESOURCES There are a number of key processes in place to ensure that resources are used economically, efficiently and effectively, which include: èè the Board has regularly reviewed the economy, efficiency and effectiveness of resources through the regular performance management reports (the Integrated Performance Report, finance reports, and quality and safety reports) considered at each meeting èè savings targets are set annually in the form of cost improvement programmes. The Trust has a strong track record in terms of delivering annual savings targets, whilst ensuring that quality of service is in no way compromised
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6. INFORMATION GOVERNANCE
èè the content of the Quality Report is not inconsistent with internal and external sources of information èè the officers accountable for the preparation of the Quality Report have the necessary skills and experience èè appropriate processes have been used to develop and quality assure the Quality Report ensuring that it represents a balanced view of performance; this has included scrutiny by the Audit Committee and Quality and Safety Committee èè the performance information reported in the Quality Report is reliable and accurate èè there are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm they are working effectively in practice èè the data underpinning the measures of performance reported in the Quality Report are robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review.
Information governance and data security risks are identified through the use of the NHS Connecting for Health Information Governance Toolkit. Risks are recorded in the risk register and managed via specific action plans which are subject to regular review by the Trust’s Information Governance Steering Group. The Trust has carried out a self assessment against the 2015/16 Information Governance Toolkit, achieving an overall score of 72%. This compares with a score of 71% in 2014/15. There have been no reportable information security breaches during 2015/16.
7. ANNUAL QUALITY REPORT The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial year. Monitor has issued guidance to NHS Foundation Trust Boards on the form and content of annual Quality Reports which incorporate the above legal requirements in the NHS Foundation Trust Annual Reporting Manual.
8. REVIEW OF EFFECTIVENESS As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of internal control. My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, clinical audit and the executive managers and clinical leads within the NHS Foundation Trust who have responsibility for the development and maintenance of the internal control framework.
In preparing the Quality Report which is included within the Annual Report, the Trust’s Directors have taken steps to satisfy themselves that: èè the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2015/16
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èè staff satisfaction surveys èè Care Quality Commission reports èè the Quality Accounts and Annual Report
I have drawn on the content of the Quality Report attached to this Annual Report and other performance information available to me. My review is also informed by comments made by the external auditors in their management letter and other reports. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the Audit Committee, the Quality and Safety Committee, and the Risk Assurance and Compliance Committee, and a plan to address weaknesses and ensure continuous improvement of the system is in place.
There have been three particular key sources of assurance for me in 2015/16: èè in November 2015, a planned, focused inspection of our NHS 111 services was undertaken by the Care Quality Commission. This concluded that our NHS 111 services are safe, effective, responsive and well-led èè we have retained a “green” governance rating from our regulator Monitor (now NHS Improvement) throughout 2015/16 èè we received an annual Head of Internal Audit Opinion for 2015/16 of “moderate assurance”, defined as “generally a sound system of internal control designed to achieve system objectives with some exceptions”.
Executive managers within the organisation who have responsibility for the development and maintenance of the system of internal control provide me with assurance. The Board Assurance Framework itself provides me with evidence that the effectiveness of controls that manage the risks to the organisation achieving its principal objectives have been reviewed. My review during 2015/16 has also been informed by:
9. CONCLUSION My review confirms that South Central Ambulance Service NHS Foundation Trust has a generally sound system of internal control that supports the achievement of its policies, aims and objectives. No significant internal control issues have been identified in relation to the 2015/16 financial year.
èè internal and external audit reports èè the Annual Audit/Management Letter èè the Head of Internal Audit Opinion èè reports to the Board from the Audit Committee, and Quality and Safety Committee èè reviews of serious incidents requiring investigation and the associated learning from these èè reports to the Executive Management Committee from its relevant sub-committees, as well as the work of the Risk, Assurance and Compliance Committee èè the monthly Integrated Performance Report, which covers clinical, operational, service development, financial and human resources
Will Hancock, Chief Executive Date: 25 May 2016
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BOARD OF DIRECTORS All Board members (executive and nonexecutive) have joint responsibility for decisions of the Board and share the same liability.
The Trust’s Board of Directors (the “Board”) held six Board meetings in public between 1 April 2015 and 31 March 2016. The agendas, papers, presentations, and minutes of Board meetings are available on the Trust’s website.
All members also have responsibility to constructively challenge the decisions of the Board and help develop proposals on priorities, risk mitigation, values, standards and strategy.
DECISIONS TAKEN BY THE BOARD AND DELEGATED TO MANAGEMENT
The Board delegates certain powers to its sub-committees (not including executive powers unless expressly authorised). The executive team is responsible for the day-to-day running of the organisation and implementing decisions taken at a strategic level by the Board.
The Board has overall and collective responsibility for the exercising of the powers and the performance of the Trust, and its duties include to: èè provide effective and proactive leadership of the Trust èè ensure compliance with the provider license, constitution, mandatory guidance issued by Monitor, and other relevant statutory obligations èè set the Trust’s strategic aims at least annually, taking into consideration the views of the Council of Governors, ensuring that the necessary resources are in place for the Trust to meet its main priorities and objectives èè ensure the quality and safety of healthcare services for patients, education, training and research delivered by the Trust, applying the relevant principles and standards of clinical governance èè ensure that the Trust exercises its functions effectively, efficiently and economically, including in relation to service delivery èè set the Trust’s visions, values and standards of conduct and ensure that its obligations to patients and other key stakeholders are delivered
BOARD OF DIRECTORS BALANCE The Board continually reviews its composition to ensure that it reflects the skills and competencies required to enable the Trust to fulfil its obligations. The Board started 2015/16 with six Non Executive Directors, including the Chairman, and six Executive Directors, including the Chief Executive. During this period, the Chairman had a second/ casting vote for any decisions requiring a vote of the Board of Directors. One Non Executive Director joined the Board during the course of 2015/16 (in March 2016) as part of the Board’s NED succession planning arrangements.
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There was a change in the Chief Operating Officer role, and the Interim Director of Human Resources was substantively appointed to the position of Executive Director of Human Resources and Organisational Development in March 2016, meaning the Board ended the year with seven Non Executive Directors, including the Chairman, and seven Executive Directors, including the Chief Executive. All fourteen members had voting rights, with the Chairman having a second/ casting vote for any decisions requiring a vote of the Board of Directors.
èè a Board Evaluation Review was undertaken by an independent body (NHS Thames Valley and Wessex Leadership Academy), using consultants with extensive knowledge of NHS Boards and leadership. The review was commissioned to obtain an independent view on the functioning of the Board and its effectiveness, and also to provide further information to support ongoing executive and non-executive succession planning arrangements All three processes reached positive conclusions about the effectiveness of the SCAS Board of Directors, with a report on the outcomes being presented at the first Board meeting in public in 2015/16.
BOARD OF DIRECTORS PERFORMANCE EVALUATION AND REVIEW
The focus of the Board during 2015/16 has been on addressing the areas for further improvement that were identified as part of these three reviews.
The Board undertook a significant review of its functioning and performance during the second half of 2014/15, with three key independent evaluations:
There has also been a strong focus on NED succession planning, with the Trust’s governors working closely with the Chairman and Vice-Chair/Senior Independent Director to identify the skills and expertise required by the Trust going forward, and in light of three Non Executive Directors due to leave when their final terms of office end during the course of 2016/17. Two new Non Executive Directors were appointed early in 2016.
èè a review of Board governance was undertaken by an independent consultant (with extensive knowledge of the ambulance sector and corporate governance), shaped by Monitor’s Well-Led Framework for Governance Reviews: Guidance for NHS Foundation Trusts èè the Trust was subject to a pilot inspection by the Care Quality Commission under the new A Fresh Start for the Regulation of Ambulance Services approach; this looked at aspects of Board and management leadership
In addition, to the processes outlined above, the Board has a systematic approach to assessing its collective performance including through the appraisal system. Reviews of the effectiveness of the key Board committees (e.g. Audit, Quality and Safety, Charitable Funds, and Remuneration) are undertaken annually and presented to the Board.
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GOVERNANCE
The Board continues to apply the Fit and Proper Person Requirement regulations, satisfying itself that all current and newly appointed Board members fulfil the requirements. At each Board meeting in public, Board members are asked to declare whether there are any new factors which may impact on their ability to be regarded as ‘fit and proper’.
The Board uses Monitor’s NHS Foundation Trust Code of Governance as best practice advice to improve governance practices across the Trust. Furthermore the effectiveness of the Trust’s governance arrangements is regularly assessed, including through internal audit. The Trust had one area of noncompliance with the Monitor Code during 2015/16. For most of the year, there was an equal number of voting Non Executive and Executive Directors (whilst the Trust carried out a detailed review of its NED succession planning arrangements), rather than an excess of the former over the latter, as recommended in the Code. To mitigate this, the Chairman has had a second/ casting vote should any Board decisions have required a vote, although this has not proven to be necessary.
NON EXECUTIVE DIRECTORS Non Executive Directors are members of the Board of Directors. They are not involved in the day to day running of the business, but are instead guardians of the governance process and monitor the executive activity as well as contributing to the development of strategy. They have four specific areas of responsibility – strategy, performance, risk and people – and should provide independent views on resources, appointments and standards of conduct.
The Trust was compliant with its Constitution at all times throughout 2015/16, making some minor amendments with the approval of the Board of Directors and Council of Governors.
Non Executive Directors have a particular duty to ensure appropriate challenge is made, and that the Board acts in the best interests of the public. They should:
The Board operates within a comprehensive structure and with robust reporting arrangements, which facilitates good information flows between the Board of Directors, various committees, and the Council of Governors.
èè bring independence, external skills and perspectives, and challenge strategy development èè scrutinise the performance of, and hold to account, the executive management in meeting agreed objectives, receive adequate information, and monitor the reporting of performance. èè satisfy themselves as to the integrity of financial, clinical and other information, and that financial and clinical quality controls and systems of risk management and governance are robust and implemented.
The Trust maintains a register of Board members interests, gifts and hospitality, and this is presented on an annual basis at one of the Trust’s Board meetings in public. Board members are also asked to declare any new interests at each meeting of the Board, or highlight any existing interest that might be relevant to the discussions at that meeting.
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èè be responsible for determining appropriate levels of remuneration of executive directors and have a prime role in appointing, and where necessary removing, executive directors, and in succession planning. The Chair is one of the Non Executive Directors and is personally responsible for the leadership of the Board of Directors and the Council of Governors, ensuring their effectiveness on all aspects of their role and setting their agenda.
NED
DATE APPOINTED TO FT BOARD
CURRENT TERM OF OFFICE
TERM (RESET AT FT)
Trevor Jones (Chair)
1 March 2012
31 March 2017
Second/final
Alastair Mitchell-Baker (Vice-Chair / Senior Independent Director)
1 March 2012
28 February 2017
Second/final
Ilona Blue
1 March 2012
28 February 2018
Second
Nigel Chapman
1 March 2016
28 February 2019
First
Mike Hawker
1 January 2014
31 December 2017
First
Keith Nuttall
1 March 2012
31 March 2017
Second/final
Professor David Williams
1 March 2012
31 December 2017
Second
Details of each Non Executive Director Board member, including any declared interests, can be seen on the Trust’s website at www.scas.nhs.uk.
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EXECUTIVE DIRECTORS Non Executive Directors are members of the Board of Directors. The Executive Directors are responsible for the dayto-day running of the organisation, and the Chief Executive, as Accounting Officer, is responsible for ensuring that the organisation works in accordance with national policy and public service values, and maintains proper financial stewardship. The Chief Executive is directly accountable to the Board for ensuring that its decisions are implemented. At the end of the 2015/16 financial year there were seven voting Executive Directors on the Trust Board:
EXECUTIVE DIRECTOR
POSITION
Will Hancock
Chief Executive
Philip Astle
Chief Operating Officer
John Black
Medical Director
Charles Porter
Director of Finance
Melanie Saunders
Director of Human Resources and Organisational Development
Deirdre Thompson
Director of Patient Care
James Underhay
Director of Strategy, Business Development, Communications and Engagement
Sue Byrne, Chief Operating Officer left the Trust in March 2016, and was replaced by Philip Astle. Details of each Executive Director Board member, including any declared interests, can be seen on the Trustâ&#x20AC;&#x2122;s website at www.scas.nhs.uk.
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BOARD COMMITTEES The Board has four committees: Audit, Quality and Safety, Remuneration, and Charitable Funds. The Audit and Quality and Safety Committees jointly oversee governance, quality and risk within the organisation and provide assurance to the Board. The Audit Committee also seeks assurance that financial reporting and internal control principles are applied. Its members at the end of 2015/16 were Mike Hawker (Chair), Ilona Blue and Professor David Williams, five meetings were held during 2015/16. The main focus of the Quality and Safety Committee is to enhance Board oversight of quality performance, and probe quality and care issues. Its members at the end of 2015/16 were Professor David Williams (Chair), Alastair Mitchell-Baker and Keith Nuttall; three meetings were held during 2015/16. Nigel Chapman will join the committee from 1 April 2016. The Remuneration Committee is responsible for ensuring that a policy and process for the appointment, remuneration and terms of service, and performance review and appraisal, of the Chief Executive, Executive Directors and senior managers are in place. Its members at the end of 2015/16 were Alastair Mitchell-Baker (Chair), Trevor Jones, and Ilona Blue, and five meetings were held during 2015/16. The Charitable Funds Committee acts with delegated authority from the Board (the corporate trustee) to ensure that the SCAS NHS Charity operates with appropriate governance. Its members at the end of 2015/16 were Keith Nuttall (Chair) and Mike Hawker; Nigel Chapman will join the committee from 1 April 2016. Four meetings were held during 2015/16.
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LILI RATCLIFFE Paramedic Newbury Resource Centre Lili joined SCAS as a paramedic in September 2012, having spent two years studying her Foundation Degree in Paramedic Emergency Care at Oxford Brookes University. Prior to this she had volunteered for the British Red Cross providing first aid at events and worked as a health care assistant on a trauma ward in hospital for a year. During her course at Oxford Brookes University, Lili undertook placements at our Bracknell and Wexham ambulance stations but is now based permanently at Newbury where she works a range of 8, 10 and 12 hour shifts across weekends, days and nights. “The job itself is both physically and mentally challenging, but the best part of it is seeing the positive change in the patients I treat. I am very lucky to work in an autonomous environment in which I strive to provide the best care possible to the patients I see, often when working alone. It can be a challenge to maintain a healthy work / life balance, especially in my case as I am also studying part-time at the University of the West of England for a BSc in Applied Paramedic Science. But the satisfaction I get from helping patients, seeing and hearing the gratitude from them and their families and knowing I’ve made a real difference to their lives is incredibly rewarding.”
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THE AUDIT COMMITTEE
EXTERNAL AUDIT
The Audit Committee is a statutory committee of the Board comprising Non-Executive Directors of the Trust, all of whom are considered independent. There were five meetings during 2015/16 and all of its members attended each of those meetings. Members of the Audit Committee were Mike Hawker (Chair), Ilona Blue and Professor David Williams.
The Trust appointed KPMG as its auditors, following a competitive tender process, for the 2012/13 financial statements for an initial period of three years with an option to extend for a further two years. Following a recommendation made from the Committee to the Council of Governors (COG), KPMG’s term of office was extended for a further two years.
Other managers are regular attendees of the Audit Committee which includes the Director of Finance, Director of Patient Care and the Company Secretary. Representatives of External Audit, Internal Audit and the Counter Fraud Team are also in regular attendance. Other managers also attend the Audit Committee on an irregular basis.
KPMG attend every committee reporting on progress and developments that are likely to impact on the final accounts. The effectiveness of internal and external audit is reviewed on a periodic basis by the Audit Committee. KPMG have attended COG meetings from time to time. There was no non-audit work undertaken by KPMG on behalf of the Trust in 2015/16. The value of statutory audit work undertaken was £63k compared to £60k in 2014/15 and includes £11k in relation to work on the Quality Accounts.
The Audit Committee’s responsibilities include: èè Review Trust’s draft accounts and make recommendations with regard to their approval to the Board èè Provide assurance to the Board as to the effectiveness of internal controls and the risk management processes that underpin them èè Agree annual plans for external audit, internal audit and counter fraud èè Make recommendations to the Council of Governors regarding the appointment of the External Auditors.
SIGNIFICANT ISSUES At its meeting on 4 May 2016, the Audit Committee considered matters relating to the 2015/16 accounts which included the following: ACCOUNTING FOR SOUTH CENTRAL FLEET SERVICES LTD The Audit Committee was requested to note that the Trust Accounts included the results of South Central Fleet Services Ltd which is a wholly owned subsidiary of SCAS. The accounting statements included the results of the Group which included Trust and the Company and Trust results excluding the Company.
In discharging its responsibilities, the Committee reviews taking into account the Board Assurance Framework, the Trust’s Risk Registers and the work of other Board Committees such as the Quality and Safety Committee.
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NHSD Activities Ongoing activities in relation to NHSD were discussed by the Committee and the accounting treatment of these activities was discussed by the Committee. ANALYSIS OF NOTES RELATING TO EXPENDITURE The Committee discussed at length the presentation of expenditure. It was agreed that transport related expenditure, as previously reported, included an element relating to purchase of healthcare. It was agreed that this should be shown as a separate line in the operating expenses note (5.1) including previous year comparatives. In addition it was agreed that premises expenditure should be divided into premises and information technology including prior year comparatives. GOING CONCERN The Committee sought assurance in relation to the going concern declaration in the light of the Trustâ&#x20AC;&#x2122;s reported deficit for 2015/16. It was recommended that some further analysis work be undertaken in relation to projected future cash flows, and that the going concern was expanded to explain the background of the deficit, but the declaration could be made that the Trust had adequate resources to continue operating into the foreseeable future. Mike Hawker Audit Committee Chairman 25 May 2016
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ATTENDANCE AT MEETINGS DURING 2015/16 The attendance at meetings / teleconferences during 2015/16 of those who have served on the Board, and reflecting their membership of the various committees, is as follows:
NON EXECUTIVE DIRECTORS Name
Trust Board
Audit Committee
Quality and Safety Committee
Remuneration Committee
Charitable Funds Committee
Total meetings
6
5
3
5
4
Trevor Jones
6
n/a
n/a
4
n/a
Alastair Mitchell-Baker
6
n/a
2
5
n/a
Ilona Blue
6
5
n/a
4
n/a
Nigel Chapman
1/1
n/a
n/a
n/a
n/a
Mike Hawker
6
5
n/a
n/a
4
Keith Nuttall
6
n/a
3
n/a
4
Professor David Williams
5
5
3
n/a
n/a
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EXECUTIVE DIRECTORS Name
Trust Board
Audit Committee
Quality and Safety Committee
Remuneration Committee
Charitable Funds Committee
Total meetings
6
5
3
5
4
Will Hancock
6
n/a
n/a
4
n/a
Philip Astle
1/1
n/a
n/a
n/a
n/a
John Black
6
n/a
1
n/a
n/a
Sue Byrne
4/4
n/a
n/a
n/a
n/a
6
5
n/a
n/a
4
Melanie Saunders
1/1
n/a
n/a
1/1
n/a
Deirdre Thompson
6
n/a
3
n/a
n/a
James Underhay
6
n/a
n/a
n/a
n/a
Charles Porter
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OPERATIONAL AND FINANCIAL REVIEW The Group, which includes the results of the Trust and South Central Fleet Services Ltd (a wholly owned subsidiary of SCAS incorporated in September 2015), reported a deficit in 2015/16 of £3.7m from its continuing operations. There was a benefit of £2.5m relating to lower NHSD direct liabilities which was a reversal of expenditure recognised in discontinued activities in 2014/15, therefore the overall deficit of the Trust was £1.2m. The Trust has faced significant operational pressures which has resulted in increased costs. Therefore despite an increased income base, Trust expenditure has risen faster than income. The method of calculation for the continuity of service risk rating was amended in year to include two new measures; an income and expenditure margin rating and an income and expenditure margin variance rating. The Trust achieved an overall 2 for the new continuity of service risk rating (where 4 is the highest rating) which reflects a material risk.
SUMMARY OF FINANCIAL PERFORMANCE èè On Income and Expenditure the Trust reported an operating deficit of £3.7m for the year and £1.2m after taking into account discontinued activities èè Earnings Before Interest, Tax, Depreciation and Amortisation (EBITDA) of £6.2m represented 3.5% of turnover which is £2.2m below last year and £3.2m below plan for the year
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èè Capital expenditure was £5.9m (£11.4m in 2014/15) which was predominantly for replacement of ambulances èè The year-end cash balance was £19.9m which was a reduction of £7.1m when compared to the previous year. The main reductions in cash were due to the impact of the deficit above (£3.7m), the part repayment of long term loan (£1.7m) and an adverse movement in working capital (£1.7m) èè It has been a financially challenging year but we still managed to achieve £6.4 million of cost improvements in 2015/16 which was just £0.2m below plan èè Total revenue income to meet pay and other day to day running costs reached £175.0m of which the majority was secured through various service level agreements with clinical care commissioning groups and hospital NHS trusts. èè The accounts are stated in accordance with International Financial Reporting Standards. Total fixed assets (land, buildings and capital equipment) of the Trust were valued at £69.4m (£69.8m in 2015) èè The Trust formed a subsidiary company (South Central Fleet Services Ltd) to provide fleet services which was incorporated in September 2015 and commenced trading on 1 November 2015. The results of the activities of the company are included in the group results with the company recording a deficit of £57k for the five months ending 31 March 2016.
Annual Report and Accounts 2015/16 Annual Report and Accounts 2015/16
ANALYSIS OF INCOME The Trust reported income of £175.1 million for the year end 31 March 2016 (2015: £172.6 million). The increase of over 1.4% was firstly due to increased 999 income relating to more patients calling the 999 service, and income to fund an investment in recruitment and development of staff. Secondly it related to higher income in our non–emergency patient transport services following the expansion of the service in Hampshire. The Trust’s principal source of income is from local NHS commissioning contracts for the provision of the emergency service. This income totalled £124.6 million (£120.3 million in 2015) which represented 71.2% of the Trust turnover (2015: 70%). The Trust confirms that the NHS income it receives for the provision of healthcare exceeds its income received for any other purpose in accordance with the requirements of the Health and Social Care Act 2012. The amount of income that the Trust received in this regard for 2015/16 was £168.7m representing 96.5% of total income.
£9.7m Other £15.2m 111 Call handling
£175.0m Total
£3.1m HART
£22.4m Patient Transport Servics
15/16
£124.6m Emergency services
£12.4m Other £15.7m 111 Call handling
£172.6m Total
£3.1m HART £21.1m Patient Transport Servics
//104
£120.3m Emergency services
14/15
//104
//Accountability Report
ANALYSIS OF OPERATING EXPENDITURE Total operating expenditure for the Group (excluding depreciation, amortisation and impairments) was £168.9 million for the year ended 31 March 2016 (2015: £163.9 million). The increase of 3.0% was mainly due to increased staff costs arising from the expansion of the non-emergency transport service and costs relating to the additional emergency frontline staff recruited and the development of our frontline workforce. Staff costs represent 65.1% of total operating expenditure (2015: 66.9 %). The increase in other expenditure is due to an increase in use of frontline ambulance private providers.
£168.9m Total £51.7m Other expenses
15/16 £4.5m Vehicle fuel
£109.9m Emergency services
£2.8 m Clinical supplies and drugs expenditure
£163.9m Total £51.3m Other
14/15 £103.9m Staff
£4.8m Vehicle fuel £3.9m Clinical supplies & drugs expenditure
//105
//105
Annual Report and Accounts 2015/16
CAPITAL INVESTMENT Investment in capital resources for 2015/16 was £5.9 million (2014: £11.4 million) which was within the initial capital plan and within resources generated internally within the Trust. The Trust was able to replace all necessary front line ambulances and fund necessary infrastructure costs.
£0.4m Other
£5.9m Total
£1.5m Information Technology
15/16 £3.0m Fleet
£1.0m Estates £2.2m Other
£11.4m Total
£5.2m Fleet
14/15 £3.0m Information Technology £1.0m Estates
//106
//Accountability Report
GOING CONCERN After making enquiries, the Directors have a reasonable expectation that South Central Ambulance Service NHS Foundation Trust (SCAS) has adequate resources to continue in operational existence for the foreseeable future. For this reason SCAS continues to adopt the going concern basis in preparing the accounts.
DISCLOSURE OF INFORMATION TO THE AUDITORS As far as each of the Directors is aware, there is no relevant audit information of which the auditors are unaware. Each Director has taken all the steps a Director ought to have taken to make themselves of any relevant audit information and to establish that the auditors are aware of such information.
COST ALLOCATION AND CHARGING South Central Ambulance Service NHS Foundation Trust has complied with the cost allocation and charging requirements set out in HM Treasury and Office of Public Sector information guidance.
SICKNESS ABSENCE The overall sickness rate for the Trust for 2015/16 was 6.3% (5.9% in 2014/15) which equated to 14.2 days lost per person (13.3 days lost in 2014/15).
//107
Annual Report and Accounts 2015/16
REMUNERATION REPORT The Remuneration and Nominations Committee met six times during 2015/16, and in accordance with its terms of reference, considered and agreed the remuneration and terms of service of the Chief Executive and Executive Directors, being the only employees within the Trust currently covered by the Trustâ&#x20AC;&#x2122;s Remuneration Policy for Senior Trust Staff during the preceding year.
ANNUAL STATEMENT FROM CHAIR OF REMUNERATION COMMITTEE The Remuneration Committee regularly reviews the Remuneration Policy; the Committee is satisfied that the policy provides a framework for agreeing salaries and is consistent with the Monitor FT Code of Governance and the NHS Act 2006. The Committee benchmarks against similar sized Foundation Trusts but must also take into account other factors when reviewing executive director pay, to ensure pay is proportionate and justifiable. These include the local employment market, being situated in a high cost area, and also competing with the London recruitment market. As a result, remuneration levels are set to be sufficient to attract, retain and motivate Executive Directors of the quality and with the skills and experience required to lead the Trust.
In accordance with the policy, the Committee undertook a review of salaries informed by a benchmarking report, and agreed that salaries of five of the Executive team remained within current market rates. With the backing of the full Non Executive membership of the Board, the Committee approved increases in salaries from 1 April 2015 for five Executive Directors. In accordance with the policy, the Committee had agreed in 2013, that 5% of Executive salaries be available in 2015/16 for payment of non-consolidated bonuses where performance targets had been met in 2014/15. For consideration of a bonus to be paid, the Committee would first be assured that the Trust had met corporate targets; only then would the performance of individual directors be reviewed.
The Committee reviews performance of each Director each year before any decision regarding remuneration is made. The Trust takes its responsibility in approving all salaries seriously and acts in accordance with its responsibilities towards protecting public money. The Trust only has one Executive Director on a higher salary than the Prime Minister; this is as a result of a comprehensive review taking into account the scope of the role and the local labour market. Any future salary above ÂŁ142,500 would only be recommended to the Board by the Remuneration Committee where there was clear and justifiable evidence that this was appropriate.
Having undertaken this review, the Committee approved non-consolidated bonuses to be paid to five of the Executive Directors in July 2015. In 2015, the Committee again agreed that 5% of Executive salaries be available in 2016/17 for payment of non-consolidated bonuses where performance targets had been met in 2015/16.
//108
//Accountability Report
Following a review of the contractual arrangements of two other senior managers within the Trust, the committee agreed to offer the Very Senior Manager contract to both these managers during quarter 1 of 2015/16. The committee also agreed to appoint the new Charities Chief Executive Officer onto the VSM contract, during quarter 4 2015/16. During 2015/16 no decisions were made regarding the loss of office of Senior Trust staff resulting in severance payments.
Alastair Mitchell-Baker Chair Remuneration and Nominations Committee
//109
1
47.59
5 - 10
52.5 - 55
215 - 220
15 - 20
35 - 40
//110 0-5 157.5 25.48 6.18
Melanie Saunders (Director of Human Resources and Organisational Development) 5
Band of highest paid Director’s Total
Median Total Remuneration (£000)
Ratio
56.61
105 - 110
John Black (Medical Director) 7
0-5
5 - 10
Philip Astle (Chief Operating Officer) 4 35.93
0-5
110 - 115
Sue Byrne (Chief Operating Officer) 3, 6
110 - 115
0-5
110 - 115
Charles Porter (Director of Finance) 6
James Underhay (Director of Strategy and Business Development) 6
0-5
110 - 115
25 - 27.5
27.5 - 30
25 - 27.5
15 - 17.5
140 - 145
5 - 10
140 - 145
140 - 145
130 - 135
6.30
25.85
162.50
95 - 100
110 - 115
120 - 125
110 - 115
110 - 115
Taxable benefits to the nearest £100 53.94
36.28
11.11
22.95
22.46
21.88
5 - 10
5 - 10
5 - 10
5 - 10
Annual Performance related bonuses in bands of £5,000
Deirdre Thompson (Director of Patient Care) 6
150 - 155
15 - 20
32.5 - 35
22.5 - 25
37.5 - 40
22.5 - 25
62.5 - 65
All pension related benefits
150 - 155
0-5
15 - 20
Mike Hawker
10 - 15
15 - 20
2014/15
150 - 155
150 - 155
160 - 165
135 - 140
225 - 230
Total in bands of £5,000
William Hancock (Chief Executive)
Taxable benefits to the nearest £100 10 - 15
15 - 20
6
Annual Performance related bonuses in bands of £5,000
0
Professor David Williams (Non - Executive Director)
Nigel Chapman
All pension related benefits 0
10 - 15
2
Total in bands of £5,000
0
Keith Nuttall (Non - Executive Director)
Clare Carless (Non - Executive Director)
Ilona Blue (Non - Executive Director)
15 - 20
Alastair Mitchell - Baker (Non - Executive Director)
Salary (bands of £5,000) £000 35 - 40
Salary (bands of £5,000) £000
Trevor Jones (Chairman)
NAME AND TITLE
2015/16
Annual Report and Accounts 2015/16
DIRECTORS SALARIES AND BENEFITS FOR THE YEAR ENDED 31 MARCH 2016
Real increase in pension at age 60
(bands of £2,500)
//111 0 - 2.5
James Underhay (Director of Strategy and
Notes. 1. Clare Carless left the Trust on 31 March 2015 2. Nigel Chapman joined the Trust on 1 March 2016 3. Sue Byrne left the Trust on 31 March 2016. 4. Philip Astle joined the Trust on 14 March 2016 5. Melanie Saunders became a voting executive director on 23 March 2016
Dr John Black (Medical Director)
na
0 - 2.5
Sue Byrne (Chief Operating Officer)
Business Development)
0 - 2.5
age 60 (bands of £2,500)
Charles Porter (Director of Finance)
Real increase in pension lump sum at
na
0
0
0
2.5 - 5
March 2016 (bands of £5,000)
0 - 2.5
Total accrued pension at age 60 at 31
Deirdre Thompson (Director of Patient Care)
7.
6.
na
0
0
35 - 40
100 - 105
135 - 140
na
147
37
222
581
752
na
120
59
200
552
710
£000
na
25
22
21
22
33
£000
Will Hancock, Charles Porter, Sue Byrne, James Underhay and Deirdre Thompson were awarded an annual bonus based on individual performance against objectives, overall contribution to organisational performance, and their leadership in relation to activities undertaken in 2014/15 Dr John Black is a recharge from the Oxford University Hospitals NHS Foundation Trust
na
10 - 15
5 - 10
10 - 15
30 - 35
(bands of £5,000)
45 - 50
accrued pension at 31 March 2016
2.5 - 5
Lump sum at aged 60 related to
2.5 - 5
March 2016
£000
Cash Equivalent Transfer Value at 31
£000
March 2015
£000
Cash Equivalent Transfer Value at 31
£000
Transfer Value 31 March 2016
£000
Real increase in Cash Equivalent
Will Hancock (Chief Executive)
NAME AND TITLE
//Accountability Report
PENSIONS FOR THE YEAR ENDED 31 MARCH 2016
Annual Report and Accounts 2015/16
CASH EQUIVALENT TRANSFER VALUE
They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost.
A Cash Equivalent Transfer Value (CETV) is the actuarially completed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme.
CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. REAL INCREASE IN CETV
A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme.
This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period.
The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme.
Government Actuary Department (GAD) factors for the calculation of Cash Equivalent Transfer Factors (CETVs) assume that benefits are indexed in line with CPI which is expected to be lower than RPI which was used previously and hence will tend to produce lower transfer values.
EXPENSES Details of number and value of expenses claimed by governors and directors are attached below: 2014/15
2015/16 Total Total Number Number in Office Receiving Expenses
Aggregate Total Sum of Number Expenses in Office paid (£00)
Total Number Receiving Expenses
Aggregate Sum of Expenses paid (£00)
Governors 24
13
37
26
17
58
15
10
162
14
12
195
Directors
//112
//Accountability Report
FOREWORD TO THE ACCOUNTS South Central Ambulance Service NHS Foundation Trust These accounts for the twelve months ended 31 March 2016 are prepared in accordance with paragraphs 24 and 25 of schedule 7 to the NHS Act 2006 and comply with the annual reporting guidance within the NHS Foundation Trust Annual Reporting Manual.
Will Hancock Chief Executive Date: 25 May 2016
//113
Annual Report and Accounts 2015/16
CONSOLIDATED STATEMENT OF COMPREHENSIVE INCOME GROUP Note
2015/16 £000
2014/15 £000
Operating income from patient care activities
3
168,655
162,014
Other operating income
4
6,406
10,635
175,061
172,649
(177,194)
(171,276)
(2,133)
1,373
70
41
(171)
(104)
PDC Dividends payable
(1,465)
(1,260)
NET FINANCE COSTS
(1,566)
(1,323)
SURPLUS/(DEFICIT) FROM CONTINUING OPERATIONS
(3,699)
50
2,505
2,497
(1,194)
2,547
Impairments
-
1,534
Revaluations
-
(1)
(1,194)
4,080
TOTAL OPERATING INCOME FROM CONTINUING OPERATIONS Operating expenses
5
OPERATING SURPLUS/(DEFICIT) FROM CONTINUING OPERATIONS Finance income
10
Finance expense
Gain / (loss) from absorption and discontinuance of operations
13
SURPLUS/(DEFICIT) FOR THE YEAR Other comprehensive income Will not be reclassified to income and expenditure
TOTAL COMPREHENSIVE INCOME / (EXPENSE) FOR THE YEAR
The notes on pages 120 to 174 form part of these accounts.
//114
//Accountability Report
STATEMENTS OF FINANCIAL POSITION GROUP Note
31 March 2016 £000
TRUST
31 March 2015 £000
31 March 2016 £000
31 March 2015 £000
Non-current assets Intangible assets
14
3,403
3,324
3,369
3,324
Property, plant and equipment
15
66,005
68,424
63,239
68,424
Other investments
16
-
-
441
-
Other financial assets
20
TOTAL NON-CURRENT ASSETS
-
-
2,700
-
69,408
71,748
69,749
71,748
Current assets Inventories
17
1,031
946
684
946
Trade and other receivables
18
11,414
8,568
11,191
8,568
Other financial assets
20
-
-
300
-
Non-current assets for sale
21
2,950
2,950
2,950
2,950
Cash and cash equivalents
22
19,926
27,100
19,754
27,100
35,321
39,564
34,879
39,564
TOTAL CURRENT ASSETS Current liabilities Trade and other payables
23
(15,364)
(15,974)
(15,206)
(15,974)
Borrowings
25
(1,738)
(1,738)
(1,738)
(1,738)
Provisions
28
TOTAL CURRENT LIABILITIES TOTAL ASSETS LESS CURRENT LIABILITIES
(4,637)
(6,234)
(4,637)
(6,234)
(21,739)
(23,946)
(21,581)
(23,946)
82,990
87,366
83,047
87,366
Non-current liabilities Trade and other payables
23
(18)
(30)
(18)
(30)
Borrowings
25
(4,878)
(6,616)
(4,878)
(6,616)
Provisions
28
(8,044)
(9,476)
(8,044)
(9,476)
(12,940)
(16,122)
(12,940)
(16,122)
70,050
71,244
70,107
71,244
Public dividend capital
57,874
57,874
57,874
57,874
Revaluation reserve
10,998
11,061
10,998
11,061
Other reserves
(350)
(350)
(350)
(350)
Income and expenditure reserve
1,528
2,659
1,585
2,659
70,050
71,244
70,107
71,244
TOTAL NON-CURRENT LIABILITIES TOTAL ASSETS EMPLOYED Financed by
TOTAL TAXPAYERS’ AND OTHERS’ EQUITY
The financial statements on pages 114 to 119 were approved by the Board on 25 May 2016 and signed on its behalf by
Will Hancock Chief Executive
Date: 25 May 2016
//115
Annual Report and Accounts 2015/16
STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31 MARCH 2016
GROUP
£000
Other reserves * £000
Income and expenditure reserve £000
£000
57,874
11,061
(350)
2,659
71,244
Surplus/(deficit) for the year
-
-
-
(1,194)
(1,194)
Other transfers between reserves
-
(63)
-
63
-
57,874
10,998
(350)
1,528
70,050
Taxpayers’ equity at 1 April 2015 brought forward
TAXPAYERS' EQUITY AT 31 MARCH 2016
Public Dividend Capital £000
Revaluation Reserve
Total
STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31 MARCH 2015
GROUP
Public Dividend Capital £000
Revaluation Reserve £000
Other reserves * £000
Income and expenditure reserve £000
57,874
£000
9,535
(350)
105
67,164
Surplus/(deficit) for the year
-
-
-
2,547
2,547
Transfer from revaluation reserve to income and expenditure reserve for impairments arising from consumption of economic benefits
-
(7)
-
7
-
Impairments
-
1,534
-
-
1,534
Revaluations
-
(1)
57,784
11,061
Taxpayers’ equity at 1 April 2014 brought forward
TAXPAYERS' EQUITY AT 31 MARCH 2015
//116
Total
(1) (350)
2,659
71,244
//Accountability Report
STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31 MARCH 2016
TRUST
Taxpayers’ equity at 1 April 2015 brought forward
Public Dividend Capital £000
Revaluation Reserve £000
Other reserves * £000
Income and expenditure reserve £000
£000
57,874
11,061
(350)
2,659
71,244
(1,137)
(1,137)
Surplus/(deficit) for the year Other transfers between reserves TAXPAYERS' EQUITY AT 31 MARCH 2016
Total
-
(63)
-
63
-
57,874
10,998
(350)
1,585
70,107
STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31 MARCH 2015
TRUST
Taxpayers’ equity at 1 April 2014 brought forward
Public Dividend Capital £000
Revaluation Reserve £000
Other reserves * £000
Income and expenditure reserve £000
57,874
£000
9,535
(350)
105
67,164
(2,547)
(2,547)
Surplus/(deficit) for the year Transfer from revaluation reserve to income and expenditure reserve for impairments arising from consumption of economic benefits
Total
-
(7)
-
7
-
Impairments
-
1,534
-
-
1,534
Revaluations
-
(1)
-
-
(1)
57,874
11,061
(350)
2,659
71,244
TAXPAYERS' EQUITY AT 31 MARCH 2016
*Other Reserves was a residual balance required in 2006 when the Trust was formed from ambulance predecessor trusts to balance opening net assets with taxpayers’ equity.
//117
Annual Report and Accounts 2015/16
INFORMATION ON RESERVES PUBLIC DIVIDEND CAPITAL Public dividend capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS trust. Additional PDC may also be issued to NHS foundation trusts by the Department of Health. A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable to the Department of Health as the public dividend capital dividend. REVALUATION RESERVE Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent that, they reverse impairments previously recognised in operating expenses, in which case they are recognised in operating income. Subsequent downward movements in asset valuations are charged to the revaluation reserve to the extent that a previous gain was recognised unless the downward movement represents a clear consumption of economic benefit or a reduction in service potential. INCOME AND EXPENDITURE RESERVE The balance of this reserve is the accumulated surpluses and deficits of the NHS foundation trust.
//118
//Accountability Report
STATEMENT OF CASH FLOWS GROUP
TRUST
2015/16 £000
2014/15 £000
2015/16 £000
2014/15 £000
(2,133)
1,373
(2,076)
1,373
8,249
7,297
8,247
7,297
-
(299)
-
(299)
(Gain)/loss on disposal of non-current assets
(14)
(188)
(14)
(188)
(Increase)/decrease in receivables and other assets
(2,951)
3,613
(2,728)
3,613
Cash flows from operating activities Operating surplus/(deficit) Non-cash income and expense Depreciation and amortisation Impairments and reversals of impairments
(Increase)/decrease in Inventories
(85)
97
262
97
Increase/(decrease) in payables and other liabilities
419
(28,206)
264
(28,206)
(3,065)
7,356
(3,065)
7,356
420
(8,957)
890
(8,957)
70
39
70
39
-
-
(441)
-
(1,132)
(1,800)
(1,177)
(1,800)
-
-
-
-
(5,818)
(8,683)
(3,057)
(8,683)
14
954
97
954
(6,866)
(9,490)
(4,508)
(9,490)
(1,738)
6,512
(1,738)
6,512
Increase/(Decrease) in Provisions NET CASH GENERATED FROM/(USED IN) OPERATING ACTIVITIES Cash flows from investing activities Interest received Purchase and sale of financial assets Purchase of intangible assets Sales of intangible assets Purchase of property, plant, equipment and investment property Sales of property, plant, equipment and investment property NET CASH GENERATED FROM/(USED IN) INVESTING ACTIVITIES Cash flows from investing activities Movement on loans from the Department of Health Other interest paid
(135)
(57)
(135)
(57)
PDC dividend paid
(1,360)
(1,421)
(1,360)
(1,421)
2,505
(3,820)
2,505
(3,820)
-
-
(3,000)
-
(728)
1,214
(3,728)
1,214
Increase/(decrease) in cash and cash equivalents
(7,174)
(17,233)
(7,346)
(17,233)
Cash and cash equivalents at 1 April
27,100
8,329
27,100
8,329
-
36,004
-
36,004
19,926
27,100
19,754
27,100
Financing cash flows of discontinued operations Cash flows from (used in) other financing activities NET CASH GENERATED FROM/(USED IN) FINANCING ACTIVITIES
Cash and cash equivalents transferred under absorption accounting CASH AND CASH EQUIVALENTS AT YEAR END
//119
Annual Report and Accounts 2015/16
NOTES TO THE ACCOUNTS 1 ACCOUNTING POLICIES AND OTHER INFORMATION
GOING CONCERN In the preparation of the year end accounts the Board is required to undertake an assessment confirming that the Trust will continue as a going concern (i.e. that it will continue in the business of healthcare provision in the foreseeable future).
BASIS OF PREPARATION Monitor is responsible for issuing an accounts direction to NHS foundation trusts under the NHS Act 2006.
The current economic environment for all NHS foundation trusts is challenging, with increasing demand and staffing shortages creating increasing financial and operating pressure. These factors have played a significant part in the Trustâ&#x20AC;&#x2122;s reported deficit for 2015/16.
Monitor has directed that the financial statements of NHS foundation trusts shall meet the accounting requirements of the Foundation Trust Accounting Reporting Manual (FT ARM) which shall be agreed with the Secretary of State. Consequently, the following financial statements have been prepared in accordance with the FT ARM 2015/16 issued by Monitor. The accounting policies contained in that manual follow IFRS and HM Treasuryâ&#x20AC;&#x2122;s Government Financial Reporting Manual (FReM) to the extent that they are meaningful and appropriate to NHS foundation trusts.
The FT ARM states that financial statements should be prepared on a going concern basis unless, management either intends to apply to the Secretary of State for the dissolution of the foundation trust without the transfer of the services to another entity, or has no realistic alternative but to do so. There has been no application to the Secretary of State for the dissolution of the Trust and financial plans have been developed and published for future years.
The accounting policies have been applied consistently in dealing with items considered material in relation to the accounts. ACCOUNTING CONVENTION
However, we plan to operate with a financial deficit in 2016/17 and therefore the Board has considered the principle of going concern, and the forecast cash requirements and facilities available to the Trust.
These accounts have been prepared under the historical cost convention modified to account for the revaluation of property, plant and equipment, intangible assets, inventories and certain financial assets and financial liabilities.
//120
//Accountability Report
Accordingly, the Directors’ have concluded that there is a reasonable expectation that the Trust will have access to adequate resources to continue with operational existence for the foreseeable future, and therefore will continue to adopt the going concern basis in preparing the accounts.
The Trust has taken advantage of section 408 of the Companies Act 2006 and elected not to prepare a Trust Statement of Comprehensive Income. The deficit for the year included in the financial statements of the Trust was £1.137m.
1.2 INCOME
1.1 CONSOLIDATION
Income in respect of services provided is recognised when, and to the extent that, performance occurs and is measured at the fair value of the consideration receivable. The main source of income for the Trust is contracts with commissioners in respect of health care services.
SUBSIDIARIES NHS Charitable Fund South Central Ambulance NHS Foundation Trust is the corporate trustee to South Central Ambulance Service (SCAS) NHS Charity. South Central Ambulance NHS Foundation Trust has considered the materiality of the current annual value of transactions and as a result has not consolidated the charitable fund results in to the Trust accounts.
Where income is received for a specific activity, which is to be delivered in a subsequent financial year, that income is deferred. Income from the sale of non-current assets is recognised only when all material conditions of sale have been met, and is measured as the sums due under the sale contract.
The SCAS Charity had total assets of £549k as at 31 March 2016 (31 March 2015: £593k). During 2015/16 the Charity received income of £122k (2014/15: £236k) and incurred expenditure of £166k (2014/15: £181k).
1.3 EXPENDITURE ON EMPLOYEE BENEFITS
South Central Fleet Services Ltd
SHORT-TERM EMPLOYEE BENEFITS
On 5 September 2015 the Trust established a wholly owned subsidiary company ‘South Central Fleet Services Ltd’. The Accounts show results for the Group and the Trust. The Group incorporates financial results for both the Trust and South Central Fleet Services Ltd.
Salaries, wages and employmentrelated payments are recognised in the period in which the service is received from employees. The cost of annual leave entitlement earned, but not taken by employees at the end of the period, is recognised in the financial statements to the extent that employees are permitted to carry-forward leave into the following period.
The Company began trading on 1 November 2015 and provides a range of fleet services to the Trust. The Trust’s investment in the company is £441,340 of share capital.
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1.5 PROPERTY, PLANT AND EQUIPMENT
PENSION COSTS NHS Pension Scheme
RECOGNITION
Past and present employees are covered by the provisions of the NHS Pension Scheme. The scheme is an unfunded, defined benefit scheme that covers NHS employers, general practices and other bodies, allowed under the direction of Secretary of State, in England and Wales. It is not possible for the NHS foundation trust to identify its share of the underlying scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme.
Property, plant and equipment is capitalised where: èè it is held for use in delivering services or for administrative purposes èè it is probable that future economic benefits will flow to, or service potential be provided to, the Trust èè it is expected to be used for more than one financial year and the cost of the item can be measured reliably èè the item has a cost of at least £5,000; or collectively a number of items have a cost of at least £5,000 and individually have a cost of more than £250, where the assets are functionally interdependent, they had broadly simultaneous purchase dates, are anticipated to have simultaneous disposal dates and are under single managerial control; or èè items form part of the initial equipping and setting-up cost of a new building, irrespective of their individuals or collective cost.
Employer’s pension cost contributions are charged to operating expenses as and when they become due. Additional pension liabilities arising from early retirements are not funded by the scheme except where the retirement is due to ill-health. The full amount of the liability for the additional costs is charged to the operating expenses at the time the Trust commits itself to the retirement, regardless of the method of payment.
Where a large asset, for example a building, includes a number of components with significantly different asset lives, e.g., plant and equipment, then these components are treated as separate assets and depreciated over their own useful economic lives.
1.4 EXPENDITURE ON OTHER GOODS AND SERVICES Expenditure on goods and services is recognised when, and to the extent that they have been received, and is measured at the fair value of those goods and services. Expenditure is recognised in operating expenses except where it results in the creation of a non-current asset such as property, plant and equipment.
MEASUREMENT Valuation All property, plant and equipment assets are measured initially at cost, representing the costs directly attributable to acquiring or constructing the asset and bringing it to the location and condition necessary for it to be capable of operating in the manner intended by management.
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All assets are measured subsequently at fair value. Land and buildings, used for the Trust’s services, or for administrative purposes, are stated in the Statement of Financial Position at their revalued amounts, being the fair value at the date of revaluation less any impairment.
Depreciation Items of property, plant and equipment are depreciated over their remaining useful economic lives in a manner consistent with the consumption of economic or service delivery benefits. Freehold land is considered to have an infinite life and is not depreciated.
Revaluations are performed with sufficient regularity to ensure that carrying amounts are not materially different from those that would be determined at the end of the reporting period. Fair values are determined as follows:
Property, plant and equipment, which has been reclassified as ‘held for sale’, ceases to be depreciated upon the reclassification. Assets in the course of construction and residual interests in off-Statement of Financial Position PFI contract assets are not depreciated until the asset is brought into use, or reverts to the Trust, respectively.
èè Land and non specialised buildings market value for existing use èè Specialised buildings - depreciated replacement cost
Revaluation gains and losses Revaluation gains are recognised in the revaluation reserve, except where, and to the extent that, they reverse a revaluation decrease that has previously been recognised in operating expenses, in which case they are recognised in operating income.
An item of property, plant and equipment which is surplus with no plan to bring it back in to use is valued at fair value under IFRS 13, if it does not meet the requirements of IFRS 40 or IFRS 5. Subsequent expenditure
Revaluation losses are charged to the revaluation reserve to the extent that there is an available balance for the asset concerned, and thereafter are charged to operating expenses.
Subsequent expenditure relating to an item of property, plant and equipment is recognised as an increase in the carrying amount of the asset when it is probable that additional future economic benefits, or service potential deriving from the cost incurred to replace a component of such item, will flow to the enterprise and the cost of the item can be determined reliably.
Gains and losses recognised in the revaluation reserve are reported in the Statement of Comprehensive Income as an item of ‘other comprehensive income’. Impairments
Where a component of an asset is replaced, the cost of the replacement is capitalised, if it meets the criteria for recognition above. The carrying amount of the part replaced is de-recognised. Other expenditure, that does not generate additional future economic benefits or service potential, such as repairs and maintenance, is charged to the Statement of Comprehensive Income in the period in which it is incurred.
In accordance with the FT ARM, impairments that arise from a clear consumption of economic benefits, or of service potential in the asset, are charged to operating expenses.
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A compensating transfer is made from the revaluation reserve to the income and expenditure reserve of an amount equal to the lower of (i) the impairment charged to operating expenses; and (ii) the balance in the revaluation reserve attributable to that asset before the impairment.
ÒÒ the sale is expected to be completed within 12 months of the date of classification as ‘held for sale’ and ÒÒ the actions needed to complete the plan indicate it is unlikely that the plan will be dropped or significant changes made to it.
An impairment that arises from a clear consumption of economic benefit, or of service potential, is reversed when and to the extent that, the circumstances that gave rise to the loss is reversed. Reversals are recognised in operating income to the extent that the asset is restored to the carrying amount it would have had if the impairment had never been recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the time of the original impairment, a transfer was made from the revaluation reserve to the income and expenditure reserve, an amount is transferred back to the revaluation reserve when the impairment reversal is recognised.
Following reclassification, the assets are measured at the lower of their existing carrying amount and their ‘fair value less costs to sell’. Depreciation ceases to be charged. Assets are de-recognised when all material sale contract conditions have been met. Property, plant and equipment, which is to be scrapped or demolished, does not qualify for recognition as ‘held for sale’ and instead is retained as an operational asset and the asset’s economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs. DONATED, GOVERNMENT GRANT AND OTHER GRANT FUNDED ASSETS
Other impairments are treated as revaluation losses. Reversals of ‘other impairments’ are treated as revaluation gains.
Donated and grant funded property, plant and equipment assets are capitalised at their fair value on receipt. The donation/grant is credited to income at the same time, unless the donor has imposed a condition that the future economic benefits embodied in the grant are to be consumed in a manner specified by the donor, in which case, the donation/grant is deferred within liabilities and is carried forward to future financial years to the extent that the condition has not yet been met.
De-recognition Assets intended for disposal are reclassified as ‘held for sale’ once all of the following criteria are met: èè the asset is available for immediate sale in its present condition subject only to terms which are usual and customary for such sales; èè the sale must be highly probable i.e.: ÒÒ management are committed to a plan to sell the asset ÒÒ an active programme has begun to find a buyer and complete the sale ÒÒ the asset is being actively marketed at a reasonable price
The donated and grant funded assets are subsequently accounted for in the same manner as other items of property, plant and equipment.
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USEFUL ECONOMIC LIVES OF PROPERTY, PLANT AND EQUIPMENT Useful economic lives reflect the total life of an asset and not the remaining life of an asset. The range of useful economic lives are shown in the table below:
Min Life Years
Max Life Years
-
-
Property excluding dwellings
20
70
Dwellings
20
70
Plant & Machinery
5
15
Transport Equipment
5
10
Information Technology
5
5
Furniture & Fittings
5
15
Tangible assets purchased Land
Finance-leased assets (including land) are depreciated over the shorter of the useful economic life or the lease term, unless the FT expects to acquire the asset at the end of the lease term in which case the assets are depreciated in the same manner as owned assets above.
Internally generated intangible assets
1.6 INTANGIBLE ASSETS
Expenditure on development is capitalised only where all of the following can be demonstrated: èè the project is technically feasible to the point of completion and will result in an intangible asset for sale or use èè the Trust intends to complete the asset and sell or use it èè the Trust has the ability to sell or use the asset èè how the intangible asset will generate probable future economic or service delivery benefits, e.g., the presence of a market for it or its output, or where it is to be used for internal use, the usefulness of the asset;
Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar items are not capitalised as intangible assets. Expenditure on research is not capitalised.
Recognition Intangible assets are non-monetary assets without physical substance which are capable of being sold separately from the rest of the Trust’s business or which arise from contractual or other legal rights. They are recognised only where it is probable that future economic benefits will flow to, or service potential be provided to, the Trust and where the cost of the asset can be measured reliably.
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èè adequate financial, technical and other resources are available to the Trust to complete the development and sell or use the asset and èè the Trust can measure reliably the expenses attributable to the asset during development.
Amortisation Intangible assets are amortised over their expected useful economic lives in a manner consistent with the consumption of economic or service delivery benefits.
Software Software which is integral to the operation of hardware, e.g. an operating system, is capitalised as part of the relevant item of property, plant and equipment. Software which is not integral to the operation of hardware, e.g. application software, is capitalised as an intangible asset. Measurement Intangible assets are recognised initially at cost, comprising all directly attributable costs needed to create, produce and prepare the asset to the point that it is capable of operating in the manner intended by management. Subsequently intangible assets are measured at current value in existing use. Where no active market exists, intangible assets are valued at the lower of depreciated replacement cost and the value in use where the asset is income generating. Revaluations gains and losses and impairments are treated in the same manner as for property, plant and equipment. An intangible asset, which is surplus with no plan to bring it back into use, is valued at fair value under IFRS 13, if it does not meet the requirements of IAS 40 of IFRS 5. Intangible assets held for sale are measured at the lower of their carrying amount or “fair value less costs to sell”.
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USEFUL ECONOMIC LIFE OF INTANGIBLE ASSETS Useful economic lives reflect the total life of an asset and not the remaining life of an asset. The range of useful economic lives are shown in the table below:
Min Life Years
Max Life Years
Intangible assets - internally generated Information technology
-
-
Development expenditure
-
-
Other
-
-
Software
3
5
Licences & trademarks
-
-
Intangible assets - purchased
1.7 REVENUE GOVERNMENT AND OTHER GRANTS
1.9 FINANCIAL INSTRUMENTS AND FINANCIAL LIABILITIES
Government grants are grants from government bodies other than income from commissioners or NHS trusts for the provision of services. Where a grant is used to fund revenue expenditure, it is taken to the Statement of Comprehensive Income to match that expenditure.
RECOGNITION Financial assets and financial liabilities which arise from contracts for the purchase or sale of non-financial items (such as goods or services), which are entered into in accordance with the Trustâ&#x20AC;&#x2122;s normal purchase, sale or usage requirements, are recognised when, and to the extent which, performance occurs, i.e. when receipt or delivery of the goods or services is made.
1.8 INVENTORIES Inventories are valued at the lower of cost and net realisable value. This is considered to be a reasonable approximation to fair value due to the high turnover of stocks.
DE-RECOGNITION All financial assets are de-recognised when the rights to receive cash flows from the assets have expired or the Trust has transferred substantially all of the risks and rewards of ownership. Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.
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The effective interest rate is the rate that discounts exactly estimated future cash receipts through the expected life of the financial asset or, when appropriate, a shorter period, to the net carrying amount of the financial asset.
CLASSIFICATION AND MEASUREMENT Financial assets are categorised as loans and receivables. Financial liabilities are categorised as other financial liabilities.
Interest on loans and receivables is calculated using the effective interest method and credited to the Statement of Comprehensive Income.
FINANCIAL ASSETS AND FINANCIAL LIABILITIES AT “FAIR VALUE THROUGH INCOME AND EXPENDITURE”
OTHER FINANCIAL LIABILITIES
Financial assets and financial liabilities at “fair value through income and expenditure” are financial assets or financial liabilities held for trading. A financial asset or financial liability is classified in this category if acquired principally for the purpose of selling in the short-term.
All other financial liabilities are recognised initially at fair value, net of transaction costs incurred, and measured subsequently at amortised cost using the effective interest method. The effective interest rate is the rate that discounts exactly estimated future cash payments through the expected life of the financial liability or, when appropriate, a shorter period, to the net carrying amount of the financial liability.
These financial assets and financial liabilities are recognised initially at fair value, with transaction costs expensed in the income and expenditure account. Subsequent movements in the fair value are recognised as gains or losses in the Statement of Comprehensive Income.
They are included in current liabilities, except for amounts payable more than 12 months after the Statement of Financial Position date, which are classified as long-term liabilities.
LOANS AND RECEIVABLES
Interest on financial liabilities carried at amortised cost is calculated using the effective interest method and charged to finance costs. Interest on financial liabilities taken out to finance property, plant and equipment or intangible assets is not capitalised as part of the cost of those assets.
Loans and receivables are nonderivative financial assets with fixed or determinable payments which are not quoted in an active market. They are included in current assets. The Trust’s loans and receivables comprise cash and cash equivalents, NHS receivables, accrued income and “other receivables”.
IMPAIRMENT OF FINANCIAL ASSETS At the Statement of Financial Position date, the Trust assesses whether any financial assets, other than those held at “fair value through income and expenditure” are impaired.
Loans and receivables are recognised initially at fair value, net of transactions costs, and are measured subsequently at amortised cost, using the effective interest method.
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Financial assets are impaired and impairment losses are recognised if, and only if, there is objective evidence of impairment as a result of one or more events which occurred after the initial recognition of the asset and which has an impact on the estimated future cash flows of the asset.
OPERATING LEASES Other leases are regarded as operating leases and the rentals are charged to operating expenses on a straightline basis over the term of the lease. Operating lease incentives received are added to the lease rentals and charged to operating expenses over the life of the lease.
For financial assets carried at amortised cost, the amount of the impairment loss is measured as the difference between the assetâ&#x20AC;&#x2122;s carrying amount and the present value of the revised future cash flows discounted at the assetâ&#x20AC;&#x2122;s original effective interest rate. The loss is recognised in the Statement of Comprehensive Income and the carrying amount of the asset is reduced directly.
LEASES OF LAND AND BUILDINGS Where a lease is for land and buildings, the land component is separated from the building component and the classification for each is assessed separately.
1.11 PROVISIONS
1.10 LEASES
The NHS foundation trust recognises a provision where it has a present legal or constructive obligation of uncertain timing or amount; for which it is probable that there will be a future outflow of cash or other resources; and a reliable estimate can be made of the amount. The amount recognised in the Statement of Financial Position is the best estimate of the resources required to settle the obligation. Where the effect of the time value of money is significant, the estimated risk-adjusted cash flows are discounted using the discount rates published and mandated by HM Treasury.
FINANCE LEASES Where substantially all risks and rewards of ownership of a leased asset are borne by the NHS foundation trust, the asset is recorded as property, plant and equipment and a corresponding liability is recorded. The value at which both are recognised is the lower of the fair value of the asset or the present value of the minimum lease payments, discounted using the interest rate implicit in the lease. The asset and liability are recognised at the commencement of the lease. Thereafter the asset is accounted as an item of property plant and equipment.
Clinical negligence costs The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the NHS foundation trust pays an annual contribution to the NHSLA, which, in return, settles all clinical negligence claims. Although the NHSLA is administratively responsible for all clinical negligence cases, the legal liability remains with the NHS foundation trust.
The annual rental is split between the repayment of the liability and a finance cost so as to achieve a constant rate of finance over the life of the lease. The annual finance cost is charged to Finance Costs in the Statement of Comprehensive Income. The lease liability is de-recognised when the liability is discharged, cancelled or expires.
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1.13 PUBLIC DIVIDEND CAPITAL
The total value of clinical negligence provisions carried by the NHSLA on behalf of the NHS foundation trust is disclosed at note 29 but is not recognised in the NHS foundation trust’s accounts.
Public dividend capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time of establishment of the predecessor NHS trust. HM Treasury has determined that PDC is not a financial instrument within the meaning of IAS 32.
Non-clinical risk pooling The NHS foundation trust participates in the Property Expenses Scheme and the Liabilities to Third Parties Scheme. Both are risk pooling schemes under which the Trust pays an annual contribution to the NHS Litigation Authority and in return receives assistance with the costs of claims arising. The annual membership contributions, and any “excesses” payable in respect of particular claims are charged to operating expenses when the liability arises.
A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable as public dividend capital dividend. The charge is calculated at the rate set by HM Treasury (currently 3.5%) on the average relevant net assets of the NHS foundation trust during the financial year. Relevant net assets are calculated as the value of all assets less the value of all liabilities, except for (i) donated assets (including lottery funded assets), (ii) average daily cash balances held with the Government Banking Services (GBS) and National Loans Fund (NLF) deposits, excluding cash balances held in GBS accounts that relate to a short-term working capital facility, and (iii) any PDC dividend balance receivable or payable. In accordance with the requirements laid down by the Department of Health (as the issuer of PDC), the dividend for the year is calculated on the actual average relevant net assets as set out in the “pre-audit” version of the annual accounts. The dividend thus calculated is not revised should any adjustment to net assets occur as a result the audit of the annual accounts.”
1.12 CONTINGENCIES Contingent assets (that is, assets arising from past events whose existence will only be confirmed by one or more future events not wholly within the entity’s control) are not recognised as assets, but are disclosed in note 30 where an inflow of economic benefits is probable. Contingent liabilities are not recognised, but are disclosed in note 30, unless the probability of a transfer of economic benefits is remote. Contingent liabilities are defined as: èè possible obligations arising from past events whose existence will be confirmed only by the occurrence of one or more uncertain future events not wholly within the entity’s control; or èè present obligations arising from past events but for which it is not probable that a transfer of economic benefits will arise or for which the amount of the obligation cannot be measured with sufficient reliability.
1.14 VALUE ADDED TAX Most of the activities of the NHS foundation trust are outside the scope of VAT and, in general, output tax does not apply and input tax on purchases is not recoverable. Irrecoverable VAT is charged to the relevant expenditure category or included in the capitalised purchase cost of fixed assets.
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Where output tax is charged or input VAT is recoverable, the amounts are stated net of VAT.
Exchange gains or losses on nonmonetary assets and liabilities are recognised in the same manner as other gains and losses on these items.
1.15 CORPORATION TAX
1.17 THIRD PARTY ASSETS
South Central Ambulance NHS Foundation Trust has determined that it has no corporation tax liability as the Trust’s profit generated from nonoperational income falls below the threshold amount of £50,000.
Assets belonging to third parties (such as money held on behalf of patients) are not recognised in the accounts since the NHS Foundation Trust has no beneficial interest in them. However, they are disclosed in a separate note to the accounts in accordance with the requirements of HM Treasury’s FReM.
1.16 FOREIGN EXCHANGE The functional and presentational currency of the Trust is sterling. A transaction which is denominated in a foreign currency is translated into the functional currency at the spot exchange rate on the date of the transaction.
1.18 LOSSES AND SPECIAL PAYMENTS Losses and special payments are items that Parliament would not have contemplated when it agreed funds for the health service or passed legislation. By their nature they are items that ideally should not arise. They are therefore subject to special control procedures compared with the generality of payments. They are divided into different categories, which govern the way that individual cases are handled. Losses and special payments are charged to the relevant functional headings in expenditure on an accruals basis, including losses which would have been made good through insurance cover had NHS foundation trusts not been bearing their own risks (with insurance premiums then being included as normal revenue expenditure).
Where the Trust has assets or liabilities denominated in a foreign currency at the Statement of Financial Position date: èè monetary items (other than financial instruments measured at “fair value through income and expenditure”) are translated at the spot exchange rate on 31 March èè non-monetary assets and liabilities measured at historical cost are translated using the spot exchange rate at the date of the transaction and èè non-monetary assets and liabilities measured at fair value are translated using the spot exchange rate at the date the fair value was determined.
However the losses and special payments note is compiled directly from the losses and compensations register which reports on an accrual basis with the exception of provisions for future losses.
Exchange gains or losses on monetary items (arising on settlement of the transaction or on re-translation at the Statement of Financial Position date) are recognised in income or expense in the period in which they arise.
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1.19 EARLY ADOPTION OF STANDARDS, AMENDMENTS AND INTERPRETATIONS
1.21 CRITICAL ACCOUNTING ESTIMATES AND JUDGEMENTS In the application of the Foundation Trust’s accounting policies, management is required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from those estimates and the estimates and underlying assumptions are continually reviewed. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period or in the period of the revision and future periods if the revision affects both current and future periods.
No new accounting standards or revisions to existing standards have been early adopted in 2015/16.
1.20 STANDARDS, AMENDMENTS AND INTERPRETATIONS IN ISSUE BUT NOT YET EFFECTIVE OR ADOPTED At the date of authorisation of these financial statements, the following Standards and Interpretations which have not been applied in these financial statements, were in issue but not yet effective. None of them are expected to impact upon the Trust’s financial statements:
The following are the critical judgements, apart from those involving estimations (see below), that management has made in the process of applying the Foundation Trust’s accounting policies and that have the most significant effect on the amounts recognised in the financial statements.
èè IFRS 11 (amendment) Acquisition of an interest in a joint operation èè IAS 16 (amendment) and IAS 38 (amendment) Depreciation and amortisation èè IAS 16 (amendment) and IAS 41 (amendment) Bearer plants èè IAS 27 (amendment) Equity method in separate financial statements èè IFRS 10 (amendment) and IAS 28 (amendment) Sale or contribution of assets èè IFRS10 (amendment) and IAS 28 (amendment) Investment entities applying the consolidation exception èè IAS 1 (amendment) Disclosure initiative èè IFRS15 Revenue from contracts with customers èè Annual Improvements to IFRS:201215 cycle èè IFRS 9 Financial Instruments
Indexation has not been applied to any Non Current assets as no material changes were reflected in any relevant price indices. Information provided by the NHS Litigation Authority has been used to determine provisions required for potential employer liability claims and disclosure of Clinical Negligence liability. The NHS Pensions agency has provided information with regard to disclosure and calculation of ill health retirement liability. Key sources of estimation uncertainty
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The following are the key assumptions concerning the future, and other key sources of estimation uncertainty at the end of the reporting period, that have a significant risk of causing a material adjustment to the carrying amounts of assets and liabilities within the next financial year These valuations are judgemental and future events (such as a change in economic conditions) could cause these valuations to change. Non current assets relating to land and buildings had a carrying value of ÂŁ39.7m as at 31 March 2016 (31 March 2015 ÂŁ40.1m).
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2 OPERATING SEGMENTS Each segment is reported separately in the monthly Board report. Emergency Services include the 999 service, NHS 111 call handling, Education and Training and the Hazardous Area Response Team. Non-Emergency Services include Patient Transport Services (PTS), Logistic Services and Commercial Training Income. Direct costs include employee and non employee costs (staff costs, drugs, medical equipment, vehicle costs etc). The Trust only reports contribution before overheads by service line reporting to the Trust Board at Public Board meetings.
2015/16
Income Direct Costs
Emergency Services
Non-Emergency Services
Total
£000
£000
£000
147,439
27,622
175,061
(119,529)
(24,810)
(144,339)
27,910
2,812
30,722
CONTRIBUTION OPERATIONAL ACTIVITIES Total Overheads
(24,608)
Depreciation and amortisation
(8,247)
TOTAL COSTS BEFORE DIVIDENDS AND INTEREST
(32,855)
OPERATING SURPLUS/(DEFICIT)
(2,133)
2014/15
Income Direct Costs
Emergency Services
Non-Emergency Services
Total
£000
£000
£000
147,770
24,879
172,649
(117,413)
(22,799)
(140,212)
30,357
2,080
32,437
CONTRIBUTION OPERATIONAL ACTIVITIES Total Overheads
(23,766)
Depreciation and amortisation
(7,298)
TOTAL COSTS BEFORE DIVIDENDS AND INTEREST
(31,064)
OPERATING SURPLUS/(DEFICIT)
1,373
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3 OPERATING INCOME FROM PATIENT CARE 3.1 INCOME FROM PATIENT CARE ACTIVITIES (BY NATURE) GROUP 2015/16 £000
2014/15 £000
A&E Income
143,637
139,941
PTS Income
24,023
21,064
Other Income TOTAL INCOME FROM ACTIVITIES
995
1,009
168,655
162,014
3.2 INCOME FROM PATIENT CARE ACTIVITIES (BY SOURCE) GROUP 2015/16 £000
2014/15 £000
161,798
153,353
92
90
-
-
Other NHS foundation trusts
1,045
1,645
NHS trusts
1,788
1,771
NHS other
2,551
3,644
Non-NHS: private patients
-
-
Non-NHS: overseas patients (chargeable to patient)
-
-
NHS injury scheme (was RTA)
439
556
Non-NHS: other
942
955
CCGs and NHS England Local Authorities Department of Health
Additional income for delivery of healthcare services TOTAL INCOME FROM ACTIVITIES
-
-
168,655
162,014
168,655
162,014
-
-
Of which: Related to continuing operations Related to discontinued operations
Injury cost recovery income is subject to a provision for impairment of receivables of 100% for claims in excess of three years, 50% for claims between two and three years, 25% for claims between one and two years and 15% of all other claims, to reflect expected rates of collection.
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4 OTHER OPERATING INCOME GROUP
Research and development Education and training Receipt of capital grants and donations Charitable and other contributions to expenditure Non-patient care services to other bodies Support from the Department of Health for mergers Profit on disposal of non-current assets Reversal of impairments
2015/16 £000
2014/15 £000
-
-
1,872
2,079
160
-
-
-
2,472
2,657
-
-
14
249
-
358
Other income *
1,888
5,292
TOTAL OTHER OPERATING INCOME
6,406
10,635
6,406
10,635
-
-
Of which: Related to continuing operations Related to discontinued operations
* Other income includes £584k of funding for implementation of Electronic Patient Record Forms (2014/15: £3,695k), £383k commercial training (2014/15: £397k), £272k radio mast income (2014/15: £285k) and £398k income covering costs incurred in the management of NHS LMO (2014/15: £786k).
4.1 INCOME FROM ACTIVITIES ARISING FROM COMMISSIONER REQUESTED RESERVES Under the terms of its provider license, the Trust is required to analyse the level of income from activities that has arisen from commissioner requested and noncommissioner requested services. Commissioner requested services are defined in the provider license and are services that commissioners believe would need to be protected in the event of provider failure. £140m of income received relates to Commissioner Requested Services (£136m in 2014/15). All other income relates to Non-Commissioner Requested Services.
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5.1 OPERATING EXPENSES GROUP 2015/16 £000
2014/15 £000
13,644
12,428
Employee expenses - executive directors
787
828
Remuneration of non-executive directors
211
217
Purchase of healthcare from non-NHS bodies
Employee expenses - staff
108,747
102,855
Supplies and services - clinical
2,491
3,618
Supplies and services - general
1,179
921
Establishment
3,321
2,995
Transport
18,350
16,641
Premises
3,099
2,669
Information Technology
3,304
7,097
(31)
44
(6)
-
267
334
Rentals under operating leases
4,794
4,327
Depreciation on property, plant and equipment
7,151
6,489
Amortisation on intangible assets
1,098
808
-
59
audit services - statutory audit
52
49
Other auditor remuneration (external auditor only)
11
19
754
487
-
61
Legal fees
115
283
Consultancy costs
532
240
Internal audit costs
82
99
881
653
16
16
Insurance
1,459
1,349
Other services, e.g. external payroll *
3,746
4,714
Other **
1,140
976
177,194
171,276
177,194
171,276
-
-
Increase/(decrease) in provision for impairment of receivables Change in provisions discount rate(s) Drug costs
Impairments Audit fees payable to the external auditor;
Clinical negligence Loss on disposal of non-current assets
Training, courses and conferences Hospitality
TOTAL INCOME FROM ACTIVITIES Of which: Related to continuing operations Related to discontinued operations
* Other contracted services includes £2,551k from the National Pandemic Flu Service (2014/15: £3,676k) ** Other includes £276k for additional injury benefit provision (2014/15: £616k)
//137
Annual Report and Accounts 2015/16
5.2 OTHER AUDITOR REMUNERATION GROUP 2015/16 £000
2014/15 £000
11
11
OTHER AUDITOR REMUNERATION PAID TO THE EXTERNAL AUDITOR: Audit-related assurance services Other non-audit services TOTAL
-
8
11
19
5.3 LIMITATION ON AUDITOR’S LIABILITY The Trust’s contract with its auditors for 2015/16, as set out in the engagement letter, limited the auditor’s liability to £1m (2014/15: £1m).
6 IMPAIRMENT OF ASSETS GROUP 2015/16 £000
2014/15 £000
-
(299)
NET IMPAIRMENTS CHARGED TO OPERATING SURPLUS / DEFICIT RESULTING FROM: Changes in market price Other
-
-
TOTAL NET IMPAIRMENTS CHARGED TO OPERATING SURPLUS / DEFICIT
-
(299)
Impairments charged to the revaluation reserve
-
1,534
TOTAL NET IMPAIRMENTS
-
1,833
There were no impairments identified or reversals of previous impairments identified in relation to non current assets during 2015/16.
//138
//Accountability Report
7 EMPLOYEE BENEFITS
GROUP Permanent
Other
£000 Salaries and wages Social security costs Employer's contributions to NHS pensions
£000
2015/16 Total £000
2014/15 Total £000
85,208
120
85,328
81,898
6,362
-
6,362
6,167
10,703
-
10,703
10,034
Pension cost - other
-
-
-
-
Other post employment benefits
-
-
-
-
Other employment benefits
-
-
-
-
Termination benefits
-
-
-
-
Agency/contract staff
-
7,141
7,141
5,584
102,273
7,261
109,534
103,683
TOTAL GROSS STAFF COSTS
-
-
-
-
102,273
7,261
109,534
103,683
Recoveries in respect of seconded staff TOTAL STAFF COSTS
7.1 RETIREMENTS DUE TO ILL-HEALTH During 2015/16 there was one early retirement from the Trust agreed on the grounds of ill-health (three in the year ended 31 March 2015). The estimated additional pension liabilities of these ill-health retirements is £97k (£155k in 2014/15). The cost of these ill-health retirements will be borne by the NHS Business Services Authority - Pensions Division.
7.2 DIRECTOR’S REMUNERATION The aggregate amounts payable to directors were: GROUP 2015/16 £000
2014/15 £000
704
721
Social Security Costs
83
86
Performance related bonuses
20
29
Salary
Employer’s pension contributions TOTAL
87
86
894
922
èè Further details of directors’ remuneration can be found in the remuneration report which is included in the Trust Annual Report 2015/16. èè The above costs exclude the Trust’s Clinical Director. He is employed by another NHS Trust and therefore the Trust charged a fee for his services being £105k 2015/16 (2014/15: £97k). èè In the year ended 31 March 2016, six directors (2015: five) accrued benefits under a defined pension scheme. èè During the year to 31 March 2016, the highest paid director for the Trust was the Chief Executive who was paid a salary between £150k and £155k and was assessed as in receipt of benefits in kind of £4.8k.
//139
Annual Report and Accounts 2015/16
7.3 AVERAGE NUMBER OF EMPLOYEES (WTE BASIS) GROUP Permanent
Other Number
2015/16 Total Number
2014/15 Total Number
Number -
-
-
-
1,614
10
1,624
1,369
Administration and estates
735
73
808
839
Healthcare assistants and other support staff
314
60
374
441
86
6
92
86
-
-
-
-
2,749
149
2,898
2,735
-
-
-
-
Medical and dental Ambulance staff
Nursing, midwifery and health visiting staff Nursing, midwifery and health visiting learners TOTAL AVERAGE NUMBERS Of which: Number of employees (WTE) engaged on capital projects
7.4 REPORTING OF COMPENSATION SCHEMES The Group had no compensation scheme exit package costs in 2015/16 (2014/15: three cases, totalling ÂŁ23k) The Group had no other non-compulsory departure costs in 2015/16 (2014/15: nil).
7.5 OFF-PAYROLL ENGAGEMENTS For all off-payroll engagements as of 31 March 2016, for more than ÂŁ220 per day and that last for longer than six months. 2015/16 Number of engagements NUMBER OF EXISTING ENGAGEMENTS AS OF 31 MARCH 2016
8
OF WHICH: Number that have existed for less than one year at the time of reporting
5
Number that have existed for between one and two years at the time of reporting
1
Number that have existed for between two and three years at the time of reporting
-
Number that have existed for between three and four years at the time of reporting
2
Number that have existed for four or more years at the time of reporting
-
In relation to the above engagements, all have been subject to a risk based assessment as to whether the individual is paying the correct amount of tax and where necessary that assurance has been sought.
//140
//Accountability Report
For all new off-payroll engagements, or those that reached six months in duration, between 01 Apr 2015 and 31 Mar 2016, for more than ÂŁ220 per day and that last for longer than six months.
2015/16 Number of engagements Number of new engagements, or those that reached six months in duration between 1 April 2015 and 31 March 2016
2
Number of the above which include contractual clauses giving the Trust the right to request assurance in relation to income tax and national insurance obligations
2
Number for whom assurance has been requested
2
Of which: Number for whom assurance has been received
2
Number for whom assurance has not been received
-
Number that have been terminated as a result of assurance not being received
-
For any off-payroll engagements of Board members, and/or senior officials with significant financial responsibility, between 1 April 2015 and 31 March 2016
2015/16 Number of engagements Number of off-payroll engagements of Board members, and/ or, senior officials with significant financial responsibility, during the financial year.
-
Number of individuals that have been deemed â&#x20AC;&#x153;Board members and/or senior officials with significant financial responsibilityâ&#x20AC;?. This figure should include both off-payroll and on-payroll engagements.
6
//141
Annual Report and Accounts 2015/16
8 PENSION COSTS
The Scheme Regulations were changed to allow contribution rates to be set by the Secretary of State of Health, with the consent of HM Treasury, and consideration of the advice of the Scheme Actuary and appropriate employee and employer representatives as appropriate. Employers pay contributions at 14% of pensionable pay and most employees had, up to April 2008 paid 6%, with manual staff paying 5%.
Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of the benefits payable under these provisions can be found on the NHS Pensions website at www.nhsbsa.nhs.uk/ pensions. The scheme is an unfunded, defined benefit scheme that covers NHS employers, GP practices and other bodies, allowed under the direction of the Secretary of State, in England and Wales. The scheme is not designed to be run in a way that would enable NHS bodies to identify their share of the underlying scheme assets and liabilities. Therefore, the scheme is accounted for as if it were a defined contribution scheme: the cost to the NHS Body of participating in the scheme is taken as equal to the contributions payable to the scheme for the accounting period.
Following the full actuarial review by the Government Actuary undertaken as at 31 March 2004 and after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his valuation report recommended that employer contributions could continue at the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay depending on total earnings. On advice from the scheme actuary, scheme contributions may be varied from time to time to reflect changes in the schemeâ&#x20AC;&#x2122;s liabilities.
The scheme is subject to a full actuarial valuation every four years (until 2004, every five years) and an accounting valuation every year. An outline of these is as below: a) Full actuarial (funding) valuation
b) Accounting valuation
The purpose of this valuation is to assess the level of liability in respect of the benefits due under the scheme (taking into account its recent demographic experience), and to recommend the contribution rates. The last formal actuarial valuation undertaken for the NHS Pension Scheme was completed for the year ending 31 March 2004. Consequently, a formal actuarial valuation would have been due for the year ending 31 March 2008. However, formal actuarial valuations for unfunded public service schemes have been suspended by HM Treasury on value for money grounds while consideration is given to recent changes to public service pensions, and while future scheme terms are developed as part of the reforms to public service pension provision in 2015.
A valuation of the scheme liability is carried out annually by the scheme actuary as at the end of the reporting period. Actuarial assessments undertaken in intervening years between formal valuations using updated membership data are accepted as providing suitably robust figures for financial reporting purposes. The valuation of the scheme liability as at 31 March 2013, is based on the valuation data as at March 2012, updated to 31 March 2013 with summary global member and accounting data. In undertaking this actuarial assessment, the methodology prescribed in IAS 19, relevant FReM interpretations, and the discount rate prescribed by HM Treasury have also been used.
//142
//Accountability Report
The latest assessment of the liabilities of the scheme is contained in the scheme actuary report, which forms part of the annual NHS Pension Scheme (England and Wales) Pension Accounts, published annually. These accounts can be viewed on the NHS Pensions website. Copies can also be obtained from The Stationery Office.
A death gratuity of twice final year’s pensionable pay for death in service, and five times their annual pension for death after retirement is payable. For early retirements other than those due to ill health the additional pension liabilities are not funded by the scheme. The full amount of the liability is charged to the Statement of Comprehensive Income at the time the Trust commits itself to the retirement, regardless of the method of payment.
c) Scheme provisions The NHS Pension Scheme provided defined benefits, which are summarised below. This list is an illustrative guide only, and is not intended to detail all the benefits provided by the Scheme or the specific conditions that must be met before these benefits can be obtained: The Scheme is a “final salary” scheme.
Members can purchase additional service in the NHS Scheme and contribute to money purchase AVCs run by the Scheme’s approved providers or by other Free Standing Additional Voluntary Contributions (FSAVC) providers.
Annual pensions are normally based on 1/80th for the 1995 section and of the best of the last three years pensionable pay for each year of service, and 1/60th for the 2008 section of reckonable pay per year of membership. Members who are practitioners as defined by the Scheme Regulations have their annual pensions based upon total pensionable earnings over the relevant pensionable service. With effect from 1 April 2008 members can choose to give up some of their annual pension for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules. This new provision is known as “pension commutation”. Annual increases are applied to pension payments at rates defined by the Pensions (Increase) Act 1971, and are based on changes in retail prices in the twelve months ending 30 September in the previous calendar year. From 2011-12 the Consumer Price Index (CPI) will be used to replace the Retail Prices Index (RPI). Early payment of a pension, with enhancement, is available to members of the scheme who are permanently incapable of fulfilling their duties effectively through illness or infirmity.
d) National Employment Savings Trust (NEST) The Pensions Act 2008 introduced new duties on employers in providing access to a workplace pension for all of its employees. The NHS Pension Scheme is not available to all employees and the Trust has provided access to a scheme for these employees which is operated by the National Employment Savings Trust (NEST). NEST is a defined contribution scheme where a minimum contribution is paid by the employer. South Central Ambulance NHS Foundation Trust currently contributes 1% of qualifying earnings to the scheme and employees contribute 1% of pensionable pay. NEST levies a contribution charge of 1.8% and an annual management charge of 0.3% which is paid from the employer contributions. There are no separate employer charges levied by NEST and the Trust is not required to enter into a contract to utilise NEST qualifying pension schemes. Staff who are recruited by South Central Fleet Services Ltd will be auto-enrolled into the NEST Pension Scheme.
//143
Annual Report and Accounts 2015/16
9 OPERATING LEASES 9.1 OPERATING LEASES The Group had no Operating lease income in 2015/16 (2014/15: nil).
9.2 OPERATING LEASE EXPENDITURE 2015/16 £000
2014/15 £000
OPERATING LEASE EXPENSE Minimum lease payments
4,794
4,327
Contingent rents
-
-
Less sublease payments received
-
-
4,794
4,327
2015/16 £000
2014/15 £000
3,286
3,161
TOTAL
FUTURE MINIMUM LEASE PAYMENTS DUE: - not later than one year - later than one year and not later than five years
8,521
8,714
- later than five years
11,472
11,542
TOTAL
23,279
23,417
The Group leases property, vehicles and equipment under operating leases. The figures in the table above are identical for both the Group and the Trust
10 FINANCE INCOME GROUP
Interest on bank accounts
2015/16 £000
2014/15 £000
70
41
Interest on loans and receivables
-
-
Other
-
-
70
41
TOTAL
//144
//Accountability Report
11 FINANCE EXPENDITURE GROUP
Loans from Department of Health Commercial loans TOTAL INTEREST EXPENSE Other finance costs TOTAL
2015/16 £000
2014/15 £000
135
87
-
-
135
87
-
-
135
87
11.2 THE LATE PAYMENT OF COMMERCIAL DEBTS (INTEREST) ACT 1998 No interest payments were made by the Group in the reporting period.
12 CORPORATION TAX The Trust has determined that it has no corporation tax liability as there was no profit generated by the Trust’s subsidiary, South Central Fleet Services Ltd, in the qualifying period. The Trust does not have any other qualifying income from any of its other activities.
13 DISCONTINUED OPERATIONS 2015/16 £000
2014/15 £000
-
6,317
Movement in provisions for liabilities on discontinued operations
2,505
(3,820)
GAIN/ (LOSS) FROM ABSORPTION AND DISCONTINUANCE OF OPERATIONS
2,505
2,497
Gain on disposal of discontinued operations
The Trust is the appointed successor body to NHS Direct which ceased providing services on 31 March 2014.
//145
Annual Report and Accounts 2015/16
14.1 INTANGIBLE ASSETS - 2015/16 GROUP
Software licences
Licences & trademarks
£000
Total
£000
Intangible assets under construction £000
4,719
-
2,236
6,955
Valuation/gross cost at start of period for new FTs
-
-
-
-
Transfers by absorption
-
-
-
-
Valuation/gross cost at 1 April 2015 brought forward
Additions
£000
362
-
770
1,132
Reclassifications
1,767
-
(1,722)
45
Disposals / derecognition
(215)
-
-
(215)
GROSS COST AT 31 MARCH 2016
6,633
-
1,284
7,917
Amortisation at 1 April 2015 - brought forward
3,631
-
-
3,631
Amortisation at start of period for new FTs
-
-
-
-
Transfers by absorption
-
-
-
-
1,098
-
-
1,098
-
-
-
-
Provided during the year Transfers to / from assets held for sale Disposals / derecognition
(215)
-
-
(215)
AMORTISATION AT 31 MARCH 2016
4,514
-
-
4,514
Net book value at 31 March 2016
2,119
-
1,284
3,403
Net book value at 1 April 2015
1,088
-
2,236
3,324
//146
//Accountability Report
14.2 INTANGIBLE ASSETS - 2014/15 GROUP
Valuation/gross cost at 1 April 2014 brought forward
Software licences
Licences & trademarks
£000
Total
£000
Intangible assets under construction £000
4,382
-
773
5,155
-
-
-
-
4,382
-
773
5,155
-
-
-
-
Prior period adjustments GROSS COST AT 1 April 2014 RESTATED Valuation/gross cost at start of period for new FTs
£000
Transfers by absorption
-
-
-
-
Additions
7
-
1,793
1,800
330
-
(330)
-
Reclassifications
-
-
-
-
VALUATION / GROSS COST AT 31 MARCH 2015
Disposals / derecognition
4,719
-
2,236
6,955
Amortisation at 1 April 2014 - as previously stated
2,823
-
-
2,823
-
-
-
-
2,823
-
-
2,823
-
-
-
-
808
-
-
808
Prior period adjustments AMORTISATION AT 1 APRIL 2014 RESTATED Amortisation at start of period for new FTs Provided during the year
-
-
-
-
AMORTISATION AT 31 MARCH 2015
Disposals / derecognition
3,631
-
-
3,631
Net book value at 31 March 2015
1,088
-
2,236
3,324
Net book value at 1 April 2014
1,559
-
773
2,332
Note: there is no revaluation reserve held for intangible assets.
//147
Annual Report and Accounts 2015/16
14.1 INTANGIBLE ASSETS - 2015/16 TRUST
Software licences
Licences & trademarks
£000
Total
£000
Intangible assets under construction £000
4,719
-
2,236
6,955
Valuation/gross cost at start of period for new FTs
-
-
-
-
Transfers by absorption
-
-
-
-
Valuation/gross cost at 1 April 2015 brought forward
Additions
£000
362
-
770
1,132
Reclassifications
1,767
-
(1,722)
45
Disposals / derecognition
(338)
-
-
(338)
GROSS COST AT 31 MARCH 2016
6,510
-
1,284
7,794
Amortisation at 1 April 2015 - brought forward
3,631
-
-
3,631
Amortisation at start of period for new FTs
-
-
-
-
Transfers by absorption
-
-
-
-
1,098
-
-
1,098
-
-
-
-
Provided during the year Transfers to / from assets held for sale Disposals / derecognition
(304)
-
-
(304)
AMORTISATION AT 31 MARCH 2016
4,425
-
-
4,425
Net book value at 31 March 2016
2,085
-
1,284
3,369
Net book value at 1 April 2015
1,088
-
2,236
3,324
//148
//Accountability Report
14.2 INTANGIBLE ASSETS - 2014/15 TRUST
Valuation/gross cost at 1 April 2014 brought forward
Software licences
Licences & trademarks
£000
Total
£000
Intangible assets under construction £000
4,382
-
773
5,155
-
-
-
-
4,382
-
773
5,155
-
-
-
-
Prior period adjustments GROSS COST AT 1 April 2014 RESTATED Valuation/gross cost at start of period for new FTs
£000
Transfers by absorption
-
-
-
-
Additions
7
-
1,793
1,800
330
-
(330)
-
Reclassifications
-
-
-
-
VALUATION / GROSS COST AT 31 MARCH 2015
Disposals / derecognition
4,719
-
2,236
6,955
Amortisation at 1 April 2014 - as previously stated
2,823
-
-
2,823
-
-
-
-
2,823
-
-
2,823
-
-
-
-
808
-
-
808
Prior period adjustments AMORTISATION AT 1 APRIL 2014 RESTATED Amortisation at start of period for new FTs Provided during the year
-
-
-
-
AMORTISATION AT 31 MARCH 2015
Disposals / derecognition
3,631
-
-
3,631
Net book value at 31 March 2015
1,088
-
2,236
3,324
Net book value at 1 April 2014
1,559
-
773
2,332
Note: there is no revaluation reserve held for intangible assets.
//149
-
Disposals / derecognition
//150 9,203 9,203
Net book value at 31 March 2016
Net book value at 1 April 2015
-
ACCUMULATED DEPRECIATION AT 31 MARCH 2016 30,913
30,457
5,985
-
1,432
-
Provided during the year
4,533
36,442
-
948
28
35,466
Buildings excluding dwellings £000
-
Disposals / derecognition
Accumulated depreciation at 1 April 2015 - brought forward
9,203
-
Reclassifications
VALUATION/GROSS COST AT 31 MARCH 2016
-
9,203
£000
Land
Additions - purchased
Valuation/Gross cost at 1 April 2015
GROUP
154
148
13
-
6
7
161
-
-
-
161
£000
Dwellings
7,494
1,599
-
-
-
-
1,599
-
(6,770)
875
7,494
£000
Assets under construction
15.1 PROPERTY, PLANT AND EQUIPMENT - 2015/16
4,520
5,683
8,199
(448)
1,056
7,591
13,882
(448)
1,023
1,196
12,111
£000
Plant and machinery
13,271
16,500
26,543
(4,418)
3,556
27,405
43,043
(4,418)
4,109
2,676
40,676
£000
Transport equipment
2,264
1,867
5,068
(3,123)
1,042
7,149
6,935
(3,123)
645
-
9,413
£000
Information technology
605
548
860
-
59
801
1,408
-
-
2
1,406
£000
Furniture & fittings
68,424
66,005
46,668
(7,989)
7,151
47,506
112,673
(7,989)
(45)
4,777
115,930
£000
Total
Annual Report and Accounts 2015/16
-
Impairments
//151 -
Reversal of impairments
Revaluations
Transfers to / from assets held for sale
Disposals / derecognition
ACCUMULATED DEPRECIATION AT 31 MARCH 2015 9,091
-
Provided during the year
Net book value at 1 April 2014
-
Accumulated depreciation at 1 April 2014 - restated
9,203
-
Prior period adjustments
Net book value at 31 March 2015
-
9,203
-
(126)
-
Accumulated depreciation at 1 April 2014 - as previously stated
VALUATION/GROSS COST AT 31 MARCH 2015
Disposals / derecognition
Transfers to / from assets held for sale
Reclassifications
238
-
Additions - purchased / leased / grants / donations
Reversal of impairments
9,091
-
9,091
£000
Land
Valuation/Gross cost at 1 April 2014 restated
Prior period adjustments
Valuation/Gross cost at 1 April 2014
GROUP
27,882
30,913
4,553
-
(10)
-
38
1,307
3,218
-
3,218
35,466
-
8
2,569
1,698
(20)
111
31,100
-
31,100
Buildings excluding dwellings £000
147
154
7
-
-
1
-
6
-
-
-
161
-
-
-
14
-
-
147
-
147
£000
Dwellings
3,951
7,494
-
-
-
-
-
-
-
-
-
7,494
-
-
(3,855)
-
-
7,398
3,951
-
3,951
£000
Assets under construction
15.2 PROPERTY, PLANT AND EQUIPMENT - 2015/16
3,050
4,520
7,591
(20)
-
-
-
747
6,864
-
6,864
12,111
(20)
-
219
-
-
1,998
9,914
-
9,914
£000
Plant and machinery
16,329
13,271
27,405
(773)
-
-
-
3,602
24,576
-
24,576
40,676
(875)
-
621
-
-
25
40,905
-
40,905
£000
Transport equipment
2,630
2,264
7,149
(28)
-
-
-
767
6,410
-
6,410
9,413
(28)
-
368
-
-
33
9,040
-
9,040
£000
Information technology
586
605
801
-
-
-
-
60
741
-
741
1,406
-
-
78
-
-
1
1,327
-
1,327
£000
Furniture & fittings
63,666
68,424
47,506
(821)
(10)
1
38
6,489
41,809
-
41,809
115,930
(923)
(118)
-
1,950
(20)
9,566
105,475
-
105,475
£000
Total
//Accountability Report
9,203
30,457
890
-
-
29,567
£000
Buildings excluding dwellings
148
-
-
-
148
£000
Dwellings
1,599
-
-
-
1,599
Assets under construction £000
5,683
//152
VALUATION/GROSS COST AT 31 MARCH 2015
Donated
9,203
904
-
-
-
Finance leased
Government granted 30,913
905
-
30,008
8,299
Owned
Net book value at 31 March 2015
154
-
-
-
154
7,494
-
-
-
7,494
-
-
-
5,683
£000
Plant and machinery
4,520
-
-
-
4,520
15.4 PROPERTY, PLANT AND EQUIPMENT FINANCING 2014/15
VALUATION/GROSS COST AT 31 MARCH 2016
904
-
Government granted
Donated
-
8,299
£000
Land
Finance leased
Owned
Net book value at 31 March 2016
GROUP
15.3 PROPERTY, PLANT AND EQUIPMENT FINANCING 2015/16
13,271
-
-
-
13,271
16,500
-
-
-
16,500
£000
Transport equipment
2,264
-
-
-
2,264
1,867
-
-
-
1,867
£000
Information technology
605
-
-
-
605
548
-
-
-
548
£000
Furniture & fittings
68,424
1,809
-
-
66,615
66,005
1,794
-
-
64,211
£000
Total
Annual Report and Accounts 2015/16
-
Disposals / derecognition
//153 9,203
ACCUMULATED DEPRECIATION AT 31 MARCH 2016
Net book value at 1 April 2015
-
Disposals / derecognition
9,203
-
Provided during the year
Net book value at 31 March 2016
-
Accumulated depreciation at 1 April 2015 - brought forward
9,203
-
Reclassifications
VALUATION/GROSS COST AT 31 MARCH 2016
-
9,203
£000
Land
Additions - purchased
Valuation/Gross cost at 1 April 2015
TRUST
30,913
30,457
5,985
-
1,432
4,533
36,442
-
948
28
35,466
Buildings excluding dwellings £000
154
148
13
-
6
7
161
-
-
-
161
£000
Dwellings
7,494
1,599
-
-
-
-
1,599
-
(6,770)
875
7,494
£000
Assets under construction
15.1 PROPERTY, PLANT AND EQUIPMENT - 2015/16
4,520
5,416
7,758
(887)
1,054
7,591
13,174
(935)
1,023
975
12,111
£000
Plant and machinery
13,271
14,002
26,543
(4,418)
3,556
27,405
40,545
(4,418)
4,109
178
40,676
£000
Transport equipment
2,264
1,867
5,068
(3,123)
1,042
7,149
6,935
(3,123)
645
-
9,413
£000
Information technology
605
547
860
-
59
801
1,408
-
-
1
1,406
£000
Furniture & fittings
68,424
63,239
46,227
(8,428)
7,149
47,506
109,466
(8,476)
(45)
2,057
115,930
£000
Total
//Accountability Report
-
//154 -
Revaluations
Transfers to / from assets held for sale
Disposals / derecognition
ACCUMULATED DEPRECIATION AT 31 MARCH 2015 9,203
-
Reversal of impairments
9,091
-
Provided during the year
Net book value at 31 March 2015
-
Accumulated depreciation at 1 April 2014 - restated
Net book value at 1 April 2014
-
9,203
-
(126)
-
Accumulated depreciation at 1 April 2014 - as previously stated
VALUATION/GROSS COST AT 31 MARCH 2015
Disposals / derecognition
Transfers to / from assets held for sale
Reclassifications
238
Impairments
Reversal of impairments
-
Additions - purchased / leased / grants / donations
27,882
30,913
4,553
-
(10)
-
38
1,307
3,218
3,218
35,466
-
8
2,569
1,698
(20)
111
31,100
31,100
9,091 9,091
Valuation/Gross cost at 1 April 2014
£000
Buildings excluding dwellings £000
Land
Valuation/Gross cost at 1 April 2014 restated
TRUST
147
154
7
-
-
1
-
6
-
-
161
-
-
-
14
-
-
147
147
£000
Dwellings
3,951
7,494
-
-
-
-
-
-
-
-
7,494
-
-
(3,855)
-
-
7,398
3,951
3,951
£000
Assets under construction
15.2 PROPERTY, PLANT AND EQUIPMENT - 2014/15
3,050
4,520
7,591
(20)
-
-
-
747
6,864
6,864
12,111
(20)
-
219
-
-
1,998
9,914
9,914
£000
Plant and machinery
16,329
13,271
27,405
(773)
-
-
-
3,602
24,576
24,576
40,676
(875)
-
621
-
-
25
40,905
40,905
£000
Transport equipment
2,630
2,264
7,149
(28)
-
-
-
767
6,410
6,410
9,413
(28)
-
368
-
-
33
9,040
9,040
£000
Information technology
586
605
801
-
-
-
-
60
741
741
1,406
-
-
78
-
-
1
1,327
1,327
£000
Furniture & fittings
63,666
68,424
47,506
(821)
(10)
1
38
6,489
41,809
41,809
115,930
(923)
(118)
-
1,950
(20)
9,566
105,475
105,475
£000
Total
Annual Report and Accounts 2015/16
9,203
30,457
890
-
-
29,567
£000
Buildings excluding dwellings
148
-
-
-
148
£000
Dwellings
1,599
-
-
-
1,599
Assets under construction £000
5,416
//155
-
VALUATION/GROSS COST AT 31 MARCH 2015
9,203
904
Government granted
Donated
-
8,299
Finance leased
Owned
Net book value at 31 March 2015
30,913
905
-
-
30,008
154
-
-
-
154
7,494
-
-
-
7,494
-
-
-
5,416
£000
Plant and machinery
4,520
-
-
-
4,520
15.4 PROPERTY, PLANT AND EQUIPMENT FINANCING 2014/15
VALUATION/GROSS COST AT 31 MARCH 2016
904
-
Government granted
Donated
-
8,299
£000
Land
Finance leased
Owned
Net book value at 31 March 2016
TRUST
15.3 PROPERTY, PLANT AND EQUIPMENT FINANCING 2015/16
13,271
-
-
-
13,271
14,002
-
-
-
14,002
£000
Transport equipment
2,264
-
-
-
2,264
1,867
-
-
-
1,867
£000
Information technology
605
-
-
-
605
548
-
-
-
548
£000
Furniture & fittings
68,424
1,809
-
-
66,615
63,240
1,794
-
-
61,446
£000
Total
//Accountability Report
Annual Report and Accounts 2015/16
16 INVESTMENTS IN SUBSIDIARIES South Central Ambulance Service NHS Foundation Trust purchased 441,340 ordinary shares of £1 each in South Central Fleet Services Ltd. This represents a 100% direct ownership of South Central Fleet Services Ltd which is incorporated in England and Wales. This subsidiary company is included in the consolidation.
17 INVENTORIES GROUP
TRUST
2016 £000
2015 £000
2016 £000
2015 £000
Drugs
-
-
-
-
Work in progress
-
-
-
-
946
814
599
814
85
132
85
132
Inventories carried at fair value less costs to sell
-
-
-
-
Other
-
-
-
-
Inventories held by NHS charitable funds
-
-
-
-
1,031
946
684
946
Consumables Energy
TOTAL INVENTORIES
There were no inventories recognised in expenses during the reported period (2014/15: nil).
//156
//Accountability Report
18.1 TRADE RECEIVABLES AND OTHER RECEIVABLES GROUP
TRUST
2016 £000
2015 £000
2016 £000
2015 £000
1,419
2,116
1,419
2,116
-
-
-
-
(569)
(600)
(569)
(600)
Current Trade receivables due from NHS bodies Other receivables due from related parties Provision for impaired receivables Deposits and advances
-
-
-
-
Prepayments (non-PFI)
2,999
2,881
2,954
2,881
Accrued income
5,671
2,948
5,670
2,948
Interest receivable
5
5
5
5
Corporation tax receivable
-
-
-
-
Operating lease receivables
-
-
-
-
42
147
42
147
PDC dividend receivable VAT receivable
371
212
-
212
1,476
859
1,670
859
Trade and other receivables held by NHS charitable funds
-
-
-
-
TOTAL CURRENT TRADE AND OTHER RECEIVABLES
11,414
8,568
11,191
8,568
Other receivables
The Trust had no non-current trade or other receivables. The majority of trade receivables are due from clinical commissioning groups, as commissioners for NHS patient care services. As clinical commissioning groups are funded by Government to commission NHS patient care services, no credit scoring of them is considered necessary.
18.2 PROVISIONS FOR IMPAIRMENT OF RECEIVABLES GROUP
At 1 April as previously stated Prior period adjustments At 1 April restated
TRUST
2015/16 £000
2014/15 £000
2015/16 £000
2014/15 £000
600
556
600
556
-
-
-
-
600
556
600
556
At start of period for new FTs
-
-
-
-
Transfers by absorption
-
-
-
-
(31)
44
(31)
44
Amounts utilised
Increase in provision
-
-
-
-
Unused amounts reserved
-
-
-
-
569
600
569
600
AT 31 MARCH
The provision relates to £399k injury cost recovery (2014/15: £373k), £94k trade receivables (2014/15: 136k) and £76k overpaid salaries (2014/15: £91k).
//157
Annual Report and Accounts 2015/16
18.3 ANALYSIS OF IMPAIRED RECEIVABLES GROUP
31 March 2016
31 March 2015
Trade receivables £000
Other receivables £000
Trade receivables £000
Other receivables £000
0 - 30 days
-
-
-
-
30 - 60 days
-
-
-
-
Ageing of impaired receivables
60 - 90 days
-
-
-
-
90 - 180 days
-
-
-
-
Over 180 days
-
569
-
600
TOTAL
-
569
-
600
Ageing of non-impaired receivables past their due date (107)
35
287
77
30 - 60 days
0 - 30 days
57
38
112
2
60 - 90 days
67
-
90
-
-
4
-
2
90 - 180 days Over 180 days TOTAL
-
19
-
32
17
96
489
113
The Trust’s impaired receivables are identical to the Group figures stated above.
19 OTHER ASSETS The Group held no other assets as at 31 March 2016 (31 March 2015: nil).
//158
//Accountability Report
20 OTHER FINANCIAL ASSETS GROUP
TRUST
31 March 2016 £000
31 March 2015 £000
31 March 2016 £000
31 March 2015 £000
Available for sale financial assets
-
-
-
-
Held to maturity investments
-
-
-
-
Loan and other receivables
-
-
2,700
-
Other financial assets held by NHS charitable funds
-
-
-
-
TOTAL
-
-
2,700
-
Available for sale financial assets
-
-
-
-
Held to maturity investments
-
-
-
-
Loan and other receivables
-
-
300
-
Other financial assets held by NHS charitable funds
-
-
-
-
TOTAL
-
-
300
-
Non-current
Current
Other financial assets represent a loan made to South Central Fleet Services Ltd to purchase front line ambulances. The long term loan of £3.0m is repayable over a 10 year period and attracts interest of 3.5%. Repayments commence on 10 June 2016.
//159
Annual Report and Accounts 2015/16
21.1 NON-CURRENT ASSETS FOR SALE AND ASSETS IN DISPOSAL GROUPS GROUP
2015/16 Property, Investments plant & in associates equipment & joint ventures £000 £000
NBV of non-current assets for sale and assets in disposal groups at 1 April Prior period adjustment
2014/15 NHS charitable funds assets
Total
Total
£000
£000
£000 3,565
2,950
-
- 2,950
-
-
-
-
-
2,950
-
- 2,950
3,565
Transfers by absorption
-
-
-
-
-
Plus assets classified as available for sale in the year
-
-
-
-
108
Less assets sold in year
-
-
-
-
(664)
Less impairment of assets held for sale
-
-
-
-
(59)
Plus reversal of impairment of assets held for sale
-
-
-
-
-
Less assets no longer classified as held for sale, for reasons other than disposal by sale
-
-
-
-
-
NBV OF NON-CURRENT ASSETS FOR SALE AND ASSETS IN DISPOSAL GROUPS AT 31 MARCH
2,950
-
2,950
-
2,950
NBV of non-current assets for sale and assets in disposal groups at 1 April - restated
The balance for assets held for sale as at 31 March 2016 is the total open market value for Group property that has been declared as available for sale for sites at Battle and Fareham. The Trust’s assets held for sale are identical to the Group’s.
21.2 LIABILITIES IN DISPOSAL GROUPS The Trust held no liabilities in disposal groups as at 31 March 2016 (31 March 2015: nil).
//160
//Accountability Report
22.1 CASH AND CASH EQUIVALENTS MOVEMENTS Cash and cash equivalents comprise cash at bank, in hand and cash equivalents. Cash equivalents are readily convertible investments of known value which are subject to an insignificant risk of change in value. GROUP
At 1 April Prior period adjustments At 1 April (restated) At start of period for new FTs Transfers by absorption
TRUST
2015/16 £000
2014/15 £000
2015/16 £000
2014/15 £000
27,100
8,329
27,100
8,329
-
-
-
-
27,100
8,329
27,100
8,329
-
-
-
-
-
-
-
-
Net change in year
(7,174)
(17,233)
(7,346)
(17,233)
AT 31 MARCH
19,926
(8,904)
19,754
(8,904)
194
9
22
9
19,732
27,091
19,732
27,091
-
-
-
-
Broken down into: Cash at commercial banks and in hand Cash with the Government Banking Service Deposits with the National Loan Fund Other current investments TOTAL CASH AND CASH EQUIVALENTS AS IN SOFP Bank overdrafts (GBS and commercial banks) Drawdown in committed facility TOTAL CASH AND CASH EQUIVALENTS AS IN SoCF
-
-
-
-
19,926
27,100
19,754
27,100
-
-
-
-
-
-
-
-
19,926
27,100
19,754
27,100
22.2 THIRD PARTY ASSETS The Group held no third party assets as at 31 March 2016 (31 March 2015: nil).
//161
Annual Report and Accounts 2015/16
23.1 TRADE AND OTHER PAYABLES GROUP 31 March 2016 £000
TRUST
31 March 2015 £000
31 March 2016 £000
31 March 2015 £000
Current Receipts in advance
-
-
-
-
NHS trade payables
375
302
375
302
Amounts due to other related parties
1,507
1,346
1,507
1,346
Other trade payables
1,323
1,115
1,295
1,115
Capital payables
762
1,803
759
1,803
1,051
1,067
1,051
1,067
-
-
125
-
863
927
851
927
51
53
17
53
9,432
9,361
9,226
9,361
-
-
-
-
15,364
15,974
15,206
15,974
Receipts in advance
-
-
-
-
NHS trade payables
-
-
-
-
Amounts due to other related parties
-
-
-
-
Other trade payables
-
-
-
-
18
30
18
30
Social security costs VAT payable Other taxes payable Other payables Accruals PDC dividend payable TOTAL CURRENT TRADE AND OTHER PAYABLES Non-current
Other payables Accruals TOTAL NON-CURRENT TRADE AND OTHER PAYABLES
-
-
-
-
18
30
18
30
Amounts due to related parties represents £1,507k outstanding pension contributions as at 31 March 2016 (31 March 2015 £1,346k).
23.2 EARLY RETIREMENTS IN NHS PAYABLES ABOVE There were no early retirement payments in the above.
//162
//Accountability Report
23.3 BETTER PAYMENT PRACTICE CODE Measure of compliance
March 2016 Number
March 2016 £000
March 2015 Number
March 2015 £000
Total Non-NHS Trade Invoices Paid in the Year
45,179
77,553
40,986
79,440
Total Non-NHS Trade Invoices Paid Within Target
37,452
71,716
36,184
77,471
Percentage of Non-NHS Trade Invoices Paid Within Target
82.9%
92.5%
88.3%
97.5%
Total NHS Trade Invoices Paid in the Year
539
2,484
516
1,969
Total NHS Trade Invoices Paid Within Target
459
2,377
437
1,875
85.2%
95.7%
84.7%
95.2%
Non-NHS Payables
NHS Payables
Percentage of NHS Trade Invoices Paid Within Target
The Trust will continue to try to pay invoices from its suppliers promptly and will strive to pay all valid invoices by the due date, or within 30 days of receipt of invoice in accordance with the Better Payment Practice Code.
24 OTHER LIABILITIES The Group had no other liabilities as at 31 March 2016 (31 March 2015: nil).
//163
Annual Report and Accounts 2015/16
25 BORROWINGS GROUP
TRUST
31 March 2016 £000
31 March 2015 £000
31 March 2016 £000
31 March 2015 £000
Bank overdrafts
-
-
-
-
Drawdown in committed facility
-
-
-
-
Current
Loans from the Department of Health
1,738
1,738
1,738
1,738
Other loans
-
-
-
-
Obligations under finance leases
-
-
-
-
PFI lifecycle replacement received in advance
-
-
-
-
Obligations under PFI, LIFT or other service concession contracts (excl. lifecycle)
-
-
-
-
Other current borrowings within NHS charitable funds
-
-
-
-
1,738
1,738
1,738
1,738
4,878
6,616
4,878
6,616
-
-
-
-
Other non-current borrowings within NHS charitable funds
-
-
-
-
TOTAL NON-CURRENT BORROWINGS
4,878
6,616
4,878
6,616
TOTAL CURRENT BORROWINGS Non-current Loans from the Department of Health Other loans Obligations under finance leases Obligations under PFI, LIFT or other service concession contracts
The Trust has one capital loan of £3,551k (payable over 10 years) taken out in 2008/09 at an interest rate of 4.28% and one of £7,000k (payable over 5 years) taken out in 2014/15 at an interest rate of 1.48%.
26 OTHER FINANCIAL LIABILITIES The Group had no other financial liabilities as at 31 March 2016 (31 March 2015: nil).
27 FINANCE LEASES The Group had no finance lease receivables as at 31 March 2016 (31 March 2015: nil).
//164
//Accountability Report
28 PROVISIONS FOR LIABILITIES AND CHARGES ANALYSIS Current
Non-Current
31 March 2016 £000
31 March 2015 £000
31 March 2016 £000
31 March 2015 £000
Pensions relating to other staff
238
219
3,582
4,652
Other legal claims
298
252
166
166
Restructurings
267
60
0
0
Redundancy
250
400
0
0
Other *
3,584
5,303
4,296
4,658
TOTAL CURRENT BORROWINGS
4,637
6,234
8,044
9,476
* The other provisions include £5,151k ongoing costs arising from the management of closure of activities of NHS Direct including the retention of clinical records, £725k staff related costs, £290k property delapidations, £102k for lease car related costs, £1,553k provision for credit notes and £59k for supplier disputes.
//165
//166
-
Utilised during the year
Reclassified to liabilities held in disposal groups
Reversed unused
Unwinding of discount
Movement in NHS charitable funds provisions
AT 31 MARCH 2016 -
- not later than one year
- later than one year and not later than five years
- later than five years
TOTAL
Expected timing of cash flows:
-
Arising during the year
3,820
2,699
883
238
3,820
-
36
(1,103)
-
(234)
256
(6)
-
-
Transfers by absorption
Change in the discount rate
-
-
At start of period for new FTs
464
-
166
298
464
-
-
(31)
-
-
77
-
-
-
418
£000
£000 4,871
Other legal claims
Pensions other staff
-
Pensions - former directors £000
At 1 April 2015
TRUST
267
-
-
267
267
-
-
-
-
-
207
-
-
-
60
£000
Re-structurings
250
-
-
250
250
-
-
(120)
-
(30)
-
-
-
-
400
£000
Redundancy
7,880
2,098
2,198
3,584
7,880
-
-
(2,332)
-
(1,385)
1,636
-
-
-
9,961
£000
Other
12,681
4,797
3,247
4,637
12,681
-
36
(3,586)
-
(1,649)
2,176
(6)
-
-
15,710
£000
Total
Annual Report and Accounts 2015/16
28 PROVISIONS FOR LIABILITIES AND CHARGES ANALYSIS
//Accountability Report
29 CLINICAL NEGLIGENCE LIABILITIES At 31 March 2016, £31,921k was included in provisions of the NHSLA in respect of clinical negligence liabilities of South Central Ambulance Service NHS Foundation Trust (31 March 2015: £4,208k).
30 CONTINGENT ASSETS AND LIABILITIES GROUP
TRUST
31 March 2016 £000
31 March 2015 £000
31 March 2016 £000
31 March 2015 £000
(87)
(101)
(87)
(101)
Employment tribunal and other employee related litigation
-
-
-
-
Redundancy
-
-
-
-
Other
-
(559)
-
(559)
(87)
(660)
(87)
(660)
-
-
-
-
(87)
(660)
(87)
(660)
-
-
-
-
Values of contingent liabilities NHS Litigation Authority legal claims
GROSS VALUE OF CONTINGENT LIABILITIES Amounts recoverable against liabilities NET VALUE OF CONTINGENT LIABILITIES NET VALUE OF CONTINGENT ASSETS
Additional liability on legal claims at 100% probability.
31 CONTRACTUAL CAPITAL COMMITMENTS GROUP
Property, plant and equipment Intangible assets TOTAL
//167
TRUST
31 March 2016 £000
31 March 2015 £000
31 March 2016 £000
31 March 2015 £000
185
106
185
106
77
200
77
200
262
306
262
306
Annual Report and Accounts 2015/16
32.1 FINANCIAL INSTRUMENTS
INTEREST RATE RISK The Foundation Trust’s borrowings are from government, the borrowings are for 1 – 10 years, in line with the life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the life of the loan. The Foundation Trust therefore has low exposure to interest rate fluctuations.
Financial reporting standard IFRS 7 requires disclosure of the role that financial instruments have had during the period in creating or changing the risks a body faces in undertaking its activities. Because of the continuing service provider relationship that the Foundation Trust has with clinical commissioning groups and the way those clinical commissioning groups are financed, the Foundation Trust is not exposed to the degree of financial risk faced by business entities. Also financial instruments play a much more limited role in creating or changing risk than would be typical of listed companies, to which the financial reporting standards mainly apply. The Foundation Trust has limited powers to borrow or invest surplus funds and financial assets and liabilities are generated by day-to-day operational activities rather than being held to change the risks facing the Trust in undertaking its activities.
CREDIT RISK Because the majority of the Foundation Trust’s income comes from contracts with other public sector bodies, the Foundation Trust has low exposure to credit risk. The maximum exposures as at 31 March 2016 are in receivables from customers, as disclosed in the trade and other receivables note. The Trust’s procurement process is robust and the Trust restricts prepayments to suppliers. LIQUIDITY RISK The Foundation Trust’s operating costs are incurred under contracts with clinical commissioning groups, which are financed from resources voted annually by Parliament. The Foundation Trust is not exposed to significant liquidity risks.
The Foundation Trust’s treasury management operations are carried out by the finance department, within parameters defined formally within the Foundation Trust’s standing financial instructions and policies agreed by the Board of Directors. Foundation Trust treasury activity is subject to review by the Trust’s internal auditors. CURRENCY RISK The Foundation Trust is principally a domestic organisation with the great majority of transactions, assets and liabilities being in the UK and sterling based. The Foundation Trust has no overseas operations. The Foundation Trust therefore has low exposure to currency rate fluctuations.
//168
//Accountability Report
32.2 FINANCIAL ASSETS GROUP
Loans & receivables £000
Assets at fair value through the I&E £000
Held to Available maturity for sale
Total
£000
£000
£000
Assets as per SoFP as at 31 March 2016 Trade and other receivables excluding non financial assets
7,658
-
-
-
7,658
Cash and cash equivalents at bank and in hand
19,926
-
-
-
19,926
TOTAL AT 31 MARCH 2016
27,584
-
-
-
27,584
Loans & receivables £000
Assets at fair value through the I&E £000
Held to Available maturity for sale
Total
GROUP
£000
£000
£000
Assets as per SoFP as at 31 March 2015 Trade and other receivables excluding non financial assets
5,007
-
-
-
5,007
Cash and cash equivalents at bank and in hand
27,100
-
-
-
27,100
TOTAL AT 31 MARCH 2015
32,107
-
-
-
32,107
32.3 FINANCIAL LIABILITIES GROUP
Other financial liabilities
Total
£000
Liabilities at fair value through the I&E £000
6,616
-
6,616
14,712
-
14,712
£000
Liabilities as per SoFP as at 31 March 2016 Borrowings excluding finance lease and PFI liabilities Trade and other payables excluding non financial liabilities Provisions under contract TOTAL AT 31 MARCH 2016
//169
6,356
-
6,356
27,684
-
27,684
Annual Report and Accounts 2015/16
GROUP
Other financial liabilities
Total
£000
Liabilities at fair value through the I&E £000
8,354
-
8,354
15,172
-
15,172
7,003
-
7,003
30,529
-
30,529
£000
Liabilities as per SoFP as at 31 March 2015 Borrowings excluding finance lease and PFI liabilities Trade and other payables excluding non financial liabilities Provisions under contract TOTAL AT 31 MARCH 2015
32.4 MATURITY OF FINANCIAL LIABILITIES GROUP 31 March 2016 £000
31 March 2015 £000
18,660
19,380
In more than one year but not more than two years
2,318
3,780
In more than two years but not more than five years
4,636
5,203
In more than five years
2,070
2,166
27,684
30,529
In one year or less
TOTAL
32.5 FAIR VALUES OF FINANCIAL ASSETS The Group held no non-current financial assets as at 31 March 2016 (31 March 2015: nil).
32.6 FAIR VALUES OF FINANCIAL LIABILITIES AT 31 MARCH 2016 GROUP Book value £000
Fair value £000
Provisions under contract
4,146
-
Loans
4,878
-
Other TOTAL
//170
-
-
9,024
-
//Accountability Report
32.2 FINANCIAL ASSETS TRUST
Loans & receivables £000
Assets at fair value through the I&E £000
Held to Available maturity for sale
Total
£000
£000
£000
Assets as per SoFP as at 31 March 2016 Trade and other receivables excluding non financial assets
7,658
-
-
-
7,658
441
-
-
-
441
Cash and cash equivalents at bank and in hand
19,754
-
-
-
19,754
TOTAL AT 31 MARCH 2016
27,853
-
-
-
27,853
Loans & receivables £000
Assets at fair value through the I&E £000
Held to Available maturity for sale
Total
Other investments
TRUST
£000
£000
£000
Assets as per SoFP as at 31 March 2015 Trade and other receivables excluding non financial assets
5,007
-
-
-
5,007
Cash and cash equivalents at bank and in hand
27,100
-
-
-
27,100
TOTAL AT 31 MARCH 2015
32,107
-
-
-
32,107
32.3 FINANCIAL LIABILITIES TRUST
Other financial liabilities
Total
£000
Liabilities at fair value through the I&E £000
6,616
-
6,616
14,476
-
14,476
£000
Liabilities as per SoFP as at 31 March 2016 Borrowings excluding finance lease and PFI liabilities Trade and other payables excluding non financial liabilities Provisions under contract TOTAL AT 31 MARCH 2016
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6,356
-
6,356
27,448
-
27,448
Annual Report and Accounts 2015/16
TRUST
Other financial liabilities
Total
£000
Liabilities at fair value through the I&E £000
8,354
-
8,354
15,172
-
15,172
7,003
-
7,003
30,529
-
30,529
£000
Liabilities as per SoFP as at 31 March 2015 Borrowings excluding finance lease and PFI liabilities Trade and other payables excluding non financial liabilities Provisions under contract TOTAL AT 31 MARCH 2015
32.4 MATURITY OF FINANCIAL LIABILITIES TRUST 31 March 2016 £000
31 March 2015 £000
18,424
19,380
In more than one year but not more than two years
2,318
3,780
In more than two years but not more than five years
4,636
5,203
In more than five years
2,070
2,166
27,448
30,529
In one year or less
TOTAL
32.5 FAIR VALUES OF FINANCIAL ASSETS The Trust held no non-current financial assets as at 31 March 2016 (31 March 2015: nil).
32.6 FAIR VALUES OF FINANCIAL LIABILITIES AT 31 MARCH 2016 TRUST Book value £000
Fair value £000
Provisions under contract
4,146
-
Loans
4,878
-
Other
-
-
9,024
-
TOTAL
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//Accountability Report
33 LOSSES AND SPECIAL PAYMENTS
2015/16 GROUP & TRUST
2014/15
Total number of cases Number
Total value of cases £000
Total number of cases Number
Total value of cases £000
52
31
1
4
-
-
-
-
Losses Overpayment of salaries * Fruitless payments Bad debts and claims abandoned
4
50
-
-
Stores losses and damage to property
103
279
75
272
TOTAL LOSSES
159
360
76
276
Extra-contractual payments
-
-
-
-
Extra-statutory and extra-regulatory payments
-
-
-
-
Compensation payments
-
-
-
-
Special payments
Special severance payments
-
-
-
-
Ex-gratia payments
3
1
7
7
TOTAL SPECIAL PAYMENTS
3
1
7
7
162
361
83
283
TOTAL LOSSES AND SPECIAL PAYMENTS
* Losses relating to overpayments of salaries refer to very old debts where there has been no progress on recovery. These debts have been fully provided for in the Accounts and there are no revenue costs to the Trust in 2015/16 relating to these debts.
34 TRANSFERS BY ABSORPTION The Group had no transfers by absorption in 2015/16
35 PRIOR PERIOD ADJUSTMENTS There were no prior period adjustments
36 EVENTS AFTER THE REPORTING DATE There were no events after the reporting period.
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37 RELATED PARTIES During the year none of the Board Members or members of the key management staff or parties related to them has undertaken any material transactions with South Central Ambulance Service NHS Foundation Trust. The Department of Health is regarded as a related party. During the year South Central Ambulance Service NHS Foundation Trust has had a significant number of material transactions with the Department, and with other entities for which the Department is regarded as the parent Department. These entities are listed below: Income / Expenditure Payments to related party £000
Receivables / Payables
Receipts from Amounts owed related party to related party £000
£000
Amounts due from related party £000
Health Education England
0
1,860
0
26
NHS England
0
1,293
0
77
Public Health England
0
2,522
0
31
75
1,132
17
6
Buckinghamshire Healthcare NHS Trust
0
1,724
0
178
NHS Oxfordshire CCG
0
27,401
0
640
NHS West Hampshire CCG
0
21,892
0
840
NHS Aylesbury Vale CCG
0
7,979
0
51
NHS Chiltern CCG
0
12,638
0
204
NHS Southampton CCG
0
10,410
0
284
NHS Milton Keynes CCG
0
9,341
0
581
NHS Fareham & Gosport CCG
0
9,294
0
384
NHS Portsmouth CCG
0
9,000
0
570
NHS South Eastern Hampshire CCG
0
8,655
0
401
NHS Slough CCG
0
6,375
0
117
NHS North Hampshire CCG
0
6,722
0
250
NHS South Reading CCG
0
5,676
0
89
NHS Windsor, Ascot & Maidenhead CCG
0
4,836
10
0
NHS Wokingham CCG
0
5,057
0
2
NHS Bracknell & Ascot CCG
0
4,850
0
38
NHS Newbury & District CCG
0
4,578
0
514
NHS North & West Reading CCG
0
4,205
0
7
South Central Fleet Services Ltd
5,154
3,246
0
0
British Telecom*
2,600
0
0
0
Berkshire Healthcare NHS Foundation Trust
* Other related parties arising from Ministers and other Senior Department of Health officials. During the period South Central Ambulance NHS Foundation Trust had charitable funds of £0.5m as at 31 March 2016 (2015 £0.6m) //174
//Accountability Report
ACCOUNTING OFFICER’S STATEMENT OF RESPONSIBILITIES Statement of the chief executive’s responsibilities as the accounting officer of the south central ambulance service nhs foundation trust The NHS Act 2006 states that the Chief Executive is the accounting officer of the NHS Foundation Trust. The relevant responsibilities of the accounting officer, including their responsibility for the propriety and regularity of public finances for which they are answerable, and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting Officer Memorandum issued by Monitor.
èè State whether applicable accounting standards as set out in the NHS Foundation Trust Annual Reporting Manual have been followed and disclose and explain any material departures in the financial statements èè Ensure that the use of public funds complies with the relevant legislation, delegated authorities and guidance èè Prepare the financial statements on a going concern basis.
Under the NHS Act 2006, Monitor has directed South Central Ambulance Service NHS Foundation Trust to prepare for each financial year a statement of accounts in the form and on the basis set out in the Accounts Direction.
The Accounting Officer is responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the NHS Foundation Trust and to enable him/her to ensure that the accounts comply with requirements outlined in the above mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the NHS Foundation Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
The accounts are prepared on an accruals basis and must give a true and fair view of the state of affairs of South Central Ambulance Service NHS Foundation Trust and of its income and expenditure, total recognised gains and losses and cash flows for the financial year. In preparing the accounts, the Accounting Officer is required to comply with the requirements of the NHS Foundation Trust Annual Reporting Manual and in particular to:
To the best of my knowledge and belief, I have properly discharged the responsibilities set out in Monitor’s NHS Foundation Trust Accounting Officer Memorandum.
èè Observe the Accounts Direction issued by Monitor including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis; èè Make judgements and estimates on a reasonable basis;
Will Hancock Chief Executive 25 May 2016
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//176
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//Quality Report
QUALITY REPORT
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Annual Report 2015/16 //Part 2and Accounts Annual Quality Report and Accounts 2015/16
DONYA BRYANT NEPTS Lead Dispatcher Southern House, Otterbourne Donya has worked for SCAS for four years in the Non-Emergency Patient Transport Service (NEPTS). She worked for three years as a dispatcher but for the last 12 months has been lead dispatcher for NEPTS in Hampshire and Berkshire. The NEPTS provided by SCAS undertakes over 500,000 patient journeys every year. The role of dispatchers is therefore vital to ensure the smooth, daily running of the service. They allocate patients to ambulances, remove patients from journeys if there are unexpected delays and provide travel updates to patients and hospitals or treatment centres. “I enjoy the fact that no two days at work are ever the same and it’s a very fast-paced environment. It can be challenging to make sure that all our resources are utilised most efficiently across the patch and all patients are picked up and collected when and where they need to be. We have to work closely as a team to make sure that happens as much as possible. I also have additional responsibilities to liaise with the NEPTS business managers and help drive the team’s performance so we are continually improving.”
//178
//Quality Report
PART 1 èè Chief Executive statement on quality èè An overview of what we do and the way we work
PART 2 èè Choosing and prioritising quality improvement initiatives for 2016/17 èè Our priorities for 2016/17 (Patient Safety, Clinical Effectiveness, Patient Experience) èè Statement of Assurance from the Board èè Monitor mandated Quality Indicators
PART 3 èè Looking back and report on progress with 2015/16 quality priorities èè Other quality successes èè Response letters from commissioners and HOSPs
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Annual Annual Quality Report Report and Accounts and Accounts 2015/16 2015/16
,
Chief Executive s Quality Statement As we look to 2016/17 our emphasis will remain on delivering consistently high quality care for all our patients and their families. We have worked with our staff, our Foundation Trust members and our Council of Governors, our commissioners and other external partners to select priorities which these key stakeholders feel will have the greatest impact on improving the quality of care for our patients.
Delivering consistently high quality, safe care is at the heart of our Trust’s ambition and in 2015/16 we have also focused our efforts on working with partners to help relieve pressure across the local healthcare system so that more patients get the right care at the right time, whoever they are treated by. Overall, we want to reassure the people of the South Central region that our services are safe, delivered with a caring attitude by professional staff and provide an effective and efficient use of the physical and financial resources available to us.
Our priorities for the coming year are grouped around three key themes: èè Patient safety èè Clinical effectiveness èè Patient experience
Over the last 12 months we have seen some notable achievements when it comes to measuring the quality of the range of emergency and nonemergency services we provide. A focused inspection on our NHS 111 service found that it was safe and effective; a review of incidents involving medicine errors found that we have identified key themes and cascaded learning across the Trust; changes have been implemented to our nonemergency patient transport service based on an analysis of the common origins and reasons for unsuccessful journeys; clinical governance leads have been introduced across all areas of SCAS and we have expanded the ability of the two air ambulances that support our region to offer an additional seven hours flying time each night.
Each of the priorities we are focusing on within these three themes are explored in more detail in this report. Our progress against these objectives will be monitored through quality improvement plans that are presented to the executive and senior management teams, as well as the Quality and Safety Committee. I hope you will find our Quality Report interesting and informative. To the best of my knowledge, the information we have provided within this report is accurate.
Will Hancock, CEO
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//Quality Report
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//182
//Quality Report
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Annual Report and Accounts 2015/16
PART
//184
//Quality Report - Part 1
EXECUTIVE SUMMARY
A BRIEF OVERVIEW OF WHAT WE DO AND THE WAY WE WORK
SCAS welcomes you to our Quality Accounts which we are proud to report and present. This report gives an opportunity to celebrate our successes and the staff who work hard to deliver the best care. This Quality Account reviews our performance in the last year and sets out our key priorities for quality improvement in 2016/17.
South Central Ambulance Service NHS Foundation Trust is a high performing and expanding emergency and urgent care service, covering four counties underpinned by 19 Clinical Commissioning Groups. On 1 March 2012, SCAS became an NHS Foundation Trust and since that time we have evolved our services, becoming much more than a traditional ambulance service.
Since our last Quality Account we have continued to work with partners to consider how to relieve system wide pressures across local health services while ensuring patients get the right care at the right time. This will be an ongoing workstream.
MOBILE URGENT HEALTHCARE Providing 999 responses and care in a community setting NON-EMERGENCY PATIENT TRANSPORT AND LOGISTICS Providing routine and non-emergency patient transport services (NEPTS) CLINICAL COORDINATION CENTRES - Facilitating delivery of the NHS 111 Health Helpline service and 999 and NEPTS calls 111
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Annual Report and Accounts 2015/16 Annual Quality Report and Accounts 2015/16
SERVICES PROVIDED BY SCAS ACROSS THE REGION
BEDFORDSHIRE
G
N
KI C
BU
LUTON
H E
IR
SH
AM
OXFORDSHIRE
BERKSHIRE
HAMPSHIRE
NHS 111 Emergency 999 Non-Emergency Patient Transport Service
//186
//Quality Report - Part 1
SCAS IN NUMBERS
3,000 STAFF
1,271 COMMUNITY & CO RESPONDERS
607 VEHICLES
1,238,568 CALLS TO NHS 111
541,080 CALLS TO 999
513,787 NEPTS JOURNEYS
78 SITES
107 VOLUNTEER CAR DRIVERS
POPULATION 4.6 MILLION
At 31 March 2016
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Annual Report and Accounts 2015/16
HOW DOES THE BOARD ASSURE ITSELF ON QUALITY?
Part of this program involves the process of benchmarking against other ambulance services so that comparisons can be made and targets set as part of a national ambulance program of improvement in pre-hospital and urgent care.
In order to ensure the Board are assured that we are maintaining and improving high quality services for our patients there are a number of strategies we employ.
Management of quality governance is assured through the Executive Management Group (EMG) and further monitored through the Quality and Safety Committee (Q&S). The EMG and Q&S Committee upwardly reports to the Trust Board, and is responsible for monitoring and seeking assurances with regards to clinical quality, patient safety and patient experience.
Our Trust Board comprises seven Executive and seven Non-Executive Directors who come from a wide variety of backgrounds, bringing with them a wealth of knowledge from commercial, public, healthcare and other industries. The Board draws assurance from a varied body of information collected through a network of feedback processes to ensure directors remain informed and understand where changes can be made to improve services and outcomes for patients. The Board receives an integrated performance report of quality metrics alongside a detailed quality and safety report, made available to the public through our Board papers, against which we judge our delivery against key quality goals. This is used to challenge the current performance and drive quality improvement. Additionally the Board receives key reports linked to quality from outside agencies such as the Care Quality Commission. Feedback and Board assurance reports also include:
A number of sub groups submit new guidelines, aggregated learning and other feedback to the EMG and Q&S Committee using a universal upward report template. The template provides a succinct process to ensure and assure the organisation that key issues are highlighted and acted upon. The reports highlight areas of non-compliance, areas of concern/challenge, areas for information and best practice. Actions and timescales are included. It is an auditable trail of actions, assurance, scrutiny and monitoring. The Quality Impact Assessment process ensures that all change plans, service developments or cost improvement plans undergo a formal process to assess the potential impact of the change on the quality of care we deliver.
èè Compliments èè Complaints èè Serious incidents èè Appraisals and education èè Staff survey èè Healthcare professional feedback
It is important that Board members have the opportunity to meet staff and patients and hear their stories and experiences. Board members do regular walk rounds across our call centres, ambulance stations and patient transport sites. The Board also regularly hears patient stories in which a patient (or their relative/carer) attends a public Board meeting to provide a first-hand account of their experiences and the care they received.
The Board also takes into account qualitative and quantitative data from a continuous program of internal and external audit.
//188
//Quality Report - Part 1
These stories create a platform to develop actions which drive improvements in the quality of care we provide.
CARE QUALITY COMMISSION The Trust has not been formally rated by the CQC. The inspection will take place at the beginning of May 2016 and will cover all services. Below is the selfassessment grid which was included as part of the formal submission prior to the inspection.
Safe
Effective
Caring
Responsive
Well-led
Emergency and Urgent Care
Good
Good
Outstanding
Good
Outstanding
Patient Transport Services
Good
Good
Outstanding
Good
Good
Emergency Operations Centre
Good
Good
Outstanding
Good
Outstanding
Resilience
Good
Outstanding
Outstanding
Outstanding
Outstanding
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DUTY OF CANDOUR
STAFF SURVEY INDICATORS
Candour is the quality of being open and honest. Patients should be well informed about all elements of their care and treatment, and all staff have a responsibility to be open and honest to those in their care.
NHS STAFF SURVEY RESULTS 2015
KF21 % BELIEVING THE ORGANISATION PROVIDES EQUAL OPPORTUNITIES FOR CAREER PROGRESSION / PROMOTION
The Trust has an established duty of candour process and policy. The objectives of this policy are to evidence that a robust risk management system is in place which reflects the following:
This indicator has shown an increase (better than 2014) and this is an average ranking, compared with all ambulance trusts in 2015.
èè A patient has a right to expect openness from their healthcare providers èè The Trust will learn from mistakes with full transparency and openness èè A proactive approach to patient safety with the onus on risk management systems and processes identifying incidents which require review and learning. èè Working in partnership with all stakeholders èè Staff do not intend to cause harm but unfortunately incidents do occur. When mistakes happen, patients/ relatives/carers/others should receive an apology and explanation as soon as possible. Apologising is not an admission of liability and staff should feel able to apologise at the earliest opportunity
KF26 % EXPERIENCING HARASSMENT, BULLYING OR ABUSE FROM STAFF IN LAST 12 MONTHS This indicator shows no change from the 2014 survey and is below (better than) average compared with all ambulance trusts in 2015.
The Trust has just completed the Equality and Diversity Strategy (EDS2) community grading panel and as part of the assessment will be developing an action plan for the Workforce Race Equality Standard (WRES). The Trust is due to review the WRES and publish the new data and action plan by the 30 July 2016.
//190
//Quality Report - Part 2
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Annual Report and Accounts 2015/16
CHOOSING AND PRIORITISING QUALITY IMPROVEMENT INITIATIVES
This year the Trust has continued to assess priorities in terms of:
IMPACT
In this part of the report we will outline a number of areas where we have identified that quality improvements can and should be made. Priorities are identified through scrutiny of a wealth of information collated through robust operational and engagement practices which are shared at Board level through our governance structure.
By considering the likely improvement in safety, outcomes and experience
Feasibility The ease of implementation, resources required and likely time to completion or delivery
We engage with our clinical commissioning groups and other external partners when defining our goals for quality improvement and we place high importance on the feedback we receive from patients and other healthcare professionals who tell us that they want safe, timely care delivered by competent, professional and caring staff members.
Measurability Can the priority we have set be measured accurately in order that we can show improvements
Outcomes
Leadership walk-rounds by the Executive and Non-Executive Directors also provide intelligence to develop areas for improvement and helped to engage frontline and support staff in discussions and debates about our clinical and patient priorities. Internal and external audit programs and aggregated learning outcomes from incidents and claims are another vital aid to shaping our priorities.
Will the initiative improve patient outcomes in the areas of safety, effectiveness and experience
Finally as a Foundation Trust we are fortunate to be able to draw on the input of our Council of Governors who provide a picture of the needs of the community which we serve.
//192
//Quality Report - Part 2
SCAS Quality Priorities for 2016/17 Following consultation with the Trust Board, our Council of Governors, Quality and Safety Committee, the senior leadership team and staff representation the following priorities have been approved and confirmed for the Quality Accounts:
Each of our priorities and our proposed initiatives for 2016/17 are described in detail on the following pages. They will be monitored through the quality improvement plans that are presented to the executive and senior management teams and the Quality and Safety Committee.
1 PATIENT SAFETY 1a
Improve the recognition of sepsis in children under five years old in CCC
1b
To develop systems so that discharge summaries are sent electronically in all areas of SCAS
1c
To develop feedback mechanisms for health professionals who report incidents via the Datix system
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2 Clinical Effectiveness 2a
To ensure the long wait reviews have clear actions that are monitored and the effectiveness measured
2b
To proactively manage high intensity users to reduce reactive frequent calls and provide better support
2c
Improve compliance with limb fracture care bundle
3 PATIENT EXPERIENCE 3a
To improve the number of formal complaints responded to on time by the Trust
3b
To increase support for patients in their own home/care home when they are reaching the end of life
3c
To ensure the wide range of patient feedback including surveys is considered regularly. All reviews on NHS Choices website relating to the Trust will be responded to in two working days
//194
//Quality //Part Report2 - Part 2
MEERA PATEL Emergency Call Taker Northern House, Bicester When you dial 999 and are put through to the ambulance service, Meera is one of the team who will take your call and get the right help to you. Meera joined SCAS in April 2015. As an emergency call taker, she is part of a team that works a shift pattern of six days on and four days off, covering a mix of day, evening and night shifts. Prior to working for us, she owned and ran her own guitar shop. “I enjoyed meeting and talking with members of the public in my shop, but was looking for a new challenge – something that was fast-paced but still dealing with people. I saw SCAS was advertising for emergency call takers which seemed to be exactly what I was looking for. I like the fact that every day is completely different; I never know what is going to happen until I login and take that first call. As well as getting people help when they need it, I can talk them through carrying out basic first aid, such as CPR, until the ambulance arrives. It’s a challenging, but very rewarding job.”
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1A. IMPROVE THE RECOGNITION OF SEPSIS IN CHILDREN UNDER FIVE YEARS OLD IN CCC RATIONALE Sepsis is a life-threatening condition that is caused when the body over reacts to an injury. It results in the body injuring its own tissues and organs. SCAS is involved in national work with the NHS Pathways/HSCIC and NHS England. Four questions in the Pathway have been identified and if an “Unsure” answer is selected by the call handler/emergency call taker to any one of these questions then the caller is passed to a clinician to make a full clinical assessment.
TO ACHIEVE THIS WE NEED TO: èè Continue working with the national team from NHS Pathways/HSCIC and NHS England èè All clinicians working in the CCC will complete the NHS Sick Child e-learning via the online link. èè Ensure all calls that meet the criteria for national review are redacted and available.
BOARD SPONSOR èè Deirdre Thompson Director of Quality and Patient Care
IMPLEMENTATION LEAD èè Debbie Diffey Clinical Assurance and Training Manager
//196
//Quality Report - Part 2
1B. TO DEVELOP SYSTEMS SO THAT DISCHARGE SUMMARIES ARE SENT ELECTRONICALLY IN ALL AREAS OF SCAS RATIONALE The electronic transfer of discharge information to primary care will ensure that GPs have relevant urgent care patient information in a timely manner, ensuring an improved continuity of any ongoing care that may be required. This indicator relates to patients who are ‘see and treat’.
TO ACHIEVE THIS WE NEED TO: èè Ensure that the information on the discharge summary is clinically appropriate and agreed by GPs èè Ensure that we work with the CCGs to gain a nhs.net email address for all GPs èè Enable the technology to be able to send the discharge summary electronically èè Ensure that the system is tested prior to roll out èè Ensure that summaries are sent electronically to all GPs by the end of 2016/17 èè Conduct a survey ensuring that GPs are satisfied with the discharge summary
BOARD SPONSOR èè Deirdre Thompson Director of Quality and Patient Care
IMPLEMENTATION LEAD èè Dave Sherwood Assistant Director of Patient Care
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1C. TO DEVELOP FEEDBACK MECHANISMS FOR HEALTH PROFESSIONALS WHO REPORT INCIDENTS VIA THE DATIX SYSTEM RATIONALE The Trust undertakes a staff safety culture survey twice a year. The results show that there is room for improvement in the number of staff who receive feedback once they have reported an incident on the Datix system. The results from the November 2015 survey show an improvement from the June 2015 survey but further improvement is still needed. 30% of staff in the survey in June answered that they rarely received feedback; this had improved in November to 15%.
TO ACHIEVE THIS WE NEED TO: èè Work with managers to ensure that they are aware they have a responsibility to give the reporter feedback èè The Trust now has recruited clinical governance facilitators for all services who will ensure new managers receive training on the Datix system and refresher training is offered to existing managers èè The staff safety culture survey will be conducted in 2016/17. Actions to improve will be identified and progress will be overseen by the Patient Safety Group
BOARD SPONSOR èè Deirdre Thompson Director of Quality and Patient Care
IMPLEMENTATION LEAD èè Clinical Governance Leads
//198
//Quality Report - Part 2
2A. TO ENSURE THE LONG WAIT REVIEWS HAVE CLEAR ACTIONS THAT ARE MONITORED AND THE EFFECTIVENESS MEASURED RATIONALE The Trust has a process for reviewing cases where patients have had to wait longer than expected for an ambulance response. The review meetings need to develop further this year with clearer actions and follow up from meeting to meeting.
TO ACHIEVE THIS WE NEED TO: èè Review a sample of patients monthly who have had a long wait èè Ensure the sample includes all red calls èè Clinical governance leads and senior operational staff to agree actions at meetings èè Themes from root causes to be reported quarterly in the aggregated learning report
BOARD SPONSOR èè Philip Astle Chief Operating Officer
IMPLEMENTATION LEAD èè Mark Ainsworth Director of Operations èè Jane Campbell Assistant Director of Quality
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2B. TO PROACTIVELY MANAGE HIGH INTENSITY USERS TO REDUCE REACTIVE FREQUENT CALLS AND PROVIDE BETTER SUPPORT RATIONALE High intensity users are a group of patients who access emergency healthcare on an abnormally high number of occasions. These patients often have specific healthcare or social needs, and have a significant impact on the NHS and emergency services to deliver safe services to the community due to the level of resources required to deal with their requirements.
TO ACHIEVE THIS WE NEED TO: èè Case manage users more effectively through support, advice and intervention by demand practitioners èè Care plans to be implemented supported by access to experienced primary and secondary care clinicians
BOARD SPONSOR èè Deirdre Thompson Director of Quality and Patient Care
IMPLEMENTATION LEAD èè Mark Ainsworth Director of Operations èè Tim Churchill Head of Demand Management
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2C. IMPROVE COMPLIANCE WITH LIMB FRACTURE CARE BUNDLE RATIONALE Audit data shows that improvements are required with compliance with the limb fracture care bundle. The bundle is one of the national ambulance quality indicators and relates to best practice. 2015/16 June to December 2015 compliance with care bundle 42.6%
TO ACHIEVE THIS WE NEED TO: èè Give the optimum care to those patients who have sustained a lower limb fracture and provide optimum treatment èè Ensure care is fully documented on electronic patient record èè Demonstrate through audit the increase in care bundle compliance
BOARD SPONSOR èè John Black Medical Director
IMPLEMENTATION LEAD èè Dave Sherwood Assistant Director of Patient Care
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CLINICAL QUALITY INDICATOR
SINGLE LIMB FRACTURE CARE BUNDLE
East Midlands
33.6%
East of England
27.1%
Isle of Wight
68.2%
London
33.7%
North East
44.1%
North West
65.3%
SOUTH CENTRAL
42.6%
South East Coast
57.6%
South Western
53.7%
West Midlands
40.7%
Yorkshire
42.1%
Annual Report and Accounts 2015/16
3A. TO IMPROVE THE NUMBER OF FORMAL COMPLAINTS RESPONDED TO ON TIME BY THE TRUST RATIONALE Improvement in the number of complaints responded to on time is needed. Complaints are investigated to a high standard including calls being audited and staff statements collected but often the date for response is exceeded.
TO ACHIEVE THIS WE NEED TO: èè Ensure that new processes are embedded èè New investigating officers to receive training and refresher training to be available for existing investigators èè Datix system to be the source of reporting in 2016/17 èè Percentage of complaints closed in month that were responded to on time, by service will be monitored via the Board Report
BOARD SPONSOR èè Deirdre Thompson Director of Quality and Patient Care
IMPLEMENTATION LEAD èè Amanda Painter Head of Patient Experience
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ANDY LLOYD HART Educator and Paramedic Winchester and Eastleigh Resource Centre, Hampshire Andy has worked for SCAS for eight years, starting as a student paramedic in 2008, qualifying as a paramedic in 2010 and working out of our Didcot Resource Centre. He joined the Hazardous Area Response Team (HART) in 2012. Having qualified as a Breathing Apparatus Instructor for HART in 2012, Andy was seconded to the National Ambulance Resilience Unit (NARU) in 2014 for 10 months. He worked as a national instructor training emergency services personnel from across the UK and internationally as part of the UK’s response to the ebola crisis in West Africa, and returned to SCAS HART in July 2015. “I began my career as a firefighter and then qualified as a paramedic. Joining HART seemed like a natural progression to develop my skills further with the opportunities it gave me. Delivering high-quality patient care at all times is my focus, but a lot of work I also do focuses on staff safety and education – things I’m equally, deeply passionate about. The jobs I attend are outside of the norm and really stretch me to think on my feet. Trying to cannulate a patient in a dark, dusky, enclosed space when your goggles have steamed up – that’s challenging!”
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3B. TO INCREASE SUPPORT FOR PATIENTS IN THEIR OWN HOME/CARE HOME WHEN THEY ARE REACHING THE END OF LIFE RATIONALE Improvements can be made to ensure there is increased support for patients who are reaching the end of life in their own homes. At present there is often limited access to good quality, up to date patient records with predetermined end of life management plans. Staff in the Clinical Co-ordination Centre (CCC) are often reliant on carer communication as they are unable to view the patient. SCAS clinicians are unable to access/administer palliative medications which may result in the patient being transported and admitted to hospital for medication.
TO ACHIEVE THIS WE NEED TO: èè View active care plans and deliver care aligned to patient’s wishes by increasing clinical support at home to prevent avoidable admissions. èè Care Home pilot to ensure CCC staff can ‘view patient’ in real time to assess and send the most suitable response first time. The Trust will identify two care homes with high admissions to pilot ‘Live Link’. èè Administration of additional medications to keep patients comfortable at home.
BOARD SPONSOR èè Deirdre Thompson Director of Quality and Patient Care
IMPLEMENTATION LEAD èè Simon Holbrook Head of Compliance èè Tim Churchill Head of Demand Management
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3C. TO ENSURE THE WIDE RANGE OF PATIENT FEEDBACK INCLUDING SURVEYS IS CONSIDERED REGULARLY. ALL REVIEWS ON NHS CHOICES WEBSITE RELATING THE TRUST WILL BE RESPONDED TO IN TWO WORKING DAYS RATIONALE Patient feedback is received in a number of ways from complaints and compliments to survey responses. The Trust has not been consistent in responding to comments on the NHS Choices website. This feedback can be used to enhance intelligence concerning services and guide service improvements.
TO ACHIEVE THIS WE NEED TO: èè Patient feedback including surveys will be considered and included in the regular patient experience paper to public Board Meetings. èè Themes from patient feedback will be included in the quarterly aggregated learning report. Actions for improvement will be collated and effectiveness monitored. èè All comments on the NHS Choices website will be responded to in two working days.
BOARD SPONSOR èè Deirdre Thompson Director of Quality and Patient Care
IMPLEMENTATION LEAD èè Amanda Painter Head of Patient Experience
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Statement of Assurance from the Board All NHS Foundation Trusts are asked to provide common areas of information which demonstrate assurance on the Trust’s commitment and actions to improve the quality of their service and provision of care. This section provides the requirements and statements as specified by the Quality Account regulations.
Along with qualitative data, the Board has sought assurance from a variety of sources: èè Patient surveys èè Staff surveys èè Narrative from complaints and feedback and their resolution èè Patient stories at public Board Meetings èè Root cause analysis of incidents and identified learning èè Internal audit reports èè External reviews of quality including the CQC èè Leadership walk-rounds èè Bi-monthly committee meetings
During 2015/16 South Central Ambulance Service NHS Foundation Trust (SCAS) provided and/or sub contracted three relevant services: èè Emergency 999 Ambulance Service èè Non-Emergency Patient Transport Service èè NHS 111 Telephone Advice Service
The income generated by the relevant services reviewed in 2015/16 represents 100% of the total income generated from the provision of relevant services by SCAS for 2015/16.
SCAS has reviewed all the data available to it on the quality of care in these three services.
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èè Ambulance Service Clinical Quality Indicator Cardiac Arrest Survival to Discharge (STD) Rates (and separate witnessed arrest STD rates) èè Ambulance Service Clinical Quality Indicator ST elevation Myocardial Infarction Care Bundle èè Ambulance Service Clinical Quality Indicator Primary Percutaneous Coronary Intervention (pPCI) call to Balloon within 150 minutes
During 2015/16, 11 national clinical audits and nil national confidential enquiries covered relevant health services that SCAS provides.
The national clinical audits and national confidential enquires that SCAS participated in during 2015/16 were as follows:
During 2015/16, SCAS participated in 100% national clinical audits and 0% national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in.
èè Acute Myocardial Infarction and other ACS (MINAP) èè National Clinical Performance Indicator Asthma èè National Clinical Performance Indicator Febrile Convulsions èè National Clinical Performance Indicator Below Knee Fractures èè National Clinical Performance Indicator Elderly Fall èè National Clinical Performance Indicator Mental Health èè Ambulance Service Clinical Quality Indicator Stroke Care Bundle èè Ambulance Service Clinical Quality Indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates) èè Ambulance Service Clinical Quality Indicator Cardiac Arrest Survival to Discharge (STD) Rates (and separate witnessed arrest STD rates) èè Ambulance Service Clinical Quality Indicator ST elevation Myocardial Infarction Care Bundle èè Ambulance Service Clinical Quality Indicator Primary Percutaneous Coronary Intervention (pPCI) call to Balloon within 150 minutes
The national clinical audits and national confidential enquires that SCAS was eligible to participate in during 2015/16 were as follows: èè Acute Myocardial Infarction and other ACS (MINAP) èè National Clinical Performance Indicator Asthma èè National Clinical Performance Indicator Febrile Convulsions èè National Clinical Performance Indicator Below Knee Fractures èè National Clinical Performance Indicator Elderly Falls èè National Clinical Performance Indicator Mental Health èè Ambulance Service Clinical Quality Indicator Stroke Care Bundle èè Ambulance Service Clinical Quality Indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)
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KESHIA ADAMS Dispatcher Northern House, Bicester Keshia has been working for SCAS for four years. She began as an emergency call taker, transferred to become an assistant dispatcher after 12 months, and one year later qualified as a dispatcher, a role she has held for the last two years. When 999 calls are received in our clinical co-ordination centre (CCC), Keshia is part of the team that allocate the right crews that can best meet each patient’s needs. There are four dispatch desks in the CCC, with each one looking after one of the four counties SCAS serves. This ensures dispatchers and assistant dispatchers really get to know a specific county and the crews that work in it. “As well as dispatching the right resources to emergency incidents as they come in, I also deal with police and other services if they’re involved, welfare check the crews after traumatic incidents and try to make sure they get their breaks and finish their shifts on time. Even though I don’t see patients face-to-face, I like the fact that I’m doing a job helping people when they need it most.”
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The national clinical audits and national confidential enquiries that SCAS participated in, and for which data collection was completed during 2015/16, are listed below alongside the numbers of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.
NATIONAL CLINICAL AUDIT
NUMBER OF CASES
% SUBMITTED
2624 as at April 2016
100%
National Clinical Performance Indicator Asthma
407
100%
National Clinical Performance Indicator Febrile Convulsions
180
100%
National Clinical Performance Indicator Below Knee Fractures
110
100%
National Clinical Performance Indicator Elderly Falls
300
100%
National Clinical Performance Indicator Mental Health
300
100%
Ambulance Service Clinical Quality Indicator Stroke Care Bundle
5,235 April to Dec 15
100%
Ambulance Service Clinical Quality Indicator Cardiac Arrest ROSC Rates (and separate witnessed arrest ROSC rates)
823 April to Dec 15
100%
Ambulance Service Clinical Quality Indicator Cardiac Arrest Survival to Discharge (STD) Rates (and separate witnessed arrest STD rates)
964 April to Dec 15
100%
Ambulance Service Clinical Quality Indicator ST elevation Myocardial Infarction Care Bundle
799 April to Dec 15
100%
Ambulance Service Clinical Quality Indicator Primary Percutaneous Coronary Intervention (pPCI) Call to Balloon within 150 minutes
661 as at April 16
100%
Acute Myocardial Infarction and other ACS (MINAP) - entered in to the audit by Acute Trusts, data quality checked by South Central Ambulance Service NHS Trust.
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The reports of 11 national clinical audits were reviewed in 2015/16 and the Trust intends to take the following actions to improve the quality of health care provided:
Participation in clinical research demonstrates the Trust’s commitment to improving the quality of care we offer and to making our contribution to wider health improvement. By enabling clinical staff to stay abreast of the latest treatment possibilities, we optimise patient outcomes.
èè Improve data entry compliance utilising applications in the ePR èè Provide team level data to all team leaders èè Improve integration of private provider data
Our engagement with clinical research also demonstrates the Trust’s commitment to testing and offering the latest medical treatment and techniques.
Resources this year for internal audit have been focused on long wait reviews. The Trust has a process for reviewing cases where patients have had to wait longer than expected for an ambulance response.
THE AREAS OF ENGAGEMENT DURING THE YEAR WERE: èè Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug administration In Cardiac arrest (PARAMEDIC2), a large multi-centre randomised controlled study of adrenaline in prehospital cardiac arrest with Warwick University and other ambulance trusts; èè Understanding variation in rates of ‘non-conveyance to an emergency department’ of emergency ambulance users (VAN); èè Impact of closing Emergency Departments in England (closED); èè A study of sense-making strategies and help-seeking behaviours associated with the use and provision of urgent care services; èè An exploration of the experiences of women, birth partners and midwives of using a dedicated, midwife led telephone support line for labour; èè Exploring factors increasing Paramedics’ Likelihood of initiating Analgesia IN pre-hospital Pain (EXPLAIN); èè Contributing data to the “Out of Hospital Cardiac Arrest Outcomes” study.
Changes have been made to Trust policy regarding mealtime breaks as a consequence of the results. Plans are being developed now to enable the Trust to trial new ways of working in 2016/17 in order to reduce long waits.
The number of patients receiving NHS services provided or sub contracted by SCAS in 2015/16 that were recruited to participate in research, approved by a research ethics committee, was 540 (537 in PARAMEDIC2 and 3 in VAN – see below).
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Conference presentations and publications demonstrate our commitment to transparency and desire to improve patient outcomes and experience across the NHS:
èè CD Deakin. Advanced Airways in Advanced Life Support. Cyprus Resuscitation Council. Larnaca, Cyprus. November 2015. èè CD Deakin. Pre-Hospital Resuscitation. Resuscitation Council (UK) Annual Symposium. Birmingham, November 2015. èè CD Deakin. European Resuscitation Council Guidelines Update. Cardiac Arrest Symposium. London, December 2015. èè CD Deakin. Adrenaline in Cardiac Arrest: Friend or Foe? Cardiac Arrest Symposium. London, December 2015. èè CD Deakin. Update on Cardiopulmonary Resuscitation. Recent Advances in Anaesthesia, Critical Care and Pain Management. Royal College of Anaesthetists, London, February 2016.
CONFERENCE PRESENTATIONS èè CD Deakin. Adrenaline in Cardiac Arrest: Friend or Foe? London Air Ambulance Clinical Governance Day. March 2015. èè S Gates, T Quinn, H Pocock. SCT Clinical Trial of the Year 2014: PARAMEDIC. Society for Clinical Trials. Washington, USA. May 2015 Selected by the Society for Clinical Trials (SCT) as the ‘2014 Trial of the Year’. èè CD Deakin. Resuscitation in Drowning. Innovation for PreHospital Emergency Care. South East Coast Ambulance Service. Brighton, May 2015. èè CD Deakin. 2015 Advanced Life Support Guidelines. European Resuscitation Council. Resuscitation 2015. The Guidelines Congress. Prague, Czech Republic. October 2015. èè CD Deakin. Perioperative Resuscitation. European Resuscitation Council. Resuscitation 2015. The Guidelines Congress. Prague, Czech Republic. October 2015. èè CD Deakin. 2015 Advanced Life Support Guidelines. Hellenic Society of Cardiopulmonary Resuscitation. Athens, Greece. November 2015. èè CD Deakin. Advanced Airways in Advanced Life Support. Hellenic Society of Cardiopulmonary Resuscitation. Athens, Greece. November 2015. èè CD Deakin. 2015 Advanced Life Support Guidelines. Cyprus Resuscitation Council. Larnaca, Cyprus. November 2015.
PEER-REVIEWED PUBLICATIONS èè Maconochie I, Deakin CD. Resuscitating Drowned Children. British Medical Journal. 2015 BMJ 2015; 350: h53 èè Deakin CD. One swallow does not make a summer. Resuscitation 2015; 93: A7–A8. èè Deakin CD. Pre-hospital intubation of people with serious head injuries by inexperienced staff linked to increased death rate. Commentary. NIHR Dissemination Centre. https://discover.dc.nihr.ac.uk/ portal/article?id=10.1371/journal. pone.0141034. December 2015. èè Deakin CD, Fothergill R, Moore F, Watson L, Whitbread M. Level of consciousness on admission to a Heart Attack Centre is a predictor of survival from out-of-hospital cardiac arrest. Resuscitation 2014; 85: 905–909.
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èè Lindner T, Deakin CD, Aarsetøy H, Rubertson S, Heltne HJ, Søreide, E. Does angiotensin converting enzyme (ACE) gene polymorphism influence return of spontaneous circulation following out-of-hospital cardiac arrest? A prospective observational pilot study. Open Heart 2014;1: doi:10.1136/ openhrt-2014-000138. èè Perkins GD, Lall R, Quinn T, Deakin CD, Cooke MW, Horton J, Lamb SE, Slowther AM, Woollard M, Carson A, Smyth M, Whitfield R, Williams A, Pocock H, Black JM, Wright J, Han K, Gates S, and PARAMEDIC trial collaborators. Mechanical versus manual chest compression for out-of-hospital cardiac arrest: a pragmatic, cluster-randomised trial. Lancet 2014; 385: 947-955. Selected by the Society for Clinical Trials (SCT) as the ‘2014 Trial of the Year’. èè Brooks B, Chan S, Lander P, Adamson R, Hodgetts GA, Deakin CD. Public Knowledge and Confidence in the Use of Public Access Defibrillation. Heart 2015; doi:10.1136/heartjnl-2015-307624. èè Gates S, Quinn T, Deakin CD, Blair L, Couper K, Perkins GD. Mechanical chest compression for out-of-hospital cardiac arrest: Systematic review and metaanalysis. Resuscitation 2015; 94: 91–97. èè Perkins GD, Brace-McDonnell SJ; on behalf of the OHCAO Project Group. The UK Out-of-Hospital Cardiac Arrest Outcome (OHCAO) project. BMJ Open. 2015 Oct 1;5(10):e008736. doi: 10.1136/ bmjopen-2015-008736. èè Deakin CD. 2015 Resuscitation Council (UK) Guidelines feature expanded section on pre-hospital resuscitation. Journal of Paramedic Practice 2015; 7: 538–539.
èè Whittaker A, Calver A, Corbett S, Deakin CD, Gray H, Simpson I, Wilkinson J, Curzen N. Predictors of in hospital mortality following out of hospital cardiac arrest: insights from a single centre consecutive case series. Postgraduate Medical Journal 2016. In press. èè Pocock H (2013) SQIFED: A new reflective model for action learning. Journal of Paramedic Practice, 5, 3, 146-151. èè Pocock H, Deakin CD, Quinn T, Perkins GD, Horton J, Gates S. Human Factors in Prehospital Research: Lessons from the PARAMEDIC trial. Emergency Medicine Journal 2016, In press.
A proportion of the Trust’s income in 2015/16 was conditional upon achieving quality improvement and innovation goals agreed between SCAS and the clinical commissioning groups, and any person or body they entered into a contract, agreement or arrangement with for the provision of relevant health services, through the Commissioning for Quality and Innovation (CQUIN) payment framework. CQUINS achievements show that SCAS actively engages in quality improvements that cross the boundaries of our organisation. The total for CQUIN related income for 2015/16 is expected to be approximately £1,901,997. The income from CQUIN in 2014/15 was £2,417,690.
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SCAS is required to register with the Care Quality Commission (CQC) and is currently registered without conditions in all essential standards.
SCAS has participated in a focused inspection by the Care Quality Commission during the reporting period. The CQC undertook a focused inspection of the SCAS NHS 111 service in November 2015. The report recognised SCAS as being a very safe and effective provider of NHS 111 services and whose services were both responsive and well led.
The Care Quality Commission has not taken enforcement action against SCAS during 2015/16.
The CQC did not award SCAS a rating on this occasion as the inspection was focused on particular aspects rather than a general review. SCAS welcomes the report findings and found that the process, whilst challenging, has reaffirmed our view that we have some of the most dedicated, committed and passionate staff working for us. The vision and values of the service were evident in that staff were positive about the improvement of quality of care that they provided.
Removed from the legislation by the 2011 amendments
The CQC inspectors observed and listened to staff expressing how proud they were to work for the NHS 111 service in SCAS and staff morale in the service was good. The findings also recognised that patients were involved in their care and treatment decisions and all patients were assessed and treated appropriately using best practice and current national guidance.
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The inspectors were reassured, post media coverage of the service, that none of the specific issues raised by the media were substantiated to give significant cause for concern over the safety of the care given to patients.
The Trust was not subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission.
SCAS did not submit records during 2015/16 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics, which are included in the latest published data.
SCAS will be taking the following actions to improve data quality: èè Provision of an Integrated Performance Report that outlines all quality, operational and financial data èè Regular review by the Clinical Review Group (CRG) of reliability and accuracy of data èè Board assurance framework and corporate risk register to escalate data quality concerns èè Ensure alignment and consistency across contract schedules èè Where external assurance of data quality is required a review will be undertaken by the Trust’s internal audit provider.
The Trust’s Information Governance Assessment Report overall score for 2015/16 was 72% and was graded green from the IGT Grading scheme.
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JAYNE HUNT Receptionist Northern House, Bicester If you’ve ever phoned the switchboard at our headquarters in Bicester, the chances are you’ve spoken to Jayne. Jayne joined SCAS in November 2014 and is the first voice and face that callers and visitors will encounter when contacting or visiting SCAS. With a 24/7 clinical coordination centre, executive management team and large number of support staff working at the Bicester site, Northern House is a busy place. “I’ve worked my whole career in office administration, secretarial and reception roles and when this vacancy came up 18 months ago it caught my eye. Working for the NHS feels more worthwhile, whatever you do day-today. I’m very lucky as I job share with my colleague Jo. We take it in turns to either work the morning or afternoon shift each week, and we’re able to cover each other for things like holidays. I deal with post, couriers, visitors, switchboard, meeting rooms and enjoy making sure everything runs smoothly – just as it should.”
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Monitor Mandated Quality Indicators Set by Monitor and NHS England, mandated indicators are intended to strengthen the reporting processes and create a comparable set of targets across all UK ambulance trusts. For ambulance trusts the mandated indicators for quality remain the same as the previous year.
CATEGORY A PERFORMANCE
èè The percentage of Category A telephone calls (Red 1 and Red 2 calls) resulting in an emergency response by the Trust at the scene of the emergency within eight minutes of receipt of that call during the reporting period. èè The percentage of Category A telephone calls resulting in an ambulance response by the Trust at the scene of the emergency within 19 minutes of receipt of that call during the reporting period. èè The percentage of patients with a pre-existing diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle from the Trust during the reporting period. èè The percentage of patients with suspected stroke assessed face to face who received an appropriate care bundle from the Trust during the reporting period. èè The number and, where available, rate of patient safety incidents reported within the Trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death.
The other ambulance standard for category A incidents is for trusts to send, within 19 minutes, a fullyequipped ambulance vehicle, able to transport the patient in a clinically safe manner, to 95% of Category A calls.
Category A incidents are those involving patients who present with a condition that maybe life threatening and should receive a response within eight minutes in 75% of cases.
In January 2015, the Secretary of State for Health announced the introduction of Dispatch on Disposition (DoD), allowing up to two additional minutes for triage (to identify the clinical situation and take appropriate action). Ambulance services have started introducing this in cohorts so they are not all currently using the same clock start. For Red 1 calls, the clock start time is still the instant that the telephone call connects however other calls can use DoD (if in the cohort). The differing clock start times mean that data for the different cohorts are not comparable with each other. Red 2 calls comprise the vast majority of Category A calls, so 19 minute Category A data are also not comparable for the different cohorts.
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TARGET
2014/15
2015/16
NATIONAL AVERAGE
HIGHEST TRUST
LOWEST TRUST
RED 1
75%
75%
71.9%
71.7%
78.5%
68.1%
RED 2
75%
74.5%
72.7%
68%
75.1%
60.4%
RED 19
95%
95.5%
94.4%
92.7%
97.2%
87.4%
INDICATOR
South Central Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons: èè The Trust has a robust data quality process to ensure reporting of performance information is accurate and timely èè Information is collated as per guidance for ambulance clinical quality indicators èè Information is reported to the Board and commissioners South Central Ambulance Service NHS Foundation Trust intends to take the following actions to improve this: èè Improvement plans are in place èè SCAS commenced Dispatch on Disposition in October 2015. The Trust will continue changing practice in 2016/17 as indicated by this national work.
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AMBULANCE CLINICAL QUALITY INDICATORS (ACQIS) These indicators are designed to reflect best practice in the delivery of care for specific conditions and to stimulate improvements.
2014/15 (MARCH 2015 YTD)
2015/16 (APRIL-NOV)
NATIONAL AVERAGE
HIGHEST TRUST
LOWEST TRUST
STROKE CARE BUNDLE
98.2%
98.5%
97.6%
99.6%
96.1%
STEMI CARE BUNDLE
98.2%
98.5%
97.6%
99.6%
96.1
INDICATOR
South Central Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons: èè The Trust has a robust data quality process to ensure reporting of performance information is accurate and timely èè Information is collated as per guidance for ambulance clinical quality indicators èè Information is reported to the Board and commissioners South Central Ambulance Service NHS Foundation Trust intends to take the following actions to improve this: èè The Trust has invested in an electronic patient record èè The record has a pop up field completion reminder when the chief complaint of STEMI is selected.
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NATIONAL REPORTING AND LEARNING SYSTEM All Trusts are required to submit incidents to the national reporting and learning system (NRLS). This information is analysed to identify common risks to patients and opportunities to improve patient safety. Ambulance organisations have no reporting rate calculated for them as there currently is no suitable denominator data for them. The Trust has submitted data sets for each month in the six month periods reported below. Not all ambulance trusts submitted full six months data sets so no comparisons have been made.
INDICATOR
The table below shows data from the last two nationally reported data sets from the NRLS system. 2014/15 (MARCH 2015 YTD)
2015/16 (APRIL-NOV)
570
447
52 (9.1%)
21 (4.7%)
NUMBER OF INCIDENTS NUMBER AND (%) SEVERE HARM OR DEATH
South Central Ambulance Service NHS Foundation Trust considers that this data is as described for the following reasons:
èè Report numbers and themes regularly to Patient Safety Group and Trust Board èè Quarterly aggregated report – this report uses a wide range of information including incidents, complaints and feedback. Themes are described and learning and service improvements are explained.
èè The Trust has a good culture of reporting incidents èè Information is regularly uploaded to the national reporting and learning system from the Trust reporting system South Central Ambulance Service NHS Foundation Trust intends to take the following actions to improve this: èè Continue with training on incident reporting and campaign month in 2016
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PRIORITY
PROGRESS
1 SAFETY 1a. To implement the Sepsis Care Pathway, and then to review its effectiveness and patient outcomes 1b. To ensure staff across all our services receive appropriate training in making safeguarding referrals to ensure the protection of vulnerable adults and children and understand the Mental Capacity Act 1c. To review incidents involving medicine administration errors, identify key themes and cascade aggregated learning outcomes on a Trust wide basis 1d. To ensure patients receive the right treatment, in the right place by the right health care professional and the decisions are clinically safe and appropriate
Evidence review ongoing
1e. To report on the number of patient safety incidents that resulted in severe harm or death (mandated indicator)
2 CLINICAL EFFECTIVENESS 2a To report on the percentage of patients with stroke and heart attacks who receive an appropriate care bundle (mandated indicator) 2b. To report on the percentage of patients receiving an emergency ambulance response within 8 minutes and 19 minutes (mandated indicator) 2c. To review the reasons for delays in the non-emergency patient transport service which lead to service users missing appointments, and then to implement changes required to prevent future occurrences
3 PATIENT EXPERIENCE 3a. To analyse themes and ensure aggregated learning outcomes are routinely extracted from incidents, claims, feedback, SIRI, compliments and concerns, with effective cascade throughout all areas of service provision 3b. To increase awareness of dementia within the Trust and improve the experience for patients and carers by providing additional training for all staff, including the coordination centres, in order to ensure all our patients with dementia are provided with the highest standards of care 3c. To review and improve the process for receiving and acting on healthcare professional feedback in the NHS 111 and the Non Emergency Patient Transport Service, in order to ensure learning and service improvements are maximised to improve patient experience and outcomes
Partially achieved
Achieved
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STEMI Stroke 8 mins 9 mins
Annual Report and Accounts 2015/16
1A. TO IMPLEMENT THE SEPSIS CARE PATHWAY, AND THEN TO REVIEW ITS EFFECTIVENESS AND PATIENT OUTCOMES PARTIALLY ACHIEVED The sepsis screening tools have been cascaded to staff during 2015/16 and they are currently being added to the electronic patient record system. Face to face training has been delivered to frontline staff and a sepsis campaign was held in Quarter 1 of 2015. During this campaign, two interactive case studies and teaching sessions were developed for frontline, EOC and NEPTS staff. Three posters were also developed and displayed during the campaign. A sepsis recognition scenario has been devised for the South Central Ambulance Service Mobile Simulation Vehicle, ‘Simbulance’. The purpose of the ‘Simbulance’ is to allow paramedics, ambulance nurses and doctors to practice their clinical pre-hospital skills in life-like circumstances, while developing and expanding their clinical knowledge in rare and complex critical events, in a safe and controlled environment. Sophisticated manikins, known as human patient simulators, provide the clinician with a computer-based patient. Trust staff have attended multidisciplinary sepsis management seminars and engaged with acute providers and primary care in line with the Patient Safety Collaborative. The areas of further development are a formal audit of adverse incident data and patient clinical records to monitor the use of the tool. Further feedback from leadership walkabouts to assess staff understanding of the tools and their application is also required.
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1B. TO ENSURE STAFF ACROSS ALL OUR SERVICES RECEIVE APPROPRIATE TRAINING IN MAKING SAFEGUARDING REFERRALS TO ENSURE THE PROTECTION OF VULNERABLE ADULTS AND CHILDREN AND UNDERSTAND THE MENTAL CAPACITY ACT ACHIEVED During 2015/16 the training requirements for staff by service has been reviewed to ensure that the level of training is commensurate to the role. Safeguarding training for new staff during induction has also been reviewed. The Trust campaign month for safeguarding was themed around back to basics, consent, information required for a good referral and the Care Act 2014. During the month a number of relevant items were published on the website and in Staff Matters, the weekly staff newsletter. Workshops and drop-in sessions were available in both clinical co-ordination centres. The team has continued to post items of interest throughout the year onto the intranet like FGM and honour-based violence. A sample of safeguarding referrals determined by the local authority has been audited to ensure that they were appropriate, timely and that the information was of the quality expected. This audit was completed with South Bucks and Slough CCG and Local Authority Heads of Safeguarding. The audit found that all referrals in the sample where appropriate. There were improvements that could be made to the content but these were deemed as minor. A report will be presented to the Trust Patient Safety Group. Staff training on the Mental Capacity Act (MCA) has also been reviewed during 2015/16. The Trust has included MCA in the face to face training for 2015/2016. Dementia including Mental Capacity Act was the campaign for October 2015. Senior Trust staff continue to attend the Safeguarding Boards for both adults and children within the SCAS footprint. Work continues to deliver Level 2 safeguarding training to all staff who require it. In April 2016 the Level 2 safeguarding training compliance rate is: èè Level 2 face to face child and adults safeguarding training at 68% èè Level 1 training child and adults safeguarding training 80%
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1C. TO REVIEW INCIDENTS INVOLVING MEDICINE ADMINISTRATION ERRORS, IDENTIFY KEY THEMES AND CASCADE AGGREGATED LEARNING OUTCOMES ON A TRUST WIDE BASIS ACHIEVED The medicines and research manager has presented papers to Trust committees during 2015/16 concerning incidents that have involved medication errors. Regular ‘Ask Ed’ articles are included in Trust communications and podcasts are available on the intranet. Incidents relating to medications have been included in the aggregated learning reports. The campaign month for medicines was held in August. Four posters on the theme “Medicine Errors – don’t let them happen to you” were produced and they included good practice advice and examples of medicine incidents which have occurred in the Trust. One poster a week was circulated in Staff Matters, the weekly staff magazine as well as by email to all clinical staff. The email included an anonymised and redacted reflection written by the clinician responsible for one of the medicine incidents described on the accompanying poster.
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CHERYL COPAS Control Shift Officer Clinical Coordination Centre (CCC) Hampshire Cheryl joined SCAS in 2007 as an Emergency Call Taker. Over the last nine years she has progressed through various roles and has recently been promoted to Control Shift Officer from her previous job as a Dispatcher. Before working at SCAS Cheryl had always been employed in customer / patient focused roles and so when she was made redundant, the advertisement for emergency call takers at the ambulance service seemed like a perfectly timed opportunity. “I didn’t just want a job; I wanted a role with long term career progression. And that’s exactly what I’ve enjoyed at SCAS. I’ve gone from an emergency call taker to managing a team and whilst I’m still new to the shift officer role and finding my feet, I am really enjoying it. Everyone in the team, both in CCC and frontline have been so helpful and I am really looking forward to the new challenges that lie ahead. I love working with my colleagues and it’s really great to walk away at the end of a shift knowing that you’ve done a good job and really had a positive impact on patients’ lives.”
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1D. TO ENSURE PATIENTS RECEIVE THE RIGHT TREATMENT, IN THE RIGHT PLACE BY THE RIGHT HEALTH CARE PROFESSIONAL AND THE DECISIONS ARE CLINICALLY SAFE AND APPROPRIATE PARTIALLY ACHIEVED
SEE AND TREAT
HEAR AND TREAT
To ensure that patients are receiving the most appropriate care for their needs SCAS continues to review the re-contact rates within 24 hours. This looks at patients who have contacted SCAS and have not been conveyed to Hospital. EMERGENCY INCIDENTS
HEAR AND TREAT
HEAR AND TREAT RECONTACTS
PERCENTAGE OF RECONTACTS
Apr 15
37,301
2,275
290
12.75%
May 15
38,705
2,559
271
10.59%
Jun 15
38,055
2,721
311
11.43%
Jul 15
40,695
3,815
312
8.18%
Aug 15
40,349
4,167
394
9.46%
Sep 15
39,498
4,143
386
9.32%
Oct 15
41,971
4,798
434
9.05%
Nov 15
42,047
4,910
409
8.33%
Dec 15
44,643
5,498
439
7.98%
Jan 16
45,002
5,379
483
8.98%
Feb 16
42,261
5,640
433
7.68%
Mar 16
45,811
6,109
532
8.71%
EMERGENCY INCIDENTS
SEE AND TREAT
SEE AND TREAT RECONTACTS
PERCENTAGE OF RECONTACTS
Apr 15
37,301
14,533
760
5.23%
May 15
38,705
14,603
742
5.08%
Jun 15
38,055
14,265
769
5.39%
Jul 15
40,695
15,266
702
4.60%
Aug 15
40,349
14,941
774
5.18%
Sep 15
39,498
14,578
768
5.27%
Oct 15
41,971
15,366
795
5.17%
Nov 15
42,047
15,054
771
5.12%
Dec 15
44,643
16,171
824
5.10%
Jan 16
45,002
16,265
822
5.05%
Feb 16
42,261
15,006
813
5.42%
Mar 16
45,811
16,299
757
4.64%
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1D. CONTINUED The data shows that the recontact rates have reduced towards the end of the financial year in the ‘hear and treat’ category and in the ‘see and treat’ the rates have been consistent. To support the aim ‘right care, right time’ SCAS has worked to promote the use of GP triage for frontline crews. The aim is to support the frontline crews in conjunction with the GP to ensure that the patient receives the most appropriate treatment at the time. Previously frontline crew would have transported the patient to hospital or discharged them at scene, they can now arrange for a GP to undertake a triage either over the phone or for them to attend instead; which not only supports the patient, but also aims to reduce the pressure on acute services. The following table shows the percentage of attendances where GP triage was attempted and whether this was successful or not. PERCENTAGE OF GP TRIAGE ATTEMPTS
PERCENTAGE OF SUCCESSFUL GP TRIAGE ATTEMPTS
Apr 15
11.66%
85.67%
May 15
8.19%
86.12%
Jun 15
7.87%
86.11%
Jul 15
7.60%
86.17%
Aug 15
7.55%
86.48%
Sep 15
8.07%
84.48%
Oct 15
10.82%
86.43%
Nov 15
8.35%
85.21%
Dec 15
8.42%
86.63%
Jan 16
7.98%
85.58%
Feb 16
8.38%
85.80%
Mar 16
8.18%
85.62%
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1D. CONTINUED The following table shows the rates of conveyance and see and treat for all achieved GP triage. GP TRIAGED EPISODES
% OF NON-CONVEYED
Apr 15
3,725
95.84%
May 15
2,729
95.71%
Jun 15
2,580
96.12%
Jul 15
2,666
96.25%
Aug 15
2,635
96.62%
Sep 15
2,694
95.03%
Oct 15
3,924
94.98%
Nov 15
2,990
96.02%
Dec 15
3,258
95.73%
Jan 16
3,074
95.15%
Feb 16
3,039
96.12%
Mar 16
3,208
96.57%
This demonstrates that the vast majority of GP triaged patients stay at home for treatment, which supports patients being cared for in their own homes and supports the aim to reduce inappropriate attendances at emergency departments. To ensure that SCAS learn any lessons from time critical transfers these cases are reviewed at the Trauma Committee meeting of which SCAS is an active member. This group reviews all cases to ensure that any admissions were appropriate and that any transfers were undertaken safely and appropriately. If a patient was not transported these cases are also reviewed to ensure this was the appropriate action. To provide assurance that reviews are carried out in the depth required and that lessons are shared all reviews are signed off by the Trauma Board. SCAS is also a member of the Trauma Board. Lessons learnt from the reviews are shared in a number of ways. The first being on a one to basis and where appropriate an action plan is put in place to support the staff member in meeting the standards expected of them. Regular trauma training sessions are available for all frontline crew. Within this training any lessons learnt are shared and this is disseminated to the wider team. In rare cases where the learning needs to be addressed immediately and organisation wide an internal Clinical Memo is published. SCAS has continued to work closely this year with local networks to develop pathways to improve the care to the communities we serve. A hypoglycaemia pathway has been implemented alongside Berkshire Healthcare.
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1D. CONTINUED This pathway allows for the SCAS frontline crews to refer patients to be triaged and receive extra support to manage their diabetes. This is a new pathway and as yet has not been audited for its effectiveness, but this will be undertaken once the service has been fully implemented. There is also a similar diabetes pathway that covers the south of the SCAS area. As well as these SCAS works closely with the trauma networks to ensure that our patients are going to the most appropriate unit to meet their needs. Cases are reviewed so that lessons can be learnt. During 2016/17 the Trust needs to consider an audit of referrals to Emergency Care Practitioners to ensure clinically safe non conveyance decision as stated in the indicator description last year. A further audit considering conveyance rates of patients referred from NHS 111 to 999 should be considered to identify if the patients could have been treated and seen by other health services.
1E. TO REPORT ON THE NUMBER OF PATIENT SAFETY INCIDENTS THAT RESULTED IN SEVERE HARM OR DEATH (MANDATED INDICATOR) This has been reported in section one of the report
2A. TO REPORT ON THE PERCENTAGE OF PATIENTS WITH STROKE AND HEART ATTACKS WHO RECEIVE AN APPROPRIATE CARE BUNDLE (MANDATED INDICATOR) This has been reported in section one of the report
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2B. TO REPORT ON THE PERCENTAGE OF PATIENTS RECEIVING AN EMERGENCY AMBULANCE RESPONSE WITHIN 8 MINUTES AND 19 MINUTES (MANDATED INDICATOR) This has been reported in section one of the report
2C. TO REVIEW THE REASONS FOR DELAYS IN THE NON-EMERGENCY PATIENT TRANSPORT SERVICE (NEPTS) WHICH LEAD TO SERVICE USERS MISSING APPOINTMENTS, AND THEN TO IMPLEMENT CHANGES REQUIRED TO PREVENT FUTURE OCCURRENCES ACHIEVED People entrust that SCAS NEPTS will transport them in a safe and timely manner to their healthcare appointments. Many of these appointments are vital to their ongoing health. SCAS understands the frustration that service users feel if they miss an appointment due to delays. A deep dive review was undertaken and presented to the Patient Experience Review Group in May 2015. This review was welcomed by the NEPTS as a timely opportunity to reflect on the common origins, reasons for and learning themes arising from unsuccessful journeys. A further review considering of a larger sample of 4,925 journeys was undertaken in October 2015.
AUDIT COMPARISON AND CONCLUSIONS The sample groups of both audits support the conclusion that most aborts originate from the referring hospital or clinic, representing 41% in the original audit and 38% in the expanded audit. The second most common originator was the patient themselves, representing 36% of all aborts in the original audit and 33% in the expanded audit. SCAS was found to be the third most common originator in both sample groups, representing 19% in the original group and 15% in the expanded audit.
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2C. CONTINUED ABORT ORIGIN - EXPANDED AUDIT 14% Shared
15% SCAS
33% Patient
38% Hospital
ABORT BY SCAS - EXPANDED AUDIT 2% Too ill to travel 4% Abort by hospital - patient not ready
12% Transport too late for appointment
14% Patient not ready
27% No answer at the door
41% Own transport
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2C. CONTINUED SCAS LATE REASONS The sample group consisted of 25 aborted journeys which the computer system showed SCAS to be at fault due to arriving too late for a pick up time. The reasons are shown below:
SCAS LATE REASONS 12% Within KPI
20% Crew late leaving base
4% Dispatch error
24% Unachievable planning
4% Delay with previous patient 8% Left in stack
4% Traffic 4% Renal unit route unrealistic
4% No capacity 12% No reason recorded
4% Other
Three journeys were found to have actually been undertaken within the timescale so were incorrectly recorded as late. Three late reasons could not be established despite scrutiny of all available data sources. A comprehensive action plan was written following the deep dives. Actions include - reviewing system parameters to ensure adequate time is allocated for getting people on and off transport, staff made aware of the effects of them leaving base late and the importance of abiding by planning decisions. Abort codes have been streamlined to support staff in selecting the most appropriate response and the team have also reviewed the information available to patients and their representatives which instructs them how to cancel a booking if not required. The management team will continue to monitor this data and ensure actions are taken as necessary.
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3A. TO ANALYSE THEMES AND ENSURE AGGREGATED LEARNING OUTCOMES ARE ROUTINELY EXTRACTED FROM INCIDENTS, CLAIMS, FEEDBACK, SIRI, COMPLIMENTS AND CONCERNS, WITH EFFECTIVE CASCADE THROUGHOUT ALL AREAS OF SERVICE PROVISION PARTIALLY ACHIEVED During 2015/16 the Trust has further strengthened its clinical governance structure and now has governance leads covering all the services in SCAS. The leads are essential in improving information sharing and have developed governance meetings with the operational leads in the services to aid this. Quarterly aggregated learning reports have been produced during the year. The Trust deems this priority to be partially achieved as there are further developments that need to be made. The quarterly aggregated reports have been developing over 2015/16 with a change in format and information sources considered. The next step is to ensure that clear actions are documented in the report. The report does include data sets for incidents and complaints over the quarter. In last yearâ&#x20AC;&#x2122;s account the Trust stated that we would regularly review Healthwatch and NHS Choices feedback. We have made responding to comments on NHS Choices website a priority for 2016/17 as we recognise that we have not been consistent in responding to comments on the NHS Choices website. The governance leads in all services need to ensure clear documentation and follow up of changes in practice that have been identified from key themes. This is more established in some services than others. The governance leads are working together to develop consistent reporting across services.
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3B. TO INCREASE AWARENESS OF DEMENTIA WITHIN THE TRUST AND IMPROVE THE EXPERIENCE FOR PATIENTS AND CARERS BY PROVIDING ADDITIONAL TRAINING FOR ALL STAFF, INCLUDING THE COORDINATION CENTRES, IN ORDER TO ENSURE ALL OUR PATIENTS WITH DEMENTIA ARE PROVIDED WITH THE HIGHEST STANDARDS OF CARE ACHIEVED Improved knowledge and understanding of the challenges faced by dementia patients can only improve the care given and encourage an empathetic, patient centred and individualised approach to care. The main outcomes of the 2015/2016 dementia project were: èè One named education lead for dementia èè 42 Dementia Champions trained – exceeding the target of 40 èè 2,264 staff trained in Tier 1 dementia awareness Tier 1 training is delivered to new staff as part of the SCAS induction, and to existing staff during yearly face-to-face training. This includes frontline, emergency operations centre, contact centre and patient transport services staff. In addition, there is also a dementia e-learning module available. The Tier 2 dementia training has been delivered in partnership with Age UK. Age UK has developed a unique style of training which involves simulating the process of ageing. It provides participants with the opportunity to experience a number of age and health related sensory impairments. After the simulation session, participants were encouraged to discuss their experiences in depth and apply this to their working practices. Staff are able to remotely access dementia podcasts produced by the dementia project (available on the e-learning system) at a time which is most convenient for them. These podcasts have been specifically designed for the ambulance sector and include videos on communicating with people living with dementia both in person and over the phone, in order to be relevant to both patient facing staff (frontline, NEPTS) and emergency operations centre staff. There is also a podcast discussing capacity and consent.
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3B. CONTINUED The Trust has continued to report dementia training completion figures to Health Education England Thames Valley (HEETV). Audits have been completed before and after the training. The written evaluations showed all staff who attended the Dementia Champions training felt the training had met the learning objectives, and that it has been useful to their role. In December 2015, SCAS completed a patient satisfaction survey of people over the age of 65 years with a cognitive impairment who had used SCAS services. Overall the results were positive with nearly all participants being extremely likely or likely to recommend SCAS to friends and family. Communication was recognised as being good. Areas for improvement were highlighted as ambulance response times, and including the carer in the decision making process. The Patient Satisfaction Survey of patients with a cognitive impairment will be repeated in 2016, and the results used to inform future training opportunities.
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Annual Quality Report and Accounts 2015/16 Annual Report //Part 2and Accounts 2015/16
STUART SCOURFIELD NHS 111 Call Handler Clinical Coordination Centre (CCC) Hampshire Stuart joined SCAS in October 2015 and over the last eight months has really enjoyed his new and exciting role. NHS 111 is available 24 hours a day, 365 days a year, and should be used by patients who urgently need medical help or advice but it’s not a lifethreatening situation. As a NHS 111 Call Handler, Stuart works on a shift basis and takes calls from members of the public dialling 111, assesses their needs and then implements the right course of action. That could be arranging for an ambulance to be dispatched, making a referral to another health service or simply giving the caller some basic advice. “Since I was 16 I have worked in retail and customer service as well as being a Scout Leader and so I really find it rewarding to be able to help people. My job at NHS 111 really helps me to do that and I have the ability to have a positive and important impact on the patients we help. The training was comprehensive and challenging but the support from the team has been great from the start and I am really looking forward to the future. There are lots of opportunities to learn and develop and so I am excited to see what the future holds using my previous skills and having the opportunity to learn new ones.”
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3C. TO REVIEW AND IMPROVE THE PROCESS FOR RECEIVING AND ACTING ON HEALTHCARE PROFESSIONAL FEEDBACK IN THE NHS 111 AND THE NON-EMERGENCY PATIENT TRANSPORT SERVICE, IN ORDER TO ENSURE LEARNING AND SERVICE IMPROVEMENTS ARE MAXIMISED TO IMPROVE PATIENT EXPERIENCE AND OUTCOMES ACHIEVED Health professional (HCP) feedback processes have developed during 2015/16 and the Trust has a robust system with all health professional feedback now being logged on the Datix system. The cases are thoroughly investigated and reported back via the patient experience team or governance leads. HCP feedback is considered in the aggregated report at Trust level and at the service level governance meetings so that themes can be identified and action taken. The booking for HCP transport has been changed in year as a result of feedback.
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OTHER IMPROVEMENTS MADE IN 2015/16 èè Bright Ideas - All bright ideas are acknowledged and so staff are actively encouraged to submit their ideas, whatever they are. Staff are encouraged to consider how the bright idea would work, whether it is worthwhile and has real benefits compared to effort and cost to implement. Clear questions are provided to help staff to define their idea and provide a clear understanding of it. All bright ideas are fully reviewed and updates are provided to keep staff informed of progress. èè Mental Health - The current innovations include:
This section of the report highlights other quality improvements made by SCAS. èè In partnership with the Thames Valley and Hampshire and Isle of White Air Ambulances, SCAS has commenced night flying. Night time flying means that the air ambulance can deliver the same service alongside SCAS crews for an additional seven hours every day (from 06.00 to 02.00). èè Accelerated Clinical Transformation (ACT) offers an ongoing approach to care delivery excellence that is measurable, improves quality and enhances service and care delivery. It integrates people, process and technology.
ÒÒ A Mental Health (MH) Nurse has been introduced into EOC North, currently working Thursday through to Sunday 18.00 until 04.00. This role involves talking directly to patients and also assisting crews on scene. ÒÒ Mental Health/Dementia Champions and mental health supporters have been introduced within frontline staff. Staff in these roles, are able to provide support, information and advice to staff as required regarding clinical issues including the Mental Capacity Act and dementia. To provide this support, access is available to additional resources. ÒÒ A pocket sized Mental Capacity Act checklist is available and is currently being distributed to all frontline staff. The SCAS Mental Capacity Act flowchart has also been included in the new edition of the UK Ambulance Service Clinical Guidelines (JRCALC)
The purpose of ACT is to: ÒÒ Accelerate the pace of planned change to meet the new Integrated Urgent Care Standards ÒÒ Add clinical benefits for patients ÒÒ Improve patient outcomes through increased access to specialists and patient records ÒÒ Increase SCAS and partner provider efficiency across patient clinical pathways ÒÒ To test new ways of working using modern digital technology to support people in their own homes, working with provider partners.
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//Quality Report - Part 3
ÒÒ A new suicide risk assessment tool has been developed and is in the process of being rolled out. The IPAP tool (Exploring Intent, Plan, Action and Protective measures) has been included in the new edition of the UK Ambulance Service Clinical Guidelines (JRCALC). Additional educational resources are being produced to support the IPAP tool. ÒÒ SCAS has been closely involved with the Mental Health Charity, Mind. Mind has developed a programme to support the mental health needs of all emergency service personnel. Mind supports emergency service employers to sign up to the ‘Time to Change’ pledge. On 4 February 2016, Chief Executive Will Hancock signed SCAS’ Blue Light Time to Change pledge and in doing so has demonstrated the Trust’s commitment to challenge mental health stigma and discrimination. èè Thames Valley and Hampshire Police have been training officers in the identification and management of people who are potentially suffering from Acute Behavioural Disorder (ABD) and, in its extreme state, Excited Delirium Syndrome. A partnership between SCAS and the police has been developed and a project commenced. The project demonstrates effective working and information sharing with a common goal to educate staff with the common aim to improve patient care. This will benefit staff by making them more aware of legal highs and their effects and the management of patients suffering from ABD. Being aware of the protocol that the police have to follow will ensure a smooth handover of the patient and ensure the appropriate ongoing care.
èè SCAS is working alongside Berkshire Healthcare NHS Foundation Trust on a trial of a new pathway for patients in East Berkshire who are attended to by SCAS who are hypoglycaemic commenced in February 2016. Inclusion for the trial is for patients registered with certain GP surgeries in East Berkshire who call 999 for a hypoglycaemic episode and have subsequent ambulance attendance. Patients who are effectively treated and can be discharged on scene then become eligible for referral to the new pathway. Once treated on scene, patients will be given a Hypo Leaflet explaining that they will be contacted by a Diabetes Specialist Nurse (DSN) the next working day. The DSN will triage and offer further management and advice. Patients can choose to opt out if they want to by calling the diabetes centre directly. èè Portering in selected acute settings for Non-Emergency Patient Transport Services – initiative for Hampshire. The portering service helps patients alight and board vehicles and transfers them to and from clinics within the selected sites. We know that crew members portering patients to and from the vehicle can cause delays. Some patients have to wait excessive amounts of time on board an ambulance waiting for other patients to be collected to fully utilise the resource. It will be evident on the success of this practice from patients, voluntary drivers and SCAS staff on the assistance it has brought. Also from a reporting prospective we will be able to see decreases in vehicle downtime, increased patient movements on a vehicle on a day and improved performance.
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STATEMENTS FROM HEALTHWATCH, THE OVERVIEW AND SCRUTINY PANELS AND COMMISSIONERS
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BRACKNELL FOREST COUNCIL HEALTH OVERVIEW & SCRUTINY PANEL GENERAL COMMENTS
8. Pages 14-15 – We suggest that the actions to manage high intensity users are expanded to include collaborative working with other public bodies such as the Police and Social Services, as it is likely that the same users are likely to make abnormally high demands on other public services too. 9. Page 16 – On priority 3a (complaints response times), we suggest that the Trust should consider introducing a mechanism for responding to first enquiries/ low-level complaints, similar to the PALS service operated by the Hospital Trusts. 10. Page 28 – Whilst accepting that SCAS performance would have been adversely affected by increased call volumes, we are disappointed that ambulance response times were not as fast as the previous year. We suggest that the Quality Account gives some details of the Improvement Plans which you say are in place. 11. Page 38 – The Patient Transport Service clearly requires further improvement, particularly concerning getting patients delivered in time for appointments, and in not leaving patients waiting too long for transport. We suggest that the QA includes more information on how SCAS will improve this. 12. We would encourage the Trust to include information in the QA on: ÒÒ The current situation regarding the training and retention of paramedics; ÒÒ Usage of private sector ambulances; and ÒÒ Usage and effectiveness of the triage system to screen out unnecessary requests for ambulances.
1. Our Panel was pleased to have continued good levels of engagement with SCAS during 2015/16, and we particularly thank their Chief Executive for his constructive and supportive contact with our Overview and Scrutiny Panel. We met with representatives of SCAS in 2015/16, and we plan to attend the forthcoming Quality Summit on the outcome of the Care Quality Commission (CQC) inspection of SCAS. 2. Generally, we consider that SCAS’s performance has held up very well in 2015/16, in the face of relentless increases in demand on the ambulance service nationally. 3. We were pleased to see that the outcome of the investigation of newspaper allegations regarding the NHS 111 service showed the allegations not to be substantiated. This was reinforced by a positive assessment of the NHS 111 Service by the CQC. 4. The Quality Account (QA) would benefit from more detailed information on the Trust’s performance and plans. SPECIFIC COMMENTS 5. Page 6 - We commend the Trust’s measures to listen directly to patients’ views. 6. Pages 10-11 - We support the Trust’s priorities for 2016/17. 7. Page 13 – Could the QA expand on what is being done to improve the feedback to staff on reported incidents?
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FAREHAM AND GOSPORT CLINICAL COMMISSIONING GROUP (CCG) Fareham and Gosport Clinical Commissioning Group (CCG) and its associate commissioners welcome the opportunity to participate in the governance “sign off” process for the 2015/16 Quality Account of South Central Ambulance Service NHS Foundation Trust (SCAS) for 999 and Non-Emergency Patient Transport Services.
Commissioners have requested that all future quality accounts are submitted within the regulatory time period and commissioners request a review of the planning timetable for production and publication of the 2016/17 quality account to allow sufficient time to consider the report appropriately.
COMMISSIONER INTRODUCTORY STATEMENT
The report is logically structured and is written in a style which would seem accessible to the public, stakeholders and commissioners alike. Further clarity for the reader would be achieved by the use of numbered tables, which are detailed in the main body of the report. The presentation of the National Reporting Learning System (NRLS) reporting statistics table would be enhanced if the account presented the total number of incidents by category for each year for comparison and included an explanation of the significant reduction in severe harm or death incidents. The Trust has achieved quality improvement in many aspects of its services, and could expand on this with additional narrative which explains the information contained within tables. Whilst the report states that the Trust has a positive culture of reporting incidents, the data set demonstrating the number of incidents reported in two six monthly periods, indicates fewer incidents reported in April 2015 – September 2015 compared to October 2014 – March 2015. This data would have benefited from an explanation as to why there were fewer incidents recorded in the second six month period and the reduction of incidents resulting in severe harm. It would be helpful to explain or avoid the use of the many abbreviations used in the report or include an appended glossary.
REPORT STRUCTURE
Commissioners are grateful for the opportunity to comment of the Trust’s annual quality account for 2015/16, and have determined that it meets the required regulatory requirements. Specific comments from Hampshire and Milton Keynes commissioners are included in this statement. On this occasion these are limited by the short timescale set by the Trust for the completion of feedback. Provider trust quality accounts are required to be submitted to commissioners within the set time frame which allows up to 30 days to respond. It is noted that the quality account was received with a deadline for comments which allowed only six working days for commissioners to review the document and collate comments across the Hampshire geography. If SCAS had provided commissioners with more time to respond it may have been possible for commissioners to provide informal feedback to you, to enable the report to be updated and therefore address many of the points that have been raised in this statement.
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There is a section on staff survey outcomes, however further explanation in respect of its inclusion would be beneficial.
Commissioners welcome the Trust’s intention to audit the referrals made to emergency care practitioners to ensure clinically safe non-conveyance decisions, as stated in the indicator description last year. In 2014/15 this was a CQUIN in West Hampshire Clinical Comissioning Group and a business case was agreed in 2015/16 for the recruitment of specialist paramedics who would be competent to manage patients outside of hospital, but qualitative data concerning this is not currently available to commissioners.
Although there is reference to CQUIN it would be helpful to have a link or further information to demonstrate achievements. PART 1 The Chief Executive’s quality statement was not included within the report submitted and therefore it is not possible to comment.
PATIENT SAFETY
PART 2
1A: RECOGNITION OF SEPSIS IN CHILDREN
QUALITY IMPROVEMENT PRIORITIES FOR 2016/17
Commissioners fully support the ambition to improve recognition of sepsis in children, as this fits in with improving health in a time critical illness.
SCAS has outlined its priorities for 2016/17 and all Hampshire and Milton Keynes associate commissioners have had the opportunity to review these. Commissioners note the value of including the section explaining how the Trust Board seeks assurance for quality. This section could be further enhanced by the inclusion of more detailed information on patient and public engagement and consultation. It is acknowledged that feedback from the Trust’s Council of Governors and the quality intelligence gathered from patient feedback has informed the quality priority setting process. The account could provide the reader with further background information by providing evidence (e.g. data, incident reporting or best practice) to support the rationale for the selection of the annual priorities. Commissioners note that not all priorities have a robust description of how achievement will be measured and monitored to ensure that success and quality improvement goals are achieved.
1B: ELECTRONIC DISCHARGE SUMMARIES Commissioners are unsure why this has been included as a quality improvement priority for 2016/17, as they believe the work to ensure that electronic discharges are sent to GPs has already been, or is nearing completion. Whilst some commissioners have identified that receipt of these summaries via nhs.net accounts may not yet be operational for all practices, they have acknowledged that a universal system needs to be in place to enable consistent delivery. Commissioners suggest that this priority includes discharge summaries for those patients who have been managed through hear and treat services. In addition, this quality priority should consider subcontracted private providers, as they are currently unable to provide electronic discharge summaries.
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1C: FEEDBACK MECHANISMS TO STAFF
PATIENT EXPERIENCE 3B: SUPPORT AT OWN/CARE HOME FOR PATIENTS AT THE END OF THEIR LIFE
Commissioners acknowledge the importance of providing feedback on incidents staff have reported as this can lead to learning and improved safety.
Commissioners were encouraged to see this has been made a priority in the 2016/17 quality account plans and will be interested to learn more about the outcomes of this initiative. It is noted that there is limited access to current data within patient records and therefore it would be helpful to see the Trust’s ongoing intention to work with system partners to ensure the availability and quality of patient records. Commissioners look forward to receiving quarterly updates on how the work is progressing using the two care homes identified with admissions and piloting the ‘Live Link’ telemedicine.
CLINICAL EFFECTIVENESS 2A: LONG WAITS It is not clear how the effectiveness of long wait reviews will be measured to demonstrate improvements in the quality of care. It would be useful to strengthen this statement by setting a quantitative aspiration in reducing long waits or potential harm associated with long waits, or a measurement from which improved patient experience could be demonstrated. 2B: PROACTIVE MANAGEMENT OF HIGH INTENSITY USERS.
The Trust has provided a useful selfassessment grid against the key areas of CQC assessment. In the self-assessment grid, produced in readiness for the CQC visit in May, commissioners note the Trust rates the organisation as either good or outstanding for all elements. In view of current quality intelligence, for example long waits, emergency system pressures, incidents and complaints, together with local and national workforce challenges and compliance with training thresholds, it may have been helpful to reflect how these challenges have fed into the overall assessment conclusions. Throughout the year, contract review and clinical quality contract review meetings have considered and been aware of the quality impact of these challenges on patient care and compliance with national standards for response times.
Commissioners fully support the work to ensure patients receive the right care, at the right time, by the right healthcare professionals and support the Trust intention to deliver an enhanced programme of work with high intensity users of emergency services. 2C: IMPROVE COMPLIANCE WITH LIMB FRACTURE CARE BUNDLE In order to measure progress and success it would be beneficial to identify the level of achievement to be delivered. A detailed action plan with clear milestones and individuals identified will provide assurance that there is ongoing monitoring and evaluation. However, commissioners acknowledge the quality account may not provide this level of detail and look forward to seeing the delivery of this through discussions at the Clinical Quality Review Meetings. It was helpful to review the comparative data on current performance.
Commissioners note the Trust has experienced significant recruitment challenges throughout the year and this ongoing issue could have been usefully reflected in the selected priorities.
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Overall positive results are noted from the patient satisfaction survey of people over the age of 65 years, with a cognitive impairment who had used SCAS services; nearly all participants being extremely likely or likely to recommend SCAS to friends and family. In respect of the in-year changes identified with the booking for health care professional calls it is unclear if these changes were as a result of feedback from commissioners, patients or stakeholders. This level of detail could provide SCAS with examples of how they have engaged and listened to feedback to make positive changes to the service they provide.
PART 3 ACHIEVEMENTS REPORTED AGAINST THE 2015/16 PRIORITIES AND OVERALL QUALITY EXPERIENCE As part of the regulator’s mandated quality indicators, the quality account sets out the performance against Category A calls. In October 2015 commissioners did raise a contract performance notice (CPN) due to under performance for Red 1 and Red 2 response times. The Trust developed a recovery action plan (RAP) which identified five key priorities to be acutely managed by the Trust Executive and which were to be closely monitored through daily and weekly activities.
Positively, SCAS has also secured being able to fly the air ambulance (helicopter) at night.
These included; managing demand, workforce, winter resilience, operational key performance indicators and financial actions. Despite the interventions and mitigations in place, SCAS was unable to achieve the required national response times of 75% for Red category performance.
It is disappointing to note that, on review of the NHS England’s ambulance quality indicator data submissions, SCAS has made minimal improvement on the STEMI care bundle. Whilst it is acknowledged that the Trust reports month on month improvement since August 2015, the performance is still considerably lower than the national average. Commissioners would like to see a more robust action plan on how SCAS intends to address this clinical quality indicator, with a significant improvement in performance during 2016/17.
Commissioners acknowledge the urgent and emergency care systemwide pressures and challenges which have been experienced across a number of areas in Hampshire in 2015/16. Commissioners commend SCAS for its participation and engagement in system-wide work with the joint aim to alleviate these pressures and minimise the impact on the local population.
The quality account would be strengthened by the inclusion of more quantitative evidence on quality outcomes and quality improvements made over the last year. The account does not fully reflect how the Trust has used feedback from patients/public to enact changes and how these changes have improved services.
The report does not reference the improved ‘return to work’ process that SCAS has reported to be having a positive impact on reducing the length of time employees are off sick and the positive impact that this is having on staffing. The report indicates that staff were positive about the quality of care they provide.
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Action plans reviewed through the year have, on occasions, lacked detail and SMART (specific, measurable, achievable, realistic and timely) objectives, and commissioners look forward to receiving these with enhancements during 2016/17, so that improvements are clearly evident.
1B: SAFEGUARDING AND MENTAL CAPACITY ACT (MCA) TRAINING Clear progress has been made in the year to ensure that staff have appropriate safeguarding and mental capacity act training. Patients and staff will benefit from the Trust having clear plans in place to drive improvements with this further, particularly recognising that time periods of high demand impacts on the availability of staff to attend training. The figure of 69% for Level 2 safeguarding training compliance rate reported does not support the declaration that the priority has been fully achieved.
During the year, a contract performance notice was raised in respect of compliance with safeguarding and commissioners were concerned that the lack of compliance had not been identified internally or through the Trust Board assurance. Commissioners acknowledge the improvements which have been made through the year and have clearly identified that for 2016/17, sustained compliance is expected.
CLINICAL EFFECTIVENESS 2C: DELAYS IN THE NONEMERGENCY PATIENT TRANSPORT SERVICE
Commissioners note the work being undertaken on participation in conferences/presentations and the involvement in clinical audit, which shows commitment to a national plan for improvement. It would be beneficial for the report to note what quality benefit this has had for the organisation. The clinical research and conference involvement and publications show a commitment to keeping up to date with medical and technical changes in the delivery of emergency care.
A significant amount of work has been undertaken in year regarding the quality analysis for nonâ&#x20AC;&#x201C;emergency patient transport and this should be recognised. However, there continues to be concerns raised through complaints, concerns and health care professional feedback in relation to the timeliness of conveyance. It is vital therefore that this remains a key priority for the Trust and that delays and non-attendance are minimised. As the Trust rightly mentions, missed or late attendance for appointments and treatment has a negative impact on patients and their families, and commissioners would welcome further advancements in this quality priority. Trajectories for improvement in the number of nonemergency patient transport journeys that are aborted are required for 2016/17, together with evidence of qualitative improvements, as SCAS acknowledge from their own audit that up to 19% of aborted journeys are cited as being due to SCAS process issues.
On review of the specific priorities identified for 2015/16 commissioners note the following: PATIENT SAFETY 1A: SEPSIS CARE PATHWAY From the detail provided it is difficult for commissioners to get a sense of how successful this has been in terms of effectiveness and patient outcomes. The report contains no baseline or comparison measures.
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Due to this GP activity data not being fully available it is not possible to comment on the benefits of what actions should and can be taken to support see and treat, or how the organisation is developing quality improvement and capability in order to deliver the priorities identified.
PATIENT EXPERIENCE 3A: THEMES AND LEARNING OUTCOMES The quality account would benefit from the inclusion of examples to add depth to the report; for example, it is not clear without having the source data what impact this priority has had on improving the quality of care. It is disappointing to note that only six out of 11 priorities were fully achieved (55%). There is limited detail and evidence or examples of how the priorities have led to quality improvement and the quality account lacks information on how changes have been implemented.
CLINICAL AUDIT AND RESEARCH SCAS reported no local audits during 2015/16. Commissioners acknowledge the emergency system pressures and the impact on capacity; however, local clinical audit is important for measuring and benchmarking the quality of clinical practice and for driving service improvements. Commissioners recommend SCAS review its priorities for 2016/17 to determine if local audits could be carried out within these priorities as a method of measuring improvement.
Based on the reported achievement of only 55% of the priorities identified for 2015/16, greater clarity on how progress for the nine priorities identified for 2016/17 will be taken forward and, for those priorities not fully achieved, how these will be monitored to ensure achievement of the required quality outcomes.
COMMISSIONER ASSESSMENT SUMMARY This yearâ&#x20AC;&#x2122;s quality account reflects the many positive work streams which SCAS has participated with. It would be improved by the inclusion of evidence and supporting data to clearly identify improvements to patient safety and care.
3B: PATIENTS WITH DEMENTIA It is pleasing to see that SCAS has exceeded its target for Dementia Champions within the organisation and that there are positive examples of staff using digital technology to reach a wider cohort of patients.
The national shortage of paramedics, identified in last yearâ&#x20AC;&#x2122;s quality account has continued. Commissioners acknowledge the workforce management processes SCAS has adopted in year. Further recruitment and system workforce models are essential to meet the competing demands across the health service and this must remain a priority for 2016/17.
DATA QUALITY Commissioners note that SCAS has identified where they are going to review data quality but note the Trust has not identified the timeliness of data submission as an issue. This has been problematic through the year and does not facilitate proactive collaborative service improvement. Access to GP triage data has also been problematic in the Hampshire area and the tables included within the report do not reflect GP acceptance activity and qualitative aspects of GP triage.
The engagement that SCAS has shown in participating with system-wide work is welcomed and we look forward to a continuation of this in 2016/17.
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A continued focus on reducing delays in all categories, both 999 and nonemergency transport is a priority. Commissioners also look forward to seeing an improved position with the proactive management of very high intensity users to support patient needs being met by the right service, at the right time. Commissioners consider that stronger action plans, including both quantitative and qualitative measurement will enable greater clarity of demonstrating improvements to patient safety, clinical effectiveness and patient experience. Commissioners welcome the opportunity to continue to work with SCAS as a valued health care partner who continues to seek ways to improve the quality of care for the benefit of our population. Yours sincerely Alex Berry Acting Chief Officer Fareham & Gosport & South Eastern Hampshire Clinical Commissioning Groups
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BERKSHIRE WEST CLINICAL COMMISSIONING GROUP (CCG) FEDERATION Berkshire West CCGs are pleased to continue working in partnership with them.
EXECUTIVE SUMMARY Berkshire West Clinical Commissioning Group (CCG) Federation has reviewed the South Central Ambulance Service Trust Quality Account and is providing this response on behalf of Newbury and District CCG, South Reading CCG, North and West Reading CCG and Wokingham CCG and all associate CCGs. The Quality Account 2015/16 provides information across a wide range of quality measurers and gives a comprehensive view of quality of care and upcoming priorities to be undertaken by the Trust during 2016/17. There is evidence that the Trust has relied on internal governance structures to maintain oversight and external assurance mechanisms triangulating the available data to maintain and improve safety, quality and effectiveness of the patient population.
QUALITY ACCOUNT 2015/16 The Quality Account for 2015/16 clearly identified their successes to date and also areas for further improvement and continuing focus. The CCGs support the Trustâ&#x20AC;&#x2122;s openness and transparency and is committed to working with the Trust to achieve further progression and successes in the areas identified within the Quality Account. This will be carried out through a number of both proactive and reactive mechanisms and collaborative, integral and multi-agency working. PATIENT SAFETY: FIVE IMPROVEMENT PRIORITIES We are pleased that the Trust has reached achievement in three areas out of the five stated, with demonstrable positive examples provided in medicine administration errors, patient safety incidents and recognise the work undertaken in order to provide accurate and timely safeguarding information. However, it is acknowledged that there are further areas for development in the sepsis care pathway, safeguarding systems and processes to provide accurate training data and enhance engagement with a large number of Local Safeguarding Children and Adult Boards and ensuring the patient received the right treatment by the right healthcare professional. The Trust has detailed how this information is being measured, reported, utilised and also acted upon in order to increase the achievement within this domain of which the CCGs are in support.
The CCGs are satisfied with the accuracy of the data and information contained in the Account. The CCGs agree that the eleven key priorities, within the domains of patient safety, clinical effectiveness and patient experience identified by the Trust are appropriate and a true reflection of findings and discussions we have had with them throughout the year. HISTORY South Central Ambulance Service NHS Foundation Trust is an expanding emergency and urgent care service covering a significant geographical area. On 1 March 2012, SCAS became an NHS Foundation Trust and since that time they have evolved the services, becoming much more than a traditional ambulance service to ensure responsiveness to patient need.
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There has been a significant amount of work that the Trust has undertaken in order to ensure there is learning embedded from not only formal incidents, but also that of patient feedback. The CCGs remain concerned about the Trust’s current response to complaints within an acceptable timeframe and the impact this will have on patient experience and therefore welcome this as a priority area for improvement in 2016/17, with a clear trajectory for improvement set, which the CCGs will monitor.
CLINICAL EFFECTIVENESS: THREE IMPROVEMENT PRIORITIES The Trust has experienced difficulties all year in meeting the care bundle thresholds regarding stroke and STEMI, both of which the CCGs have been kept fully appraised of the actions associated with improvement via a number of forums. However, it is with acknowledgement that there still requires improvements within both these areas of which the Trust have identified to demonstrate measurable changes.
OVERALL
In 2015/16, the Trust has also not been able to deliver the ambulance response time standards for Red 1, Red 2 and Red 19 for the Thames Valley contract. This was due to a number of factors, including workforce pressures due to difficulties in recruiting to paramedic posts and increased demand particularly in the last three months of the year. Recovery action plans have been developed and the CCGs welcome the quality priorities to ‘proactively manage high intensity users to reduce reactive frequent calls and provide better support’ and ‘to ensure the long wait reviews have clear actions that are monitored and the effectiveness measured’, to support in this area of work.
We are pleased that the Trust has chosen to focus the priorities of patient safety, clinical effectiveness and patient experience, the CCG recognises that a vast amount of work has been undertaken over the past year; however there is also recognition that further work is required in an ever increasing challenging environment for ambulance trusts and the CCGs feel that the priority areas chosen adequately focus on the key areas for improvement. We support the Trust in its continuing focus on the positive results from 2015/16 priorities and their continuing work to further those improvement and strengthen priorities over the coming financial year.
The CCG welcomes the achievement demonstrated through audit of the delays to PTS, which details learning, identification of issues and further actions for improvement.
Overall, there have been many positive highlights for the Trust and the CCG has gained assurance via a number of forums and by the undertaking of quality assurance visits therefore remain positive that the Trust are committed to offering high quality and safe care to our patients.
PATIENT EXPERIENCE: THREE IMPROVEMENT PRIORITIES The CCGs welcome the move to the development of an aggregated learning report from the Trust which aims to triangulate a number of intelligence mechanisms and are looking forward to working with the newly appointed clinical governance facilitators.
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HEALTHWATCH SLOUGH We share the aspiration of making the NHS more patient-focussed and placing the patient’s experience at the heart of health and social care. An essential part of this is making sure the collective voice of the people of Slough is heard and given due regard, particularly when decisions are being made about quality of care and changes to service delivery and provision.
HEALTHWATCH SLOUGH’S RESPONSE TO SOUTH CENTRAL AMBULANCE SERVICE (SCAS) QUALITY ACCOUNT 2015/16 Healthwatch is the independent consumer champion created to gather and represent the views of the public, patients, relatives and carers. Healthwatch plays a role at both national and local level and makes sure that the views of the public and people who use services are taken into account.
We are pleased to see that electronic discharge summaries are a quality improvement area for 2016/17. Healthwatch Slough has received a number of patient stories about their individual needs not being met either due to the call handler not relaying this information to crew or discharge summaries not being made available.
Healthwatch Slough has, amongst others, the following responsibilities; èè Promote and support local people to be involved in monitoring, commissioning and provision of local care services èè Obtain local people’s views about their needs for and experience of local care services èè Tell agencies involved in the commissioning, provision and scrutiny of care services about these views èè Produce reports and make recommendations about how local health and care services could or should be improved
Healthwatch Slough would like to see the bariatric services for obese patients being an area for quality improvement. With more adults being overweight there is more of a demand for bariatric ambulances. Patient comfort, dignity and respect is being jeopardised by not being able to respond efficiently to this patient group. We had arranged to meet with the Senior Operations Manager to discuss a number of stories we had received, unfortunately this meeting did not take place.
Healthwatch Slough thanks SCAS for providing the opportunity to comment on this Annual Quality Account, despite not receiving it until 12.5.16. We recognise that Quality Account reports are a useful tool in ensuring that NHS healthcare providers are accountable to patients and the public about the quality of service they provide. We fully support these reports as a means for providers to review their services in an open and honest manner, acknowledging where services are working well and where there is room for improvement.
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HAMPSHIRE COUNTY COUNCIL HAMPSHIRE HEALTH AND ADULT SOCIAL CARE SELECT COMMITTEE CONTRIBUTION TO QUALITY ACCOUNTS PROCESS
Please do not hesitate to contact me should you require any additional information on my comments above. Yours sincerely
Thank you for sharing with the Hampshire Health and Adult Social Care Select Committee (HASC) the draft 2015/16 Quality Accounts for South Central Ambulance Service NHS Foundation Trust.
Cllr Roger Huxstep Chairman, Health and Adult Social Care Select Committee
I have circulated these priorities to Members of the HASC for their comments, and have received general feedback which suggests that the Committee are supportive of the approach taken. Members noted that Category A performance has decreased from 2014/15 to 2015/16, a fact reflected in the statistics received by the Committee through its County-wide system resilience updates received in the previous year. For this reason, we have requested South Central Ambulance Service to attend before our June 2016 meeting, in order to provide an overview of current performance, and work being undertaken to improve response times in order to meet national quality indicator targets. We therefore do not wish to recommend any additions to these priorities. We do however request and look forward to receiving the action plan that will be drafted following the publication of your Quality Accounts, in order to ensure that the priorities raised can be monitored, and progress against them can be reviewed.
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PORTSMOUTH CCG Portsmouth Clinical Commissioning Group (CCG) and its associate commissioners welcome the opportunity to participate in the governance “sign off” process for 2015/16 Quality Account of South Central Ambulance Service NHS Foundation Trust (SCAS) 111.
Further information relating to equality and diversity would have been welcome. Specific and detailed information relating to the NHS 111 as appropriate throughout the report would have been beneficial. QUALITY IMPROVEMENT PRIORITIES 2016/17
COMMISSIONING INTRODUCTORY STATEMENT
Commissioners welcome the quality improvement objectives identified for 2016/17 across the three areas of quality of patient safety, clinical effectiveness and patient experience. Reference to application within NHS 111 would have been beneficial. Particular clarification on whether NHS Sick Child e-Learning will include NHS 111 clinicians would have been helpful, and reference to reducing wait times for call transfers to and calls back from NHS 111 clinicians to patients.
Commissioners are grateful for the opportunity to comment on the Trust’s annual Quality Account for 2015/16 in relation to NHS 111. Commissioners have determined that it meets the required regulatory requirements. Specific comments from Portsmouth, Southampton and North East Hampshire and Farnham CCGs are included in this statement. These are limited by the short timescale set by the Trust for the completion of feedback. Provider Trust quality accounts are required to be submitted to commissioners within a set time frame which allows 30 days to respond. It is noted that this quality account was received with a deadline for comments which allowed only 7 working days for commissioners to review the document and collate comments from across the Hampshire geography.
ACHIEVEMENTS REPORTED AGAINST THE 2015/16 PRIORITIES AND OVERALL QUALITY EXPERIENCE Completion of review and improvement in the process for receiving and acting on healthcare professional feedback in NHS 111 to ensure maximisation of learning and service improvements is welcomed.
REPORT STRUCTURE
Commissioners acknowledge review of all data available to the Trust on the quality of care in the NHS 111 Service as well as for emergency 999 ambulance and non-emergency patient transport services. Information relating to the Care Quality Commission’s (CQC) inspection of the NHS 111 service is welcomed. Further information on the positive and challenging aspects identified in the CQC’s report would have been beneficial.
The report is logically structured and is written in a style which would seem accessible to the public stakeholders and commissioners alike. This could be enhanced by reference on how to obtain the Account in alternative formats. Page and table numbering on the contents page would have aided navigation. The Quality Account makes reference to the NHS Equality Delivery System 2 and Workforce Race Equality Standard.
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Commissioners also acknowledge that during 2016/17 the Trust will be considering an audit to include NHS 111 to identify if patients could have been treated and seen by other health services. It is noted that the Quality Account records achievement in relation to staff training relating to safeguarding. However, the Trust also states that this remains below 100% where indicated as relevant to staff and acknowledgement that work continues to address this shortfall is welcomed. During the year commissioners raised a contract performance notice due to under-performance relating to NHS 111 calls answered within 60 minutes, timely transfer of calls from call handlers to clinicians and short falls in staffing. The Trust developed a Recovery Action Plan which identified 5 key priorities to be managed by the Trust executive. This Recovery Action Plan remains in place and is being monitored through daily and weekly activities. COMMISSIONER ASSESSMENT SUMMARY The Quality Account 2015/16 covers the three areas commissioned from SCAS of NHS 111, Emergency 999 Ambulance and Non-emergency Transport Patient Services. It reflects some positive work in relation to NHS 111 service. It would be improved by attention to the challenges and priorities to NHS 111 and inclusion of strong action plans covering qualitative and qualitative measurement. Commissioners welcome continued partnership working with SCAS as a valued health care partner that continues to seek ways to improve the quality of care for the benefit of our population.
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STATEMENT OF DIRECTORS RESPONSIBILITIES IN RESPECT OF THE QUALITY REPORT The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for each financial year. NHS Improvement has issued guidance to NHS Foundation Trust Boards on the form and content of annual quality reports (which incorporate the above legal requirements) and on the arrangements that NHS Foundation Trust Boards should put in place to support the data quality for the preparation of the quality report.
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ÒÒ The national staff survey March 2016 ÒÒ The Head of Internal Audit’s annual opinion over the trust’s control environment dated awaiting date ÒÒ The Quality Report presents a balanced picture of the NHS Foundation Trust’s performance over the period covered ÒÒ The performance information reported in the Quality Report is reliable and accurate ÒÒ There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm that they are working effectively in practice ÒÒ The data underpinning the measures of performance reported in the Quality Report is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review and ÒÒ The Quality Report has been prepared in accordance with NHS Improvements annual reporting manual and supporting guidance (which incorporates the Quality Account regulations) as well as the standards to support data quality for the preparation of the Quality Report.
In preparing the Quality Report, Directors are required to take steps to satisfy themselves that: èè The content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2015/16 and supporting guidance èè The content of the Quality Report is not inconsistent with internal and external sources of information includingBboard minutes and papers for the period April 2015 to March 2016 ÒÒ Papers relating to Quality reported to the board over the period April 2015 to March 2016 ÒÒ Feedback from commissioners ÒÒ Feedback from governors feedback from local Healthwatch organisations dated 9 May 2016 ÒÒ Feedback from Health Overview and Scrutiny Committee
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The Directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report. By order of the Board
Trevor Jones Chairman Date: 25 May 2016
Will Hancock Chief Executive Date: 25 May 2016
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INDEPENDENT AUDITOR,S REPORT TO THE COUNCIL OF GOVERNORS OF SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST ON THE QUALITY REPORT We have been engaged by the Council of Governors of South Central Ambulance Service NHS Foundation Trust to perform an independent assurance engagement in respect of South Central Ambulance Service NHS Foundation Trust’s Quality Report for the year ended 31 March 2016 (the ‘Quality Report’) and certain performance indicators contained therein.
Our responsibility is to form a conclusion, based on limited assurance procedures, on whether anything has come to our attention that causes us to believe that: èè The Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual; èè The Quality Report is not consistent in all material respects with the sources specified in the Detailed Guidance for External Assurance on Quality Reports 2015/16 (‘the Guidance’); and èè The indicator in the Quality Report identified as having been the subject of limited assurance in the Quality Report are not reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Guidance.
SCOPE AND SUBJECT MATTER The indicators for the year ended 31 March 2016 subject to limited assurance consist of the following two national priority indicators (the indicators): èè Category A call – emergency response within 8 minutes; and èè Category A call – ambulance vehicle arrives within 19 minutes. RESPECTIVE RESPONSIBILITIES OF THE DIRECTORS AND AUDITORS The Directors are responsible for the content and the preparation of the Quality Report in accordance with the criteria set out in the NHS Foundation Trust Annual Reporting Manual issued by Monitor.
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We read the Quality Report and consider whether it addresses the content requirements of the NHS Foundation Trust Annual Reporting Manual and consider the implications for our report if we become aware of any material omissions.
matter experts. This report, including the conclusion, has been prepared solely for the Council of Governors of South Central Ambulance Service NHS Foundation Trust as a body, to assist the Council of Governors in reporting the NHS Foundation Trust’s quality agenda, performance and activities. We permit the disclosure of this report within the Annual Report for the year ended 31 March 2016, to enable the Council of Governors to demonstrate they have discharged their governance responsibilities by commissioning an independent assurance report in connection with the indicator. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors as a body and South Central Ambulance Service NHS Foundation Trust for our work or this report, except where terms are expressly agreed and with our prior consent in writing.
We read the other information contained in the Quality Report and consider whether it is materially inconsistent with: èè Board minutes and papers for the period April 2015 to May 2016; èè Papers relating to quality reported to the board over the period April 2015 to May 2016 èè Feedback from commissioners; èè Feedback from governors; èè Feedback from local Healthwatch organisations èè Feedback from Overview and Scrutiny Committee èè The trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009 èè The national staff survey èè The 2015/16 Head of Internal Audit’s annual opinion over the trust’s control environment
ASSURANCE WORK PERFORMED We conducted this limited assurance engagement in accordance with International Standard on Assurance Engagements 3000 (Revised) – ‘Assurance Engagements other than Audits or Reviews of Historical Financial Information’, issued by the International Auditing and Assurance Standards Board (‘ISAE 3000’).
We consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with those documents (collectively, the ‘documents’). Our responsibilities do not extend to any other information.
Our limited assurance procedures included: èè Evaluating the design and implementation of the key processes and controls for managing and reporting the indicator; èè Making enquiries of management èè Testing key management controls èè Limited testing, on a selective
We are in compliance with the applicable independence and competency requirements of the Institute of Chartered Accountants in England and Wales (ICAEW) Code of Ethics. Our team comprised assurance practitioners and relevant subject
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basis, of the data used to calculate the indicator back to supporting documentation èè Comparing the content requirements of the NHS Foundation Trust Annual Reporting Manual to the categories reported in the Quality Report èè Reading the documents
CONCLUSION Based on the results of our procedures, nothing has come to our attention that causes us to believe that, for the year ended 31 March 2016: èè The Quality Report is not prepared in all material respects in line with the criteria set out in the NHS Foundation Trust Annual Reporting Manual èè The Quality Report is not consistent in all material respects with the sources specified in the Guidance and èè The indicators in the Quality Report subject to limited assurance have not been reasonably stated in all material respects in accordance with the NHS Foundation Trust Annual Reporting Manual and the six dimensions of data quality set out in the Guidance.
A limited assurance engagement is smaller in scope than a reasonable assurance engagement. The nature, timing and extent of procedures for gathering sufficient appropriate evidence are deliberately limited relative to a reasonable assurance engagement. Non-financial performance information is subject to more inherent limitations than financial information, given the characteristics of the subject matter and the methods used for determining such information. The absence of a significant body of established practice on which to draw allows for the selection of different, but acceptable measurement techniques which can result in materially different measurements and can affect comparability. The precision of different measurement techniques may also vary. Furthermore, the nature and methods used to determine such information, as well as the measurement criteria and the precision of these criteria, may change over time. It is important to read the quality report in the context of the criteria set out in the NHS Foundation Trust Annual Reporting Manual.
Jonathan Brown for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 100 Temple Street Bristol BS1 6AG 26 May 2016
The scope of our assurance work has not included governance over quality or the non-mandated indicator, which was determined locally by South Central Ambulance Service NHS Foundation Trust.
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INVITATION TO FEEDBACK ON THE QUALITY ACCOUNT Please tell us what you thought of this report: èè Did you find it useful? èè Did the report tell you what you wanted to know? èè Do you agree with our priorities for 2016/17? èè Is there anything else you would like to see included in future reports? You can tell us by contacting SCAS in the following ways: Email:
patientexperience@scas.nhs.uk
Phone:
0300 123 9280
Post: Jane Campbell Assistant Director of Quality South Central Ambulance service NHS Foundation Trust Units 7 & 8 Talisman Business Centre Talisman Road Bicester Oxfordshire OX26 6HR
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INDEPENDENT AUDITOR S REPORT TO THE COUNCIL OF GOVERNORS OF SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST ONLY The risk: The main source of income for the Group is the provision of healthcare services to the public under contracts with NHS commissioners and other NHS bodies, which make up 95.5% (2014/15: 92.9%) of income. The Group participates in the national Agreement of Balances (AoB) exercise which is designed by the Department of Health and mandated by Monitor for the purpose of ensuring that intraNHS balances are eliminated on the consolidation of the Department’s Consolidated Resource Account. The AoB exercise identifies mismatches between income and expenditure and receivable and payable balances recognised by the Group and its counter parties at 31 March 2016.
OPINIONS AND CONCLUSIONS ARISING FROM OUR AUDIT 1. Our opinion on the financial statements is unmodified We have audited the financial statements of South Central Ambulance Service NHS Foundation Trust for the year ended 31 March 2016 set out on pages 113 to 174. In our opinion: èè The financial statements give a true and fair view of the state of the Group’s and the Trust’s affairs as at 31 March 2016 and of the Group’s income and expenditure for the year then ended èè The financial statements have been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2015/16.
Mis-matches can occur for a number of reasons, but the most significant arise where the Group and commissioners have not concluded the reconciliations of activity levels completed within the last quarter of the financial year, which have not yet been invoiced, or there is no final agreement over proposed contract penalties as activity data for the period has not been fully verified. Commissioners are often under pressure to spend the resources available to them in any financial year. There is a risk that amounts billed to the commissioning bodies and recognised as income may be in respect of activity that either does not exist or has been recognised after the date of delivery.
2. Our assessment of risks of material misstatement In arriving at our audit opinion above on the financial statements the risks of material misstatement that had the greatest effect on our audit were as follows: NHS Income Recognition - £167.2 million (2014/15: £160.4 million) risk level is è (consistent) year on year Refer to page 98 (Audit Committee Report), page 120 (accounting policies) and pages 135 to 136 (financial disclosures).
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We do not consider NHS income to be at high risk of significant misstatement, or to be subject to a significant level of judgement. However, due to its materiality in the context of the financial statements as a whole, NHS income is considered to be one of the areas which had the greatest effect on our overall audit strategy and allocation of resources in planning and completing our audit.
We also considered the adequacy of the Group’s disclosures in respect of income, particularly in relation to any key judgments made and estimates used in recognising income. 3. Our application of materiality and an overview of the scope of our audit The materiality for the financial statements was set at £3.5 million (2014/15: £3.3 million), determined with reference to a benchmark of income from operations (of which it represents 2% (2014/15: 2%)). We consider income from operations to be more stable than a surplus related benchmark.
Our response: In this area our audit procedures included: èè Reconciling the income recorded in the financial statements to signed contracts with material commissioners and reviewing material variations agreed throughout the year to supporting invoices, supported by explanations by the Group èè Carrying out testing of invoices for material income from other NHS organisations to determine whether income was recognised in accordance with the amounts billed to corresponding parties èè Assessing whether the Group was in formal dispute or arbitration in relation to any material income balances and examining the supporting correspondence, including – if appropriate – any legal advice, for consistency with the treatment of these balances within the financial statements èè Inspecting third party confirmations from commissioners and other NHS organisations, including the results of the Agreement of Balances (AoB) exercise and comparing the values disclosed within their financial statements to the values recorded in the Group’s financial statements through the national AoB exercise èè Carrying out testing of invoices raised around the financial year-end to determine whether income had been recognised in the appropriate period.
We report to the audit committee any corrected and uncorrected identified misstatements exceeding £0.175 million (2014/15: £0.165 million), in addition to other identified misstatements that warrant reporting on qualitative grounds. 4. Our opinion on other matters prescribed by the Code of Audit Practice is unmodified In our opinion: èè the parts of the Remuneration and Staff Reports to be audited have been properly prepared in accordance with the NHS Foundation Trust Annual Reporting Manual 2015/16 èè the information given in the Annual Report for the financial year for which the financial statements are prepared is consistent with the financial statements
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In addition we are required to report to you if:
5. We have nothing to report in respect of the matters on which we are required to report by exception
èè any reports to the regulator have been made under Schedule 10(6) of the National Health Service Act 2006 èè any matters have been reported in the public interest under Schedule 10(3) of the National Health Service Act 2006 in the course of, or at the end of the audit
Under ISAs (UK and Ireland) we are required to report to you if, based on the knowledge we acquired during our audit, we have identified other information in the Annual Report that contains a material inconsistency with either that knowledge or the financial statements, a material misstatement of fact, or that is otherwise misleading. In particular, we are required to report to you if:
We have nothing to report in respect of the above responsibilities.
èè we have identified material inconsistencies between the knowledge we acquired during our audit and the directors’ statement that they consider that the Annual Report and Accounts taken as a whole is fair, balanced and understandable and provides the information necessary for patients, regulators and other stakeholders to assess the Group’s performance, business model and strategy èè ‘The Audit Committee’ report, included within the Annual Report, does not appropriately address matters communicated by us to the audit committee
Certificate of audit completion We certify that we have completed the audit of the accounts of South Central Ambulance Service NHS Foundation Trust in accordance with the requirements of Schedule 10 of the National Health Service Act 2006 and the Code of Audit Practice issued by the National Audit Office. Respective responsibilities of the accounting officer and auditor As described more fully in the Statement of Accounting Officer’s Responsibilities on page 175 the accounting officer is responsible for the preparation of financial statements which give a true and fair view. Our responsibility is to audit, and express an opinion on, the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the UK Ethical Standards for Auditors. Scope of an audit of financial statements performed in accordance with ISAs (UK and Ireland)
Under the Code of Audit Practice we are required to report to you if in our opinion: èè the Annual Governance Statement does not reflect the disclosure requirements set out in the NHS Foundation Trust Annual Reporting Manual 2015/16, is misleading or is not consistent with our knowledge of the Group and other information of which we are aware from our audit of the financial statements èè the Trust has not made proper arrangement for securing economy, efficiency and effectiveness in its use of resources
A description of the scope of an audit of financial statements is provided on our website at www.kpmg.com/uk/ auditscopeother2014.
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This report is made subject to important explanations regarding our responsibilities, as published on that website, which are incorporated into this report as if set out in full and should be read to provide an understanding of the purpose of this report, the work we have undertaken and the basis of our opinions.
The C&AG determined this criterion as necessary for us to consider under the Code of Audit Practice in satisfying ourselves whether the Trust put in place proper arrangements for securing economy, efficiency and effectiveness in its use of resources for the year ended 31 March 2016. We planned our work in accordance with the Code of Audit Practice. Based on our risk assessment, we undertook such work as we considered necessary to form a view on whether, in all significant respects, the Trust had put in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources.
Respective responsibilities of the Trust and auditor in respect of arrangements for securing economy, efficiency and effectiveness in the use of resources The Trust is responsible for putting in place proper arrangements to secure economy, efficiency and effectiveness in its use of resources, to ensure proper stewardship and governance, and to review regularly the adequacy and effectiveness of these arrangements.
The purpose of our audit work and to whom we owe our responsibilities This report is made solely to the Council of Governors of the Trust, as a body, in accordance with Schedule 10 of the National Health Service Act 2006. Our audit work has been undertaken so that we might state to the Council of Governors of the Trust, as a body, those matters we are required to state to them in an auditorâ&#x20AC;&#x2122;s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Council of Governors of the Trust, as a body, for our audit work, for this report or for the opinions we have formed.
Under Section 62(1) and Schedule 10 paragraph 1(d), of the National Health Service Act 2006 we have a duty to satisfy ourselves that the Trust has made proper arrangements for securing economy, efficiency and effectiveness in its use of resources. We are not required to consider, nor have we considered, whether all aspects of the Trustâ&#x20AC;&#x2122;s arrangements for securing economy, efficiency and effectiveness in its use of resources are operating effectively. Scope of the review of arrangements for securing economy, efficiency and effectiveness in the use of resources We have undertaken our review in accordance with the Code of Audit Practice, having regard to the guidance on the specified criterion issued by the Comptroller and Auditor General (C&AG), as to whether the Trust has proper arrangements to ensure it took properly informed decisions and deployed resources to achieve planned and sustainable outcomes for taxpayers and local people.
Jonathan Brown for and on behalf of KPMG LLP, Statutory Auditor Chartered Accountants 100 Temple Street Bristol BS1 6AG 26 May 2016
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GLOSSARY A&E
Accident and Emergency
AACP
Ambulance Anticipatory Care Plan
ACP
Anticipatory Care Plan
ACS
Acute Coronary Syndrome
AMPDS
Advanced Medical Priority Dispatch System
ATP
Adenosine Triophosphate Testing
BASICS
British Association for Immediate Care
BMJ
British Medical Journal
CAD
Computer Aided Dispatch System
CARS
Clinical Audit Record System
CBRN
Chemical, Biological, Radiological, Nuclear
CCG
Clinical Commissioning Group
CEO
Chief Executive Officer
CF
Clinical Fellow
CFR
Community First Responder
CNST
Clinical Negligence Scheme for Trusts
CPD
Continuous Professional Development
CPI
Clinical Performance Indicator
CPR
Cardiopulmonary Resuscitation
CQC
Care Quality Commission
CQUIN
Commissioning for Quality and Improvement
CSD
Clinical Support Desk
DH
Department of Health
E&D
Equality and Diversity
ECP
Emergency Care Practitioner
ECT
Emergency Call Taker
EOC
Emergency Operations Centre
EoLC
End of Life Care
ePRF
Electronic Patient Report Form
FFT
Friends and Family Test
Frem
Financial Reporting Manual
FT
Foundation Trust
GBS
Government Banking Service
GPS
Global Positioning System
HALO
Hospital Ambulance Liaison Officer
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HART
Hazardous Area Response Team
HCP
Health Care Provider
HOSC
Health Overview and Scrutiny Committee
IAS
International Accounting Standards
IFRS
International Financial Reporting Standards
JRCALC
Joint Royal Colleges Ambulance Liaison Committee
KPMG
Trustâ&#x20AC;&#x2122;s appointed external auditors
LD
Learning Disability
LMO
Legacy Management Office
MINAP
Myocardial Ischaemia National Audit Project
NHSLA
NHS Litigation Authority
PALS
Patient Advice and Liaison Service
PBL
Prudential Borrowing Limit
PCI
Primary Angioplasty
PCT
Primary Care Trust
PCR
Patient Clinical Record
PDC
Public Dividend Capital
PERG
Patient Experience Review Group
PFI
Public Finance Initiative
PRF
Patient Report From
PPCI
Primary Percutaneous Coronary Intervention
PTS
Patient Transport Services
RAG
Red, Amber, Green
RCN
Royal College of Nursing
ROSC
Return of Spontaneous Circulation
SCAS
South Central Ambulance Service
SCIE
Social Care Institute for Excellence
SID
Serious Incident Desk
SIRI
Serious Incidents Requiring Investigation
SLA
Service Level Agreement
SOP
Standard Operating Procedure
STEIS
Strategic Executive Information System
STEMI
ST Elevation Myocardial Infarction (Heart Attack)
TARN
Trauma Audit and Research Network
TUB
Trauma Unit Bypass
uDNACPR
Unified Do Not Attempt Cardio-Pulmonary Resuscitation
UKcip
United Kingdom Climates Impacts Programme
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